Assisted birth

If labor is prolonged or complications develop, you may require some assistance (medical intervention). For example, instruments — such as forceps or a vacuum extractor — may be needed to help you deliver if your cervix is fully dilated but your baby fails to make progress down the birth canal. An assisted delivery may also be necessary if your baby's head is facing the wrong direction and is wedged in your pelvis or if your baby is large. If your baby is in distress and must be delivered quickly or you're too exhausted to push any longer, your health care provider may have to intervene medically with a forceps- or vacuum-assisted birth.

Forceps-assisted birth

Forceps are shaped like a pair of spoons that, when hooked together, resemble a pair of salad tongs. The health care provider gently slides one spoon at a time into your vagina and around the side of the baby's head. The two pieces lock together, and the curved tongs cradle the baby's head. While your uterus contracts and you push, the health care provider gently pulls on the forceps to help the baby through the birth canal, which sometimes happens on the very next push.

Forceps may look intimidating, but you may welcome their use if they help you avoid a Caesarean birth. Many health care providers will try the judicious use of forceps when they feel it can be done safely.

Forceps are used today only when the baby's head has descended well into the mother's pelvis or is in the pelvic outlet. If the baby's head isn't well positioned, a Caesarean birth becomes necessary.

Vacuum-assisted birth

An instrument known as a vacuum extractor is sometimes used instead of forceps. The doctor presses a rubber or plastic cup against the baby's head, creates

• A pelvis that's roomy enough to allow for the passage of the baby If your contractions aren't forceful enough to open the cervix, you may be offered a medication to make your uterus contract. Contractions can sometimes start regularly but then stop halfway through your labor. If this happens and the progress of your labor halts for a few hours, your health care provider may suggest breaking your water — if it hasn't already broken — or artificially stimulating your labor with oxytocin.

Signs and symptoms

Problems that can develop during labor include: Prolonged early (latent) labor

This occurs when your cervix isn't dilating even to 3 centimeters (cm) — after about 20 hours of labor if you're a first-time mother or after 14 hours if you've delivered before. Sometimes, progress is slow because you're not in true labor.

suction with a pump and gently pulls on the instrument to ease the baby down the birth canal while the mother pushes.

The vacuum extractor cup does not take as much room as forceps delivery and is associated with fewer injuries to the mother. But it's likely that a vacuum-assisted birth is slightly riskier for the baby.

What to expect from an assisted delivery

An assisted delivery doesn't take very long, but it may take 30 to 45 minutes to ready you for the procedure. You may need an epidural or spinal anesthetic. Someone on your health care team may insert a thin, plastic tube (catheter) in your bladder beforehand to empty it of urine. You may be moved to an operating room, if there's a chance that the intervention won't be successful and you'll need a Caesarean birth. Your health care provider may make a cut to enlarge the opening of the vagina (episiotomy) to ease the way of the baby.

Will the use of forceps or a vacuum extractor hurt your baby? Forceps may leave bruises or red marks on the sides of your baby's head. A vacuum extractor may leave a bump on the top of the head. Bruises take about a week to go away. Red marks or a bump disappear within a few days. Serious damage with either technique is rare.

If you have any questions about assisted birth, don't hesitate to ask them. The use of instruments to deliver babies is common practice today and is generally considered safe, although they're associated with increased tearing or extension of the episiotomy. The choice of which approach to use — forceps or a vacuum extractor — is best left to your health care provider. Experience with the instrument is the greatest defense against complications.

The contractions you feel are those of false labor (Braxton-Hicks contractions), and they're not effective at opening your cervix. Certain medications for pain relief given during labor can have the unintended consequence of slowing down labor, especially if they're given too early.

Prolonged active labor

Your labor may go smoothly during the early phase, only to slow down during the second, active phase of labor. That's the case if your cervix doesn't dilate at the rate of 1 cm or greater an hour, after your cervix reaches 3 or 4 cm in diameter. The cause may be dwindling or irregular contractions.

Prolonged pushing

At times, efforts to push the baby through the birth canal aren't effective, which can result in exhaustion on the mother's part.


For prolonged early (latent) labor

Whatever the cause of your prolonged early labor, if your cervix is still fairly closed when you arrive at the hospital or birthing center and your contractions aren't very strong, your health care provider may suggest options to accelerate labor. You may be told to walk or to return home and rest. Often, the most effective treatment for a prolonged early phase is rest. A medication may be given to help you rest.

For prolonged active labor

If you're making some progress in active labor, your health care provider may allow your labor to continue naturally. He or she may suggest that you

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