Performing instrumental vaginal deliveries remains an integral part of modern Obstetric practice. Therefore, it is essential that all trainees become confident and competent in carrying out this type of delivery. The aim of this tutorial is to help trainees achieve the knowledge necessary for performing instrumental vaginal deliveries safely.
Rates of instrumental deliveries vary from 10 to 13% in the UK.
Instrumental vaginal deliveries have the potential for harm to the mother and the baby and so should be undertaken with care. However, a second-stage caesarean section is not a substitute for instrumental vaginal deliveries as it can be extremely difficult to perform and is associated with high morbidity and implications for future births.
Various techniques may help in reducing instrumental delivery rates, such as one-to-one support in labour, upright/lateral positions in labour, use of a partogram, avoidance of epidural analgesia, delaying pushing and active management of the second stage of labour with oxytocin for nulliparous women with epidurals.
When you have completed this tutorial you will be able to:
- decide when an instrumental delivery is needed
- decide which instrument is appropriate
- appreciate the techniques required for vacuum and forceps delivery
- recognise the complications associated with instrumental delivery
- know when to abandon the procedure.
This tutorial has been written by Miss Viswa Sivashanmugarajan MRCOG and Mr Wai Yoong FRCOG.
Last updated December 2015.