What is Assisted Delivery?

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If you have watched the movie 3 idiots, then the scene where Mona delivers the baby with the help of a team of engineers using a vacuum device, shows one of the versions of what is called as Assisted Delivery.

Tired mom pushingIt sometimes happens that during the process of a normal vaginal delivery things do not go as planned. The labour is at an advanced stage but it has been slow and prolonged, the mother is exhausted and cannot push any more or the baby is showing signs of distress. In such cases sometimes doctors use certain instruments to facilitate the delivery. This is called an assisted delivery.

The instruments that are commonly used are either a vacuum extractor or forceps. Which instrument will be used depends upon the situation at hand and the doctors experience in using that instrument.

Usually some form of anaesthesia is recommended. If an epidural has already been administered it could be topped up. Otherwise, a local anaesthetic could be injected directly into the nerves of the vagina. This is called a pudendal block.

Vacuum Device for birthThe vacuum device  is basically a suction cup with a hand or treadle pump attached. If the baby is lying in the right position the cup is inserted into the vagina and placed on the baby's scalp. A vacuum is created by the pump and the baby is gently pulled out by manipulation as the mother pushes down during a contraction. The vacuum extractor is also used if the mother has a heart condition and cannot exert force during labour.

Forceps, on the other hand, are like tongs with 2 curved spoons attached. These spoons can cradle around the baby's head. With manipulation  by the doctor the forceps can be used to change the position of the baby in the birth canal as well as gently pull it out.

Assisted delivery is carried out only if the baby has already travelled low down into the birth canal, the cervix is fully dilated but labour has stalled for some reason. The size of the pelvis also matters. A small pelvis will not allow the use of these instruments.

Forceps for deliveryAn assisted delivery avoids the necessity of a Caesarian section with all its attendant risks of bleeding, infection and trauma. It is also much quicker and more expedient than a C-section.

However, there is a small risk of injuries to the vagina, perineal area and sometimes the anus. A vaginal tear may occur or an episiotomy may need to be performed. Women who have assisted deliveries may also suffer from urinary and faecal incontinence.

There are also chances of injury to the baby'scalp, head and eyes or damage to the nerves. There have also been cases of more serious problems like skull fracture or internal bleeding.

A vacuum extraction can cause a cone shaped swelling over the baby's scalp. This is normal and resolves in a week or two. Sometimes, however, there is bleeding into the tissues of the scalp causing a red swelling or cephalohaematoma  over the baby's scalp . This is not a serious condition either but takes longer to resolve, usually within 6 to 8 weeks.

An assisted vaginal delivery with its attendant  perineal pain and bruising may make it difficult for the new mother to walk or sit for a time. A perineal tear may have to be stitched up. Recovery and healing of the pain and bruises takes a couple of weeks. In the meanwhile, over the counter pain killers, ice packs and sitting on a pillow can help ease the pain.

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