Operative vaginal delivery

Operative vaginal delivery refers to childbirth techniques that involve the use of medical instruments to assist in the delivery of a baby. This method is employed when a spontaneous vaginal delivery is not progressing, or when the baby or mother is showing signs of distress. The two most common forms of operative vaginal delivery are the vacuum extraction and the forceps delivery.

Indications

Operative vaginal delivery is considered in a variety of situations, including but not limited to prolonged second stage of labor, fetal distress, and certain maternal conditions where expediting delivery is beneficial. It is crucial that the decision to proceed with an operative delivery takes into account the safety and health of both the mother and the baby, the practitioner's skill and experience, and the availability of necessary equipment and facilities for emergency cesarean section if needed.

Techniques

Vacuum Extraction

In a vacuum extraction, a device known as a vacuum extractor, which consists of a soft cup attached to a pump, is applied to the baby's head. The pump creates suction, adhering the cup to the scalp, and the healthcare provider gently pulls on the handle attached to the cup to assist the baby's passage through the birth canal during contractions.

Forceps Delivery

Forceps delivery involves the use of a pair of curved instruments called obstetric forceps. These are carefully positioned around the baby's head to gently guide the baby out of the birth canal as the mother pushes during a contraction.

Risks and Considerations

Operative vaginal deliveries carry risks to both the mother and the baby. For the baby, there is a risk of scalp injuries, skull fractures, and, more rarely, nerve damage. Mothers may experience increased risk of perineal tears, episiotomy, and in some cases, pelvic organ prolapse or urinary incontinence. Therefore, these methods are only used when the perceived benefits outweigh the risks.

Training and Expertise

The successful and safe conduct of operative vaginal deliveries requires specific training and expertise. Healthcare providers performing these procedures should have adequate training and experience, and the procedure should be carried out in an environment where complications can be promptly managed.

Conclusion

Operative vaginal delivery remains an important option in obstetric care, offering an alternative to cesarean section in certain circumstances. However, the decision to proceed with an operative delivery must be made with careful consideration of the risks and benefits, and with the informed consent of the patient.