What are my chances of giving birth vaginally after having a c-section?
As long as you’re an appropriate candidate for a vaginal birth after a cesarean, also known as a VBAC, there’s a good chance you’ll succeed. Of course, your chances of success are higher if the reason for your previous c-section isn’t likely to be an issue this time around.
For example, a woman who has already had an easy vaginal delivery and then had a c-section when her next baby was breech is much more likely to have a successful VBAC than one who had a c-section after being fully dilated and pushing for three hours with her first baby who was small and properly positioned. (Having given birth vaginally boosts your odds dramatically.)
That said, it’s impossible to predict with any certainty who will be able to have a vaginal delivery and who will end up with a repeat c-section. Attempting a VBAC is called a trial of labor after cesarean (TOLAC). Overall, about 60 to 80 percent of women who attempt a VBAC deliver vaginally.
If you decide to try it, you’ll need a caregiver who supports the idea. Your caregiver must also have admitting privileges at a hospital that allows VBACs and where appropriate coverage is available around-the-clock.
Not all hospitals meet the criteria for offering a VBAC. In addition, some hospitals simply avoid the controversy – and the potential for legal issues – surrounding VBACs by not allowing them. Most often, however, it’s up to individual doctors whether they’re willing to provide a VBAC.
VBACs are controversial, and it may be challenging to find a practitioner who’s willing to do one. Give yourself plenty of time to look around.
What would make me a good candidate for a VBAC?
According to the American College of Obstetricians and Gynecologists, you’re a good candidate for a vaginal birth after a c-section if you meet all the following criteria:
- Your previous cesarean incision was a low-transverse uterine incision (which is horizontal) rather than a vertical incision in your upper uterus (known as a “classical” incision) or T-shaped, which would put you at higher risk for uterine rupture. (Note that the type of scar on your belly may not match the one on your uterus.)
- Your pelvis seems large enough to allow your baby to pass through safely. (While there’s no way to know this for sure, your practitioner can examine your pelvis and make an educated guess.)
- You’ve never had any other extensive uterine surgery, such as a myomectomy to remove fibroids.
- You’ve never had a uterine rupture.
- You have no medical condition or obstetric problem (such as a placenta previa or a large fibroid) that would make a vaginal delivery risky.
- There’s a doctor on site who can monitor your labor and perform an emergency c-section if necessary.
- There’s an anesthesiologist, other medical personnel, and equipment available around-the-clock to handle an emergency situation for you or your baby.
What factors would make it less likely for me to have a successful VBAC?
- Being an older mom
- Being overweight
- Having a baby with a high birth weight (over 4,000 grams, about 8.8 pounds)
- Having your pregnancy go beyond 40 weeks of gestation
- Having a short time between pregnancies (18 months or less)
Talk with your practitioner about your individual chance of success and carefully weigh the benefits and the risks.
What are the benefits of having a VBAC?
A successful VBAC allows you to avoid major abdominal surgery and the risks associated with it.
These include a higher risk of excessive bleeding, which can lead to a blood transfusion or even a hysterectomy in rare cases, as well as a higher risk of developing certain infections and other organ damage during the procedure. All the potential complications of major abdominal surgery increase with each cesarean delivery because the scarring can make each procedure technically more difficult.
A c-section requires a longer hospital stay than a vaginal birth, and your recovery is generally slower and more uncomfortable.
If you plan to have more children, you should know that every c-section you have raises your risk in future pregnancies of placenta previa and placenta accreta, in which the placenta implants too deeply and doesn’t separate properly at delivery. These conditions can result in life-threatening bleeding and a hysterectomy.
What are the risks of attempting a VBAC?
Even if you’re a good candidate for a VBAC, there’s a very small (less than 1 percent) risk that your uterus will rupture at the site of your c-section incision, resulting in severe blood loss for you and possibly oxygen deprivation for your baby.
Also, if you end up being unable to deliver vaginally, you could endure hours of labor only to have an unplanned c-section. And while a successful VBAC is less risky than a scheduled repeat c-section, an unsuccessful VBAC requiring a c-section after the onset of labor carries more risk than a scheduled c-section.
With an unplanned c-section after laboring, you have a higher chance of surgical complications, such as excessive bleeding that could require a blood transfusion or a hysterectomy, in rare cases, and infections of the uterus and the incision. And the risk of complications is even higher if you end up needing an emergency cesarean.
Finally, there is the risk of the baby having a serious complication that could lead to long-term neurological damage or even death. While this risk is very small overall, it may be higher in women who undergo an unsuccessful VBAC (which would mean a c-section after failed labor) than in women who have a successful vaginal delivery or a scheduled c-section.
What kind of interventions will I need if I attempt a VBAC?
A change in your baby’s heartbeat is usually the earliest sign that there might be a problem. So if you decide to try for a vaginal birth after a cesarean, you’ll need continuous electronic fetal monitoring. You’ll also need an IV (which most women in labor have), and you’ll have to refrain from eating anything during labor in case you require an emergency c-section later.
What does it mean if my baby is breech?
By around 8 months, there’s not much room in the uterus. Most babies maximize their cramped quarters by settling in head down, in what’s known as a cephalic presentation. But if your baby is breech, it means he’s poised to come out buttocks or feet first.
When labor begins at term (37 weeks or later), nearly 97 percent of babies are set to come out head first. Most of the rest are breech. (In rare cases, a baby will be sideways in the uterus with his shoulder, back, or arm presenting first — this is called a transverse lie.)
There are several types of breech presentations, including frank breech (bottom first with feet up near the head), complete breech (bottom first with legs crossed Indian-style), or footling breech (one or both feet are poised to come out first).
By the beginning of your third trimester, your practitioner may be able to tell what position your baby is in by feeling your abdomen and locating the baby’s head, back, and bottom. About a quarter of babies are breech at this point, but most will turn on their own over the next two months.
If your baby’s position isn’t clear during an abdominal exam at 36 weeks, your caregiver may do an internal exam to try to feel what part of the baby is in your pelvis. In some cases, she may use ultrasound to confirm the baby’s position.
What if my baby is still breech at 37 weeks?
Babies who are still breech near term are unlikely to turn on their own. So if your baby is still bottom down at 37 weeks, your caregiver should offer to try to turn your baby to the more favorable head-down position, assuming you’re an appropriate candidate.
This procedure is known as an external cephalic version (ECV). It’s done by applying pressure to your abdomen and manually manipulating the baby into a head-down position. (If your caregiver is not experienced in this procedure, she may refer you to someone who is.)
ECV has about a 58 percent success rate in turning breech babies (and a 90 percent success rate if the baby is in a transverse lie.) But sometimes a baby refuses to budge or rotates back into a breech position after a successful version. ECV is more likely to work if this isn’t your first baby.
Not all women can have ECV. If you’re carrying twins or your pregnancy is complicated by bleeding or too little amniotic fluid,you won’t be able to have the procedure. And, of course, you won’t have a version if you’re going to deliver by cesarean anyway — for example, if you have a placenta previa, triplets, or have had more than one previous c-section.
What is an ECV like?
Having a version isn’t entirely risk-free and some women find it very uncomfortable. You’ll want to discuss the pros and cons with your caregiver.
Severe complications, while relatively rare, can occur. For example, an ECV may cause the placenta to separate from the uterine wall so that your baby has to be delivered right away by c-section. The procedure may also cause a drop in your baby’s heart rate, which, if it doesn’t resolve quickly on its own, will require an immediate delivery.
For these reasons, a doctor should do the procedure in a hospital with facilities and staff available for an emergency c-section in case any complications arise. You’ll be told not to eat or drink anything after midnight the night before the procedure, in case you end up needing surgery.
When you go in, you’ll have blood drawn and an IV may be started. Women who are Rh-negative should get an injection of Rh immune globulin for the procedure unless the baby’s father is also Rh-negative. Your baby’s heart rate will be monitored for a time before and after the procedure.
You’ll have an ultrasound beforehand to check your baby’s position, the location of the placenta, and the amount of amniotic fluid. The ultrasound will be repeated after the maneuvers are performed. (Some doctors also use ultrasound during the procedure.)
Some studies show higher success rates for ECV when uterus-relaxing drugs are used.
If my baby doesn’t turn, will I have a c-section?
It depends. You may have a vaginal breech delivery if you have a twin pregnancy where the first baby is in the head-first position and the second baby is not, or if your labor is so rapid that you arrive at the hospital just about to deliver.
However, the vast majority of babies who remain breech arrive by c-section. A large international study published in 2000 showed that planned c-sections resulted in the safest outcomes for term singleton breech babies. The following year the American College of Obstetricians and Gynecologists (ACOG) published a Committee Opinion advising against planned vaginal delivery of these babies.
Longer-term follow-up of the babies in this study led the researchers to question this conclusion. And other recent reports suggest that certain patients may have safe vaginal deliveries. This includes women whose pelvis seemed large enough, whose labor started and progressed well on its own, and whose babies were term frank or complete breeches and appeared to be of average weight with no abnormalities shown by ultrasound.
In recognition of these studies, ACOG issued a new Committee Opinion in July 2006. This time the organization noted that it may be reasonable for some women to plan to deliver vaginally. ACOG cautioned that the caregiver must be experienced in performing vaginal breech deliveries (fewer and fewer of them are) and the woman must be made aware that the risks to her baby may be higher than with a planned cesarean delivery.
If a c-section is planned, which is likely for most women, it will usually be scheduled for no earlier than 39 weeks. To make sure your baby hasn’t changed position in the meantime, you’ll have an ultrasound at the hospital to confirm his position just before the surgery.
There’s also a chance that you’ll go into labor or your water will break before your planned c-section. If that happens, be sure to call your provider right away and head for the hospital.
What alternative techniques might I try to coax my baby to turn?
Below are some alternative methods you may hear about. There’s no proof that any of them work or are even safe. Consult your practitioner before trying them.
- Let gravity help. Get into one of the following positions twice a day, starting at around 32 weeks. The idea is to employ gravity to help your baby somersault into a head-down position.
Be sure to do these moves on an empty stomach, lest your lunch comes back up. And make sure there’s someone around to help you get up if you start feeling lightheaded.
Lie flat on your back and raise your pelvis so that it’s 9 to 12 inches off the floor. Support your hips with a pillow and stay in this position for five to 15 minutes.
Alternately, get on your knees with your forearms on the floor in front of you, so that your bottom sticks up in the air. Stay in this position for five to 15 minutes.
Be aware that no studies to date have showed that the mother’s position has any effect on the baby’s position. And if you find these positions uncomfortable, stop doing them.
- Ask your caregiver about moxibustion. This ancient Chinese technique burns herbs to stimulate key acupressure points. To help turn a breech baby, an acupuncturist or other practitioner burns mugwort near the acupressure point of your pinky toes. According to Chinese medicine, this should stimulate your baby’s activity enough that he may change position on his own.
One study showed that moxibustion in combination with acupuncture and positioning methods (like those described above) may be of some benefit. If you’ve discussed it with your caregiver and want to give it a try, contact your state acupuncture or Chinese medicine association and ask for the names of licensed practitioners.
- Try hypnosis. One small study found that women who are regularly hypnotized into a state of deep relaxation at 37 to 40 weeks are more likely to have their baby turn than other women. If you’re willing to try this technique, ask your caregiver whether she can recommend a skilled hypnotherapist.
What is macrosomia?
Macrosomia means “large body” and is used to describe a newborn who’s much larger than average. (The average newborn weighs about 7 pounds.)
Babies with macrosomia weigh more than 8 pounds, 13 ounces (4,000 grams) at birth. Macrosomic babies are more likely to have a difficult delivery. But the risk of complications is significantly greater when a baby is born weighing more than 9 pounds, 15 ounces (4,500 grams).
The Centers for Disease Control estimates that 8 percent of infants born in 2015 weighed at least 4,000 grams at birth, and 1.1 percent weighed 4,500 grams or more.
It’s difficult to tell how big your baby is while she’s still in the womb, but your healthcare provider may suspect macrosomia if you’re measuring large for dates. In this case, you may have an ultrasound to estimate your baby’s size, but it’s not likely to be very accurate late in pregnancy.
What causes macrosomia?
Some women are just genetically predisposed to have larger babies, and birth weight also tends to increase with each successive pregnancy.
Most women who have a baby weighing more than 4,500 grams have no risk factors, but macrosomia may be more likely if you:
- Already had a large baby. If you previously delivered a macrosomic baby, you’re five to 10 times more likely to have another large baby.
- Are obese
- Have unmanaged high blood sugar levels from diabetes or gestational diabetes
- Gain an excessive amount of weight during pregnancy
- Go more than two weeks past your due date
Also, male babies are more often macrosomic than females, and Hispanic women are more likely to have large babies than women of other ethnicities.
How does a big baby affect delivery?
With a big baby, you have a greater chance of a difficult vaginal delivery. You may also have an increased risk of perineal tearing, blood loss, or damage to your tailbone.
Some healthcare providers may recommend inducing labor early, but this doesn’t have any proven benefit, according to the American College of Obstetrics and Gynecologists.
A large baby also means you’re more likely to have a cesarean. Although it’s difficult to determine a baby’s exact size before birth, your doctor may want to schedule a c-section if you’re measuring large or have other risk factors for macrosomia.
Can macrosomia cause problems for my baby?
There’s a small chance of shoulder dystocia, a rare but potentially serious complication in which the baby’s shoulder gets caught behind your pubic bone, causing the baby to get stuck in the birth canal during delivery.
This situation is a medical emergency. Your healthcare provider will need to do some maneuvering or perform an episiotomy to get your baby out safely.
In rare cases, your baby could end up with a broken collarbone or upper arm bone. (The treatment is to immobilize the arm as much as possible until the fracture heals.) A more serious complication of shoulder dystocia is nerve damage to the arm on the side where the shoulder was trapped.
What is recovery like after giving birth to a large baby?
If you had a perineal tear or an episiotomy after a vaginal delivery, be sure to follow your provider’s instructions for perineal care, and watch for signs of infection. If your tailbone was injured, read about how to recover from a bruised or broken tailbone.
If you had gestational diabetes, your blood glucose levels should return to normal after birth. But you still have an increased risk of developing diabetes in the future, so within a few months of your baby’s birth, schedule a follow-up appointment with your provider to be tested for postpartum diabetes or other problems with glucose metabolism.
What is a uterine rupture?
A uterine rupture is a tear in the wall of the uterus, most often at the site of a previous c-section incision. In a complete rupture, the tear goes through all layers of the uterine wall and the consequences can be dire for mother and baby.
Fortunately, these ruptures are relatively rare events – exceedingly rare for women who’ve never had a c-section, other uterine surgery, or a previous rupture. The vast majority of uterine ruptures occur during labor, but they can also happen before the onset of labor.
What are the signs of a uterine rupture?
Ruptures typically happen early in labor, though you and your caregivers may not notice the signs right away. The first sign of a rupture is usually an abnormality in the baby’s heart rate. (This is one reason why a woman attempting a vaginal birth after cesarean, or VBAC, needs continuous fetal monitoring.)
The mother may also have symptoms such as abdominal pain, vaginal bleeding, a rapid pulse, and other signs of shock, and she may even experience referred pain in her chest caused by irritation to the diaphragm from internal bleeding. Labor may slow or stop.
What causes uterine rupture?
The majority of uterine ruptures happen at the site of a scar from a previous c-section. And ruptures tend to occur during labor because a scar is most likely to give way under the stress of contractions.
If you’ve had one c-section with the typical low-transverse uterine incision and are considered a good candidate for VBAC, most studies estimate the risk of rupture during labor to be less than one percent.
On the other hand, if you received a “classical” c-section incision, which extends vertically to the upper, more muscular part of the uterus, you have a much higher risk of rupture and should be scheduled for a c-section before the onset of labor.
The same may be true for women who have had other kinds of uterine surgery, such as an operation to remove fibroids or correct a misshapen uterus. If you’ve ever had a previous rupture, you would also automatically be scheduled for a c-section.
It’s very unusual for an unscarred uterus to rupture, but it’s possible. Risk factors include having had five or more children, a placenta that’s implanted too deeply into the uterine wall, an overly distended uterus (from too much amniotic fluid or carrying twins or more), contractions that are too frequent and forceful (whether spontaneous or from medication such as oxytocin or prostaglandins, or as the result of a placental abruption), and a prolonged labor with a baby that’s too big for the mother’s pelvis.
Trauma to the uterus, from such things as a car accident or a procedure such as an external cephalic version or a difficult forceps delivery, may also cause a uterine rupture, as can a difficult manual removal of the placenta.
How is it treated?
The baby is delivered by emergency c-section. If the damage to the woman’s uterus is extensive and the bleeding can’t be controlled, she’ll need a hysterectomy. Otherwise, her uterus will be repaired. The mother usually loses a lot of blood and requires a transfusion. And she’s usually given IV antibiotics to prevent infection.
Even if you don’t have a hysterectomy, you’ll need to take it easy to recover from both your surgery and the effects of losing so much blood. You may feel weak and lightheaded, and at first you shouldn’t try to get out of bed on your own. Once you’re home, make sure you get lots of rest, eat nutritious meals and drink plenty of fluids, take iron, and follow your caregiver’s instructions to the letter.
If you get pregnant again, you’ll definitely need a repeat c-section, so be sure your caregiver is aware of your history.
How common is it to give birth before you even get to the hospital?
It’s highly unlikely that you’ll find yourself unexpectedly giving birth at home or in the backseat of a taxi – particularly if it’s your first baby – but it can happen. In less than 1 percent of births, a woman who’s had no labor symptoms or only intermittent contractions suddenly feels an overwhelming urge to push, which may signal the imminent arrival of her baby.
If you’ve had a previous labor that was fast and furious, it’s important to be especially attuned to the signs of labor. Be prepared to make a mad dash for the hospital or birth center, because subsequent labors can go even faster. But if it feels like you’re not going to make it and you find yourself at home (or elsewhere!) with contractions coming fast and strong or a sudden overwhelming urge to push, the following steps can guide you while you wait for the emergency team to arrive.
What should I do first?
- Call 911. Tell the dispatcher that your baby is coming and that you need an emergency medical squad immediately.
- Unlock your door so the medical crew can open it. You may not be in a position to get to the door later.
- If your partner isn’t there with you, call a neighbor or nearby friend.
- Call your doctor or midwife. She’ll stay on the phone to guide you until help arrives.
- Grab towels, sheets, or blankets. Put one underneath you and keep the rest nearby so you can dry your baby immediately after birth. (If help doesn’t arrive in time and you forget this step, you can use your clothes instead.)
- If you feel an overwhelming urge to push, try to put it off by panting, using breathing techniques, or lying on your side. Be sure to lie down or sit propped up. If you deliver standing up, your baby could fall and suffer a serious injury. And don’t forget to take off your pants and underwear.
What should I do if my baby arrives before help does?
- Try to stay calm. Babies that arrive quickly usually deliver with ease.
- Do your best to guide him out as gently as possible.
- If the umbilical cord is around your baby’s neck, either ease it over his head slowly or loosen it enough to form a loop so that the rest of his body can slip through. When he’s fully out, don’t pull the cord, and don’t try to tie off or cut the cord. Leave it attached to your baby until help arrives.
- Stay where you are until you deliver the placenta, which should arrive shortly. Leave the placenta attached to the cord, too – medical personnel will take care of it.
- Dry your baby immediately. Then rest him on your tummy, skin to skin, and warm him with your body heat. Cover yourself and your baby with a dry blanket.
- Ease any mucus or amniotic fluid from his nostrils by gently running your fingers down the sides of his nose.
- If your baby doesn’t cry spontaneously at birth, stimulate him by firmly rubbing up and down his back.
- While you’re waiting for medical help, try to get your baby to nurse – but only if you can keep the umbilical cord slack, not taut (sometimes, if the placenta is still inside you, the cord won’t be long enough to allow you to bring your baby to your breast). Besides offering him comfort and security – and giving you a chance to see him close up – his suckling will prompt your body to release more oxytocin, the hormone that stimulates contractions, which will help the placenta separate and be delivered. After the placenta is out, keep nursing to help your uterus continue to contract – a well-contracted uterus is necessary to keep bleeding in check. If your baby won’t nurse right away, manually stimulate your nipples to release the hormone.
- After you deliver the placenta, firmly massage your uterus by vigorously rubbing your belly right below your navel. This will help your uterus contract and remain contracted.
Where can I get more information?
See the American College of Nurse-Midwives’ Guide to Emergency Preparedness for Childbirth. This document offers specific advice on how to deliver a baby at home and care for the baby and mother through the first few days, in the event of a regional catastrophe or terrorist attack.
What is labor augmentation?
If your labor isn’t progressing very well, your healthcare practitioner may try to help it along (or “augment” it) by doing something to stimulate your contractions. She may decide to do this if your contractions aren’t coming frequently or forcefully enough to dilate your cervix or help move your baby down the birth canal.
How is it done?
Before augmenting your labor, your practitioner will carefully assess your contraction pattern and examine you to find out how much your cervix has effaced (thinned out) and dilated, as well as how far your baby has descended. She’ll also pay close attention to your baby’s heart rate in response to the contractions you’re having, to make sure your baby will be able to tolerate stronger contractions.
Then, if she determines that it’s appropriate to augment your labor, you’ll be given a drug called oxytocin. This drug (often referred to by the brand name Pitocin) is a synthetic form of the hormone that your body naturally produces during spontaneous labor. You’ll receive it through an IV line that’s connected to a pump so your practitioner can control the amount of medication you get. (If you’re at a birth center and your practitioner decides that you need oxytocin, you’ll be transferred to a hospital.)
Your practitioner will start you off with a small dose and gradually increase it until your uterus responds appropriately. How much you’ll need depends on the quality of your contractions so far, how sensitive your uterus is to the drug, how much your cervix is dilated, and how far along you are in your pregnancy. As a rule, you’re shooting for three to five contractions every ten minutes.
The goal is to give you just enough oxytocin to bring on contractions that dilate your cervix in a timely way and help your baby descend – but not so much that your contractions become too frequent or abnormally long and strong, which could stress your baby. Having more than five contractions in ten minutes (averaged over 30 minutes), single contractions that last longer than two minutes, or contractions that occur within a minute of each other would be considered too much.
While your labor is being augmented, your practitioner will use continuous electronic fetal monitoring to keep tabs on your contractions and your baby’s well being.
Are any risks associated with using oxytocin?
The most common problem associated with oxytocin is overstimulation of the uterus. This can happen if the dose is too high, and it may in turn cause various problems with the baby’s heart rate. But because oxytocin wears off pretty quickly, your practitioner can solve that problem by lowering the dose or temporarily stopping the infusion altogether. She can also give you other drugs to relax your uterus more rapidly, if necessary. Then she can start the oxytocin again at a lower dose.
Sometimes a baby can’t tolerate the stress of any effective contractions. (This can happen with spontaneous contractions as well as contractions stimulated by oxytocin.) In this case, your practitioner would turn off the oxytocin, and you would deliver your baby by cesarean section.
Are there other ways to augment labor?
You may have heard that walking around will help move your labor along. The results of a 2009 review of research on the subject of birthing positionssuggests that among women without epidurals, remaining mostly upright (whether walking, sitting, standing, or kneeling) during the first stage of labor shortened that stage by about an hour. And there was no downside, so as long as you’re comfortable walking or otherwise remaining upright, it’s worth a try.
Your practitioner can also try to get your labor going more quickly by rupturing the membranes (the “bag of waters”) that surround your baby, if your water hasn’t already broken on its own. She can do this by inserting a slim, plastic hooked instrument through your vagina and dilated cervix to rupture your amniotic sac. This should cause no more discomfort than a regular vaginal exam.
While this procedure, known as amniotomy, has been used for a long time to augment labor, experts continue to debate its risks and benefits. Having an amniotomy may mean a somewhat shorter labor and less chance that you’ll need oxytocin. On the other hand, keeping your amniotic sac intact until it breaks on its own offers greater protection against infection and umbilical cord compression during contractions.
Your practitioner will consider whether amniotomy is a good choice for you based on factors such as how far your cervix is dilated, how low the baby is in your pelvis, whether you need internal fetal monitoring, and your risk of infection.
What is assisted delivery?
In an assisted vaginal delivery, your healthcare practitioner uses either a vacuum device or forceps to help your baby out of the birth canal. Your practitioner may recommend this if you’ve been pushing for a long time and you’re completely worn out, or if your baby’s nearly out but his heart rate is “nonreassuring.” (If you have a midwife attending you, her backup physician will perform the delivery.)
Although it may sound a bit frightening, in experienced hands an assisted delivery is considered safe as long as your baby’s head is low enough in your birth canal and there are no other problems that would complicate a vaginal delivery. If your doctor attempts an assisted delivery and is unable to get your baby out safely and in a timely manner, you’ll need to have a c-section.
According to the U.S. Centers for Disease Control and Prevention, 4 percent of vaginal deliveries in 2011 were assisted by vacuum and 1 percent were assisted by forceps.
Will an assisted delivery require special anesthesia or other procedures?
If your water hasn’t already broken, your doctor will rupture your membranes. The nurse or doctor will use a catheter to drain your bladder. And unless you already have an epidural, you may be given a pudendal block – a local anesthetic injected into your vaginal wall to numb your entire genital area.
You may also need an episiotomy (a small cut in the tissue between your vagina and your anus), particularly for a forceps delivery so that there’s room to insert the instrument. Finally, it’s routine for a pediatrician to be on hand for any delivery that requires instruments.
What is a vacuum extraction delivery like?
Your practitioner applies a flexible, rounded cup to your baby’s head in the birth canal. The cup is connected to an electric suction pump or a small handheld pump that creates vacuum pressure to hold the cup securely to the baby’s head. You’ll be asked to push while the doctor gently pulls on a handle attached to the cup, to help move your baby down and out of the birth canal.
Serious complications for your baby are relatively rare. A baby born with the help of a vacuum may have a raised bruise (called a cephalohematoma) on the top of his head. The bruise usually goes away within a few weeks, though it may take longer. If your baby does get a bruise, he’s also more likely to become jaundiced. That’s because the red blood cells in the bruise break up and release bilirubin, a blood component that causes jaundice when there’s too much of it.
Because of the pressure exerted on the baby’s head, retinal hemorrhage (bleeding in the eyes) is also more likely to happen with a vacuum extraction – though it happens with non-assisted vaginal births, too. This sounds bad, but it’s a temporary condition with no long-term consequences.
Having a vacuum-assisted delivery increases your risk of tears in your vagina, perineum, and anal sphincter, though less so than with a forceps delivery.
What is a forceps delivery like?
Your doctor inserts the forceps (a pair of spoon-shaped surgical tongs) into your vagina and applies them to the sides of your baby’s head. During contractions, she grasps the handles and gently pulls your baby down and out of the birth canal while you push.
Your baby may be slightly bruised from the forceps, but the bruises usually clear up in a few days. Sometimes a scalp blister forms where the forceps gripped the baby’s head. These blisters look unsightly, but they heal in a few weeks. Facial nerve injury is also a risk, though the damage is usually temporary. The risk of more serious problems for your baby is relatively rare.
Having a forceps delivery is generally considered more risky for the mother than the baby. Forceps delivery increases your risk of tears in your cervix, vagina, perineum, and anal sphincter.
What is recovery from an assisted delivery like?
If you have more than a tiny tear, you’ll need stitches, which will take a few weeks to fully heal. Occasionally, the tissue around an episiotomy will tear, which may cause a laceration that goes into or through the anal sphincter, increasing the risk of gas or fecal incontinence (trouble controlling bowel movements or flatulence). This type of tear can occur in any type of vaginal birth, though it’s more common with an assisted delivery.
After the sort of prolonged delivery that requires the use of forceps or a vacuum, you may find it difficult to go to the bathroom, or you may experience urine leaks because of temporary changes in your pelvic and perineal nerves and muscles. Also, if you’re feeling pain from your episiotomy or tears and you then resist moving your bowels, you may become constipated.
Video: Vacuum- or forceps-assisted delivery
Watch our assisted delivery video to learn what a vacuum and forceps look like and see how they’re used to help speed delivery.