Recovering From a Forceps or Ventouse Birth

What an assisted birth is, and how common

An assisted (or instrumental, or operative) vaginal birth is one helped by forceps or a ventouse suction cup. The RCOG puts it at “about 1 in 8 (10-15%) births in the UK”, and notes it is “much less common in women who have had a vaginal birth before” — for a first baby, the figure is 1 in 3. The NHS gives the same overall figure of about 1 in 8 births.

The reasons, per the RCOG: concerns about your baby's wellbeing during birth, labour not progressing as expected, or being unable or advised not to push. The NHS adds a premature birth, where forceps can protect the baby's head, and specifies that if birth is before 36 weeks forceps may be preferred over ventouse because the baby's head is softer.

What is different about this recovery

The instrument is not usually what you feel afterwards. The perineum is. The RCOG is direct: birth with ventouse and with forceps “does mean a higher chance of you needing to have an episiotomy or having a vaginal tear”.

Tears, with numbers

A third- or fourth-degree tear — one involving the muscle and/or the wall of the anus or rectum — “affects 3 in 100 women (3%) who have a vaginal birth. It is more common following a ventouse birth, affecting up to 4 in 100 women (4%) and following a forceps birth, affecting between 8 and 12 women in every 100 (8–12%).” The NHS quotes identical figures. So the great majority of forceps births do not involve a severe tear — but the rate is several times higher than an unassisted birth, and it is the single reason this recovery differs.

Bleeding, catheters and clots

The RCOG notes that heavier bleeding is more common straight after an assisted birth, though bleeding in the days afterwards should be similar to an unassisted vaginal birth. The NHS says you will sometimes need a catheter draining your bladder for up to 24 hours, more likely if you had an epidural, because you may not know when your bladder is full. It also flags a higher chance of blood clots in the veins of your legs or pelvis, managed by moving around as much as you can and sometimes anti-clot stockings and heparin injections. Antibiotics are given through a drip after the birth to reduce infection risk (RCOG, NHS).

Continence

The NHS states that urinary incontinence “is more common after a ventouse or forceps delivery”, and that “you should be offered physiotherapy to help prevent this happening, including advice on pelvic floor exercises”. Anal incontinence — involuntary wind or leaking stool — is also more likely, particularly where there has been a third- or fourth-degree tear. These are treatable and they are not something to endure quietly.

Perineal pain: what is normal and what is not

NICE NG194 tells clinicians to ask, at every postnatal contact, about pain not resolving or worsening, an increasing need for pain relief, discharge with a strong or unpleasant smell, swelling, and wound breakdown. It names assisted vaginal birth as a risk factor for persistent postnatal perineal pain, alongside episiotomy or tear, wound infection or breakdown, and a birth experienced as traumatic.

It also makes an important link: perineal pain that persists or worsens in the first few weeks “may be associated with symptoms of depression, long-term perineal pain, problems with daily functioning and psychosexual difficulties.” Persistent pain is a reason to be seen, not a reason to wait for the six-week check.

NICE is unambiguous about wound breakdown: if the perineal wound breaks down or there are ongoing healing concerns, refer urgently to specialist maternity services — “to be seen the same day in the case of a perineal wound breakdown”.

What helps

• Perineal hygiene. NICE recommends daily showering of the perineum, frequent changing of sanitary pads, and hand washing before and after. The HSE says the same.
• Cold, early. ACOG suggests an ice pack or cold gel pack for 10 to 20 minutes at a time, “most effective in the first 24 to 72 hours after birth”.
• Pain relief that is actually taken. The HSE says paracetamol helps with pain and ibuprofen with pain and swelling, and that both are safe when breastfeeding — check with a pharmacist if you are on other medicines. ACOG suggests ibuprofen as the usual first step while breastfeeding because little passes into breast milk.
• Position. ACOG suggests sitting on a pillow, trying a sitz bath, and breastfeeding lying on your side so there is no pressure on the perineum.
• Toilet strategy. ACOG suggests cleaning your genitals with warm water from a squeeze bottle while you are on the toilet, which also helps trigger the flow of urine, and asking your clinician about a stool softener.
• Pelvic floor exercises, once you are ready. The HSE advises waiting until 6 weeks after birth to start exercise if you had a forceps or vacuum delivery, and NICE emphasises pelvic floor exercises for everyone from the first postnatal contacts.

Your baby's marks

The NHS lists what to expect: a mark on the head from the ventouse cup (a chignon), which “usually disappears within 48 hours”; a bruise on the head (cephalohaematoma), usually nothing to worry about; forceps marks on the face, which usually disappear within 48 hours; small cuts on the face or scalp, affecting 1 in 10 babies born by assisted delivery and healing quickly; and jaundice, which should pass in a few days. A paediatrician is usually present at the birth to check the baby.

Will it happen again?

The RCOG's key point: “having an assisted vaginal birth does not mean you will need one in your next pregnancy.” It also notes that assisted birth is “much less common in women who have had a vaginal birth before” — which, from your second baby onwards, now includes you.

If the birth was frightening, NICE NG194 says you should be given the opportunity at postnatal contacts to talk about your birth experience and be told about birth reflection services. You can request that later, not only in the first weeks.

When to call

Contact your midwife, GP or maternity unit straight away if you have:

• Perineal pain that is worsening, or that needs more pain relief rather than less (NICE).
• Any sense that the wound has opened — NICE says perineal wound breakdown should be seen the same day.
• Discharge with a strong or unpleasant smell, swelling, or a fever (NICE, HSE).
• Difficulty passing urine, or being unable to control wind or stool.
• Heavy vaginal bleeding or large clots.
• Pain or swelling in one calf, chest pain, or breathlessness — possible clot.

Call your local emergency number (999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, or 111 in New Zealand) if bleeding suddenly becomes heavier and you feel faint or dizzy, or if you have chest pain or are gasping for air.