Assisted Births

Chapter 22 Assisted Births



Birth by forceps


Forceps are most commonly employed to expedite delivery of the fetal head or to protect the fetus or the mother, or both, from trauma and exhaustion. They are also used to assist the delivery of the after-coming head of the breech or to draw the head of the baby up and out of the pelvis at caesarean section birth.


The three main indications for the use of forceps are:



image delay in the second stage of labour


image fetal compromise


image maternal distress.



Types of obstetric forceps




image Wrigley’s forceps. These are designed for use when the head is on the perineum. They are also used for the after-coming head of a breech delivery, or at caesarean section.


image Neville–Barnes or Simpson’s forceps. These are generally used for a low or mid-cavity forceps delivery when the sagittal suture is in the anteroposterior diameter of the cavity/outlet of the pelvis.


image Kielland’s forceps. These are generally used for the rotation and extraction of the head that is arrested in the deep transverse or the occipitoposterior position.



Prerequisites for forceps delivery


‘Forceps’ is a useful mnemonic (Box 22.1).



Box 22.1 The ‘forceps’ mnemonic




• Full dilatation of the cervix


• O-fifths of the head palpable abdominally


• Room in pelvis and ruptured membranes


• Cephalic presentation


• Empty bladder


• Position recognised


• Suitable pain relief – epidural or pudendal block plus perineal infiltration of local anaesthetic


The paediatrician may not be required at birth, but should be kept informed of circumstances. Neonatal resuscitation equipment must be checked and prepared in case it is needed.



Complications


These are listed in Box 22.2.



Box 22.2 Some complications of forceps delivery



Maternal




• Trauma or soft tissue damage, which may occur to the perineum, vagina or cervix


• Haemorrhage from the above


• Dysuria or urinary retention, which may result from bruising or oedema to the urethra


• Painful perineum



Neonatal




• Marks on the baby’s face caused by the pressure of the forceps; these resolve quite rapidly


• Excessive bruising


• Facial palsy



Birth by the ventouse method


The ventouse vacuum extractor is an instrument that applies traction. It can be used as an alternative to forceps. The cup cleaves to the fetal scalp by suction and is used to assist maternal effort. It may be employed when there is a delay in labour, when the cervix is not quite fully dilated. It may also be useful in the case of a second twin, when the head remains relatively high.



Procedure




image The woman is usually in the lithotomy position and the same precautions are observed as for a forceps birth.


image The cup of the ventouse is placed as near as possible to, or on, the flexing point of the fetal head.


image The vacuum in the cup is increased gradually so as to achieve a close application to the fetal head. Usually a vacuum of 0.8 kg/cm2 is reached, by an increase of 0.2 kg/cm2 in stages, or an increase from 0.2 to 0.8 kg/cm2 is achieved directly.


image When the vacuum is achieved, traction is applied with a contraction and with maternal effort. This traction is applied in a downwards and backwards direction, then forwards and upwards, thus following the natural curve of the pelvis.


image The vacuum is released and the cup is removed at the crowning of the fetal head.


image The mother can then push the baby for the final part of the birth.



Complications


Prolonged traction will increase the likelihood of:



image scalp abrasions


image cephalhaematoma


image subaponeurotic bleeding.

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Related posts:

  1. The Placenta
  2. Trauma During Birth, Haemorrhage and Convulsions
  3. Obstetric Emergencies
  4. Problems of Pregnancy

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Jul 11, 2016 | Posted by in MIDWIFERY | Comments Off on Assisted Births

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