When delivery needs to be assisted

Towards the end of pregnancy, new anxieties arise about the baby’s delivery. For the majority, the onset of labor usually leads to spontaneous delivery. Some women will however require help in delivering the baby, commonly referred to as ‘Assisted Vaginal Delivery’.

Labor and delivery is a predictable event, but many variables come into play. Obstetricians and Midwives are trained to recognise and intervene when the progress of labor veers from the expected pattern. The final point when the baby is about to be born is referred to as second stage of labor. It is usually a short period, lasting no longer than one to two hours, but Obstetricians may allow a longer interval depending on circumstances.

There are occasions when spontaneous expulsion of the baby will not happen, and a decision must be made on how best to help. It may be that the second stage has lasted too long, the baby may get distressed, or simply that the baby’s position may not be optimal for spontaneous delivery. In other cases, the mother may just be too exhausted to effectively push the baby out.

In such situations, assisting delivery with an instrument comes in. The Obstetrician or Midwife must make a reasoned judgement on the safest way to deliver the baby. In most cases, the head is too low in the pelvis, making instrumental delivery safer than a Ceserean. The choice is between two instruments: Vacuum delivery or Forceps. Each of the instruments is designed to be applied to specific and safe points on the baby’s head. The mother’s pushing efforts are then aided with measured pulls, thereby easing the baby out.

Assisting delivery with an instrument raises a lot of anxieties in the prospective parents. There are genuine concerns on the safety of the procedure. Thus the most important considerations must always be directed towards the safety of the mother and her baby. The Obstetrician or Midwife carrying out the procedure must be fully trained, skilled and certified to use the chosen instrument. And the equipment must be in good working condition. An objective judgement must also be made that an assisted delivery is warranted. Any doubts must trigger consideration of an alternative mode of delivery, or a second opinion from a more experienced Obstetrician or Midwife.

The safety of assisted vaginal delivery is not in question. It contributes to saving lives of newborn babies, and also helps prevent maternal complications that may arise due to prolonged labor. The WHO identifies assisted vaginal delivery as a key component of basic emergency Obstetric care in developing countries. Increased uptake of assisted vaginal deliveries improves maternal and newborn health, parts of millennium development goals. Obstetric and midwifery training on skilled assisted vaginal delivery, coupled with patient education are the key to negating misguided concerns on assisted deliveries.