November 15, 2024 • 21 mins
Discover the hidden world of instrument-assisted delivery and learn why it remains an essential, albeit less common, aspect of modern childbirth. Join, as we navigate through the fascinating history of forceps and vacuum use, tracing back to their peak in the mid-1900s, and understand why these tools are now reserved for specific, often unexpected scenarios. Through engaging discussions and personal stories, we uncover the critical decisions faced by parents and medical teams when labor takes an unexpected turn, and why safety is always the paramount concern.
You'll gain a deeper understanding of the precise circumstances that might necessitate these instruments, such as maternal fatigue or challenging fetal positions, and the rigorous precautions in place, including having a cesarean section as a backup. We'll talk candidly about the potential risks involved, such as tissue trauma and cephalohematomas, and why every birth is a unique journey requiring careful consideration. By sharing these insights and experiences, we aim to equip you with valuable knowledge to confidently navigate your childbirth journey or support a loved one in theirs.
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Show Credits
Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Welcome to the Ordinary Doula Podcast with
Angie Rozier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice Helping thousands of
people prepare for labor,providing essential knowledge
(00:40):
and tools for positive andempowering birth experiences.
Speaker 2 (00:48):
Hello and welcome to the Ordinary Doula Podcast.
I am your host, angie Rozier,and I am glad to be here with
you today.
You are probably here becauseyou are preparing for labor, or
you know someone who is, or youare helping someone who is, or
maybe you're a doula who's goingto help someone family member,
(01:10):
however that might be.
We like to explore all types ofaspects and topics components
of childbirth, delivery,postpartum lactation, kind of
the whole big package of thatlittle slice of life that's so
pivotal and so awesome.
We hope, we hope it's awesome.
So today I want to talk aboutsomething called instrument
(01:32):
assisted delivery.
This is also referred to asoperative vaginal delivery.
I was recently reading in aforum that I follow on Facebook
that's about birth work anddoulas and childbirth a post
about instrument assisteddelivery, and I was surprised on
(01:53):
there how many doulas had notseen that or were not familiar
with what an instrument assisteddelivery is.
So let's, let's chat about thatNow.
I don't.
I have never met a singleclient of mine that has ever
said I want, I'm going to setout to have an instrument
assisted delivery.
This isn't something peopleplan for or strive to achieve or
(02:17):
ascend to, but it's something,it's an option that may be
presented at some point duringthe towards the end of the labor
process.
So if, if a delivery is beinginstrument assisted, we are at
the end, right, we are likepushing the babies close to
being born and for whateverreason, um there, and we'll talk
(02:38):
about what the reasons are forwhatever reason an instrument
assisted delivery is offered.
So let's talk about what thoseinstruments are.
We have forceps and vacuum.
Those are the two instrumentsthat, when we talk about
instrument assisted or operativevaginal delivery, I don't see a
ton of these.
I used to see more of themyears ago and they're kind of
(03:02):
getting less common.
And the type of instrumentassisted delivery has shifted a
little bit over the years aswell.
A lot bit actually.
And I'm going to give you atiny little bit of history.
I could just do a whole podcaston this little component of
history.
But in the middle part of the1900s, almost all deliveries
(03:23):
were instrument assisteddeliveries, like almost 100%.
If you're giving birth in ahospital, women were drugged in
such a way that they were nothelpful to the process.
Really, they were kind ofdraped and tied down in such a
way that they weren't helpful.
So almost 100% of deliveries,doctors would do an episiotomy,
(03:44):
would place forceps and wouldpull babies out.
So if you know someone who wasborn in the 1930s, 1940s, 1950s,
1960s, the high likelihood thattheir delivery included
instrument assisted delivery.
So we don't really do thatanymore very much, which is a
really great thing.
(04:04):
So forceps used to be the toolof instrument assistance and
they were actually created inFrance in the 1500s and it was a
very widely held secret for along time, only used for royalty
, those poor royalty that had,and it was a new piece of
technology that they were soexcited to have and very
(04:27):
protective of that knowledge andthat secret for a long time.
Um, and then they came, youknow, they spread throughout the
world and in the United Statestheir use was extremely common
for um a few decades in a timein our history when childbirth
was what I call kind of the darkperiod.
So anymore there's twoinstruments Vacuum is one and
(04:49):
forceps are another.
So let's talk about why wewould need instrument-assisted
delivery if this option shouldcome up for you or someone you
know during the delivery process.
So, like I said, we're thebabies close to being born.
We've been pushing probably fora while.
So that's called second stage.
We're in second stage and thereare a couple different reasons,
(05:09):
a couple different scenariosthat would prompt a provider to
suggest instruments.
One of those is that we havematernal fatigue Like this.
This mom has been pushing for along time.
She's kind of tuckering out,running out of steam.
Now she could do it like people.
(05:31):
I'm so impressed and sorepeatedly amazed by the
strength of the human body andthe human heart.
But the effectiveness ofpushing can decrease when
someone is absolutely fatigued.
So that might be a reason.
Like mom's been pushing for along time and we're maybe making
progress, but slow progress,and so the offering of
(05:54):
instruments, instrument assisteddelivery, is something to kind
of help in her time of fatigue.
So the two instruments thatwould be offered are forceps and
vacuum.
The baby has like a fewparameters have to be met in
order for this to be an option.
The baby has to be low enoughfor those to be safe.
(06:15):
Long ago, like even 20, 30, 40years ago, they would do high
forceps where the baby was stillpretty high in the pelvis and
they'd go up and get the babyand pull the baby down.
They don't do that anymore.
They've realized ding, ding,ding, ding ding.
That wasn't good for anyone.
Internal structures of thefemale anatomy for babies to be
(06:36):
going up, finding them, bringingthem down.
So babies have to be fairly lowon their own.
So the kind of the general rulefor that is that the presenting
part, which ideally of courseis the head and the crown of the
head at that not just the capit but the crown of the head,
has come down to a plus two.
So that's kind of like ears-isharound about the baby's ears.
(06:58):
So if we have a baby who's likea minus one, instruments are
off the table, like that's notan option.
So baby has to be descendedpretty well for those
instruments are off the table,like that's not an option.
Um, so baby has to be descendedpretty well for those
instruments to be an option.
Um, there's other parametersthat exist.
Babies have to be doing okayenough on their heart rate
because likely when we add thisintervention, um, baby's not
(07:21):
going to love it.
Uh, this is you.
You know this isn't somethingbabies are gonna absolutely say
oh, awesome, that tickles great,let's do some more of that.
Um, but these are designed tofinish up the process.
So another reason thatinstruments might be offered is
the baby is malpositioned.
Maybe mom's pushing with allher might, baby's coming down,
(07:41):
albeit slowly, and if those isthat instrument can just turn
the baby a little bit.
Maybe the baby's OP and we wantto turn it a little bit of out
of OP so it can fit better, orwe need it just to descend a
little bit more.
Um, then instruments might be amethod to kind of get baby into
a better position.
(08:02):
We also might have just a longpushing stage.
Maybe mom's doing great, baby'sdoing great, like her energy is
fine.
But it's just if we're likelooking at the several hours
mark, you know, one to threehours for second stage or
pushing is very common.
But if we're looking at three,four, five hours, we've seen six
(08:25):
, seven and this year saw ninehours of pushing, which is
pretty remarkable, and still hada vaginal delivery.
But if we're getting into thoselong hours, that might be a way
to kind of get things movingalong.
So those are a couple of thereasons and the baby has to be
in a pretty decent position asfar as depth in the pelvis for
(08:47):
that to be an option.
So generally, providers todayare going to prefer the vacuum
over the forceps.
Um, so the vacuum is a littleinstrument that really is just a
vacuum.
It's a suction cup.
Um.
There's a couple of differentkinds, different brands, but
some are, um, firm plastic, someare kind of softer, some have
(09:08):
like a spongy foam in them, butit is designed to go on the
baby's head and it does suction.
There's like a suction they canhave on the instrument.
There's a little mechanism thatshows how firm the pressure is
and it comes with a littlehandle.
So this vacuum goes onto thebaby's head and then they make
sure it's firmly applied andthey can then pull the baby out
with the handle or pull the babydown with the handle.
(09:30):
If a baby has a ton of hair,like this really awesome head of
hair, that vacuum's not reallygonna stick to anything.
So even if they try vacuuming,it might not work on some heads.
Um, if there's really squishycap it, they might be kind of
concerned about hooking to youknow attaching onto that, they
want a good deal of the crown ofthe head um available.
(09:53):
So we have more of the head Um.
Forceps are metal and vacuum,are like one use things, like
they're disposable basically.
So they open them from a youknow, a sterile package, they
use them, they're done Umforceps.
Babies can be a touch bithigher with forceps Um, and they
are a reusable instrument thatgets of course sterilized um
(10:15):
between uses in an autoclave andthen put in sterile packaging.
But they are metal kind oftongs or spoons if you will.
There's different kinds offorceps and they slide in to the
vaginal opening and go aroundthe baby's head hook to each
other and also a handle isfashioned after that, you know,
at the end of them.
So these tongs go in cup on thebaby's head hook together and
(10:39):
then creates a handle for theprovider to pull on.
Like I said, sometimes we justrotate a baby into a better
position with one use of aninstrument like one pull.
Sometimes we just rotate a babyinto a better position with one
use of an instrument like onepull.
Sometimes we pull the baby justto the perineum so the baby's
like right there, then we removethe instruments and then the
baby's born over the perineum bythe mom's own power and
(10:59):
sometimes the instruments pullthe baby entirely out altogether
.
Um, I will tell you, when ateam is looking at doing
instruments, they're, of course,very cautious.
Everything has to work out well, but and they do have an
operating room ready there'salways an operating room at the
ready when instruments areoffered and used.
(11:20):
Because if things don't go well, if baby doesn't respond well,
if it didn't work, because it'snot going to work, if this, if
this last effort isn't going tobring the baby either down and
out or down so that can then getout, then they have to go
pretty quickly, sometimes reallyquickly, to a cesarean delivery
, and there's other parametersaround the use of those that
(11:45):
limit the amount of times adoctor or provider can pull.
And, by the way, this is notsomething midwives do.
This is something that an OBwould do.
So if you have a midwife in ahospital and this is the
direction things are going thenan obstetrician would come in to
do this.
Your midwife would remain inthe room and be with you.
But this maneuver and procedureis done by an obstetrician and
(12:05):
they're're of course, monitoringthe baby's heart rate very
carefully while they do this.
No one prefers this right.
This is not a preferred methodof delivery, but we're going to
talk about some cases where itmight be preferred over other
options.
So they have a limited numberof pulls.
They can do three pulls withthat, so pull through three
contractions while monitoringthe baby closely.
They're not going to sit andpull and pull and pull for long
(12:27):
periods of time, but it's aquick effort, a last effort and
sometimes a very effectiveeffort to get that baby either
turned or descended enough to beborn or born.
Sometimes, as you can imagine,this increases what's coming out
of the vaginal opening,especially with forceps.
Like we have the baby's headand then we've just put
(12:49):
something metal at that on theoutside of the baby's head.
So we've kind of made thediameter larger.
Vacuum doesn't necessarily dothat, but some providers will do
an episiotomy before they placeforceps.
So that's a vaginal like a cutin the vaginal opening, a
surgical incision to make itwider.
Some don't.
(13:09):
But the likelihood of tissueseparation does go up with use
of forceps, not as much withvacuum, but it does go up
through use of forceps.
So why would we want this?
Like we said, if mom's justtuckered out and needs a little
oomph, a little dip, push at theend.
If baby's just littlecattywampus in the pelvis, we
(13:30):
can turn, rotate the baby, bringthe baby down a little bit and
it's a choice.
Like nobody has to useinstrument assisted delivery.
Their other option is, ifeverything's fine, keep going a
while, see what the body's ownpower does, and or do a cesarean
.
And I have seen clients who areoffered an instrument assisted
delivery and they decline.
(13:51):
They say no, thank you, I'm noteven going to try, I'd rather
do a c-section.
Others say absolutely we'll doanything to avoid a c-section.
That's a individual and acase-by-case decision, of course
.
Kind of, look at the wholesituation, the whole scenario,
and see what's going on there.
I have someone near and dear tome had a baby this summer which
(14:11):
got to be a tough, really toughsituation and five day long
labor, five hours of pushing, alot more interventions than this
person had originally plannedon, and after five hours of
pushing the doctor offeredinstrument assisted delivery.
(14:32):
The mom declined and said Nope,I'd rather take risk to my body
than to the baby's body, I'drather do a C-section.
I don't know that I would makethat same choice for myself or
my baby.
But again you got to look atthe whole picture and every
situation is very different.
But it is an effort to avoid acesarean, which is, of course,
major abdominal surgery for themom, recovery, everything that
(14:54):
goes with that, additional riskfactors in the future that come
from cesarean delivery.
Sometimes I have seen this too,where we do an instrument
assisted delivery and we wishedwe would have done a C-section,
we wish we would have chosen aC-section, assisted delivery and
we wished we would have done ac-section, we wish we would have
chosen a c-section.
And this is one of manyindicators where we make the
whole team.
The whole team makes the bestdecisions that they can in the
(15:16):
moment with the information thatthey have.
So this includes the personhaving a baby, those supporting
her, the provider as well.
But sometimes there's beenpretty severe tissue trauma that
has pretty lasting impactsafter use of forceps.
Sometimes there has beeninjuries to babies.
(15:37):
When we look at vacuum, therecan be cephalohematomas, which
is a pretty like.
The diameter of a vacuum isprobably like I don't know six,
seven centimeters and somebabies will have a pretty good
size hematoma, which is a lookslike a giant blood blister.
A bruise could cause internalbruising.
(15:57):
Bleeding on the baby's headcould increase likelihood of
jaundice because we have somerelease of red blood cells are
bleeding on the inside.
I can definitely tell when ababy's been born by instrument.
When we go to breastfeed thatbaby makes a unique kind of cry.
They like every, they have aheadache kind of, if you will.
(16:18):
When the babies make a suctionwith their mouth, there's
suctioning going on, there's apressure change in their head.
And if they have a hematoma orthey have been delivered by
instruments, you can tell theykind of whimper and cry when
they try to make a seal and alatch at the breast for that
first little while Healable.
Yes, babies born by forcepshave been known to have marks on
(16:39):
their face.
It's very rare.
Some have had nerve damage.
Like, depending on where theforceps are placed, there could
be nerve damage.
And then we also get into thepressure that is applied on the
handle.
The handle that's, you know,created, that handle created for
pulling.
(16:59):
There's an incredible amount ofpressure put on that baby.
And guess where that pressureis being put?
It's, of course there'ssomething on the baby's head, at
the pressures on their neck.
So those tiny little neck bones, you know, I've spoken to
chiropractors and infantchiropractors over the years and
, gosh, they want to see thosebabies right away.
Or craniosacral therapists torelease a lot of that pressure
(17:19):
and kind of get babies back backin alignment and undo some of
the trauma that might have beendone to their bodies during the
birth process.
That adds quite a bit morepressure and I've seen some
pretty traumatic traumatic to me, maybe not traumatic to the
client, but traumatic to meinstrument deliveries where
(17:40):
we've got a provider, a grownman, grown woman, just pulling
with all their might, tremblingarms, to get that baby out.
I've seen some doctors placeforceps or try to say I'm not
comfortable with this placement,let's move to a C-section.
I've seen some pull once andvacuums, by the way, can pop off
.
So they also get a limitednumber of what we call pop-offs,
(18:01):
like if they pull and thesuction didn't keep the vacuum
on the baby's head, they canonly work with two or three
pop-offs before they also call aC-section.
So something definitely to beaware of.
Every time there's aninstrument assisted delivery I
am going to really suggest notforce, because that's not my
role, but really suggest thatthat baby gets some quality body
(18:24):
work done pretty quickly, thatthat baby gets some quality body
work done pretty quickly, andmom too, whether that's pelvic
floor PT afterwards to helpeverything to recover.
So that's kind of the low down.
On instrument assisted delivery,again we have vacuums, forceps,
and vacuums are preferred.
Some of the information thatI've recently researched says
(18:45):
one in eight deliveries in theUnited States are done by
instrument assisted delivery.
I feel like that's a littlehigh.
I probably see, I don't know,one in 20 is what I feel like,
just anecdotally, like thinkingback on the bursts that I've
been at, you know, kind ofrecently, well, over the last 20
years too, and so, like I said,some people regret it, some
(19:06):
people are very grateful forthat because they did avoid a
c-section.
So, taking into account thatthis may come up, I just kind of
want you to know what theoptions are.
Hopefully it's not a decisionyou have to make and not a
decision you're faced with, butkind of want you to understand
what that means, what thatentails.
So, if this comes across yoursituation and your realm of
(19:29):
awareness, that you kind ofunderstand what's going on and
can make a decision from there,um, I'd love to hear what, what
you um, what you think aboutthis, if you want to visit us um
at birthlearningcom and connectwith us Love to hear any
stories you have aboutinstrument assisted deliveries.
(19:49):
There's a lot, yeah lots ofdifferent birth.
I'm a birth story junkie so I'dlove to hear your stories.
But now you have maybe a littlemore information than you did
and hopefully that's notsomething that you need to make
a decision about in your laborand birth.
But we want empowered birth andknowledge is power and so when
you know all your options, youhave options.
(20:11):
Thank you so much for being withus here today on the Ordinary
Doula, and hope you have a greatday today.
I don't know where you are orwhen you're listening to this,
but it's a beautiful, crisp fallday here when I'm recording
this and I hope you can feel thechange in the air.
That's that's here this season.
Hope you have a good one andwe'll see you next time.
Speaker 1 (20:46):
Thank you for listening to the Ordinary Doula
podcast with Angie Rozier,hosted by Birth Learning.
Episode credits will be in theshow notes Tune in next time as
we continue to explore the manyaspects of giving birth.
Thank you.
Welcome to the Ordinary Doula Podcast with
Angie Rozier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice Helping thousands of
people prepare for labor,providing essential knowledge
(00:40):
and tools for positive andempowering birth experiences.
Speaker 2 (00:48):
Hello and welcome to the Ordinary Doula Podcast.
I am your host, angie Rozier,and I am glad to be here with
you today.
You are probably here becauseyou are preparing for labor, or
you know someone who is, or youare helping someone who is, or
maybe you're a doula who's goingto help someone family member,
(01:10):
however that might be.
We like to explore all types ofaspects and topics components
of childbirth, delivery,postpartum lactation, kind of
the whole big package of thatlittle slice of life that's so
pivotal and so awesome.
We hope, we hope it's awesome.
So today I want to talk aboutsomething called instrument
(01:32):
assisted delivery.
This is also referred to asoperative vaginal delivery.
I was recently reading in aforum that I follow on Facebook
that's about birth work anddoulas and childbirth a post
about instrument assisteddelivery, and I was surprised on
(01:53):
there how many doulas had notseen that or were not familiar
with what an instrument assisteddelivery is.
So let's, let's chat about thatNow.
I don't.
I have never met a singleclient of mine that has ever
said I want, I'm going to setout to have an instrument
assisted delivery.
This isn't something peopleplan for or strive to achieve or
(02:17):
ascend to, but it's something,it's an option that may be
presented at some point duringthe towards the end of the labor
process.
So if, if a delivery is beinginstrument assisted, we are at
the end, right, we are likepushing the babies close to
being born and for whateverreason, um there, and we'll talk
(02:38):
about what the reasons are forwhatever reason an instrument
assisted delivery is offered.
So let's talk about what thoseinstruments are.
We have forceps and vacuum.
Those are the two instrumentsthat, when we talk about
instrument assisted or operativevaginal delivery, I don't see a
ton of these.
I used to see more of themyears ago and they're kind of
(03:02):
getting less common.
And the type of instrumentassisted delivery has shifted a
little bit over the years aswell.
A lot bit actually.
And I'm going to give you atiny little bit of history.
I could just do a whole podcaston this little component of
history.
But in the middle part of the1900s, almost all deliveries
(03:23):
were instrument assisteddeliveries, like almost 100%.
If you're giving birth in ahospital, women were drugged in
such a way that they were nothelpful to the process.
Really, they were kind ofdraped and tied down in such a
way that they weren't helpful.
So almost 100% of deliveries,doctors would do an episiotomy,
(03:44):
would place forceps and wouldpull babies out.
So if you know someone who wasborn in the 1930s, 1940s, 1950s,
1960s, the high likelihood thattheir delivery included
instrument assisted delivery.
So we don't really do thatanymore very much, which is a
really great thing.
(04:04):
So forceps used to be the toolof instrument assistance and
they were actually created inFrance in the 1500s and it was a
very widely held secret for along time, only used for royalty
, those poor royalty that had,and it was a new piece of
technology that they were soexcited to have and very
(04:27):
protective of that knowledge andthat secret for a long time.
Um, and then they came, youknow, they spread throughout the
world and in the United Statestheir use was extremely common
for um a few decades in a timein our history when childbirth
was what I call kind of the darkperiod.
So anymore there's twoinstruments Vacuum is one and
(04:49):
forceps are another.
So let's talk about why wewould need instrument-assisted
delivery if this option shouldcome up for you or someone you
know during the delivery process.
So, like I said, we're thebabies close to being born.
We've been pushing probably fora while.
So that's called second stage.
We're in second stage and thereare a couple different reasons,
(05:09):
a couple different scenariosthat would prompt a provider to
suggest instruments.
One of those is that we havematernal fatigue Like this.
This mom has been pushing for along time.
She's kind of tuckering out,running out of steam.
Now she could do it like people.
(05:31):
I'm so impressed and sorepeatedly amazed by the
strength of the human body andthe human heart.
But the effectiveness ofpushing can decrease when
someone is absolutely fatigued.
So that might be a reason.
Like mom's been pushing for along time and we're maybe making
progress, but slow progress,and so the offering of
(05:54):
instruments, instrument assisteddelivery, is something to kind
of help in her time of fatigue.
So the two instruments thatwould be offered are forceps and
vacuum.
The baby has like a fewparameters have to be met in
order for this to be an option.
The baby has to be low enoughfor those to be safe.
(06:15):
Long ago, like even 20, 30, 40years ago, they would do high
forceps where the baby was stillpretty high in the pelvis and
they'd go up and get the babyand pull the baby down.
They don't do that anymore.
They've realized ding, ding,ding, ding ding.
That wasn't good for anyone.
Internal structures of thefemale anatomy for babies to be
(06:36):
going up, finding them, bringingthem down.
So babies have to be fairly lowon their own.
So the kind of the general rulefor that is that the presenting
part, which ideally of courseis the head and the crown of the
head at that not just the capit but the crown of the head,
has come down to a plus two.
So that's kind of like ears-isharound about the baby's ears.
(06:58):
So if we have a baby who's likea minus one, instruments are
off the table, like that's notan option.
So baby has to be descendedpretty well for those
instruments are off the table,like that's not an option.
Um, so baby has to be descendedpretty well for those
instruments to be an option.
Um, there's other parametersthat exist.
Babies have to be doing okayenough on their heart rate
because likely when we add thisintervention, um, baby's not
(07:21):
going to love it.
Uh, this is you.
You know this isn't somethingbabies are gonna absolutely say
oh, awesome, that tickles great,let's do some more of that.
Um, but these are designed tofinish up the process.
So another reason thatinstruments might be offered is
the baby is malpositioned.
Maybe mom's pushing with allher might, baby's coming down,
(07:41):
albeit slowly, and if those isthat instrument can just turn
the baby a little bit.
Maybe the baby's OP and we wantto turn it a little bit of out
of OP so it can fit better, orwe need it just to descend a
little bit more.
Um, then instruments might be amethod to kind of get baby into
a better position.
(08:02):
We also might have just a longpushing stage.
Maybe mom's doing great, baby'sdoing great, like her energy is
fine.
But it's just if we're likelooking at the several hours
mark, you know, one to threehours for second stage or
pushing is very common.
But if we're looking at three,four, five hours, we've seen six
(08:25):
, seven and this year saw ninehours of pushing, which is
pretty remarkable, and still hada vaginal delivery.
But if we're getting into thoselong hours, that might be a way
to kind of get things movingalong.
So those are a couple of thereasons and the baby has to be
in a pretty decent position asfar as depth in the pelvis for
(08:47):
that to be an option.
So generally, providers todayare going to prefer the vacuum
over the forceps.
Um, so the vacuum is a littleinstrument that really is just a
vacuum.
It's a suction cup.
Um.
There's a couple of differentkinds, different brands, but
some are, um, firm plastic, someare kind of softer, some have
(09:08):
like a spongy foam in them, butit is designed to go on the
baby's head and it does suction.
There's like a suction they canhave on the instrument.
There's a little mechanism thatshows how firm the pressure is
and it comes with a littlehandle.
So this vacuum goes onto thebaby's head and then they make
sure it's firmly applied andthey can then pull the baby out
with the handle or pull the babydown with the handle.
(09:30):
If a baby has a ton of hair,like this really awesome head of
hair, that vacuum's not reallygonna stick to anything.
So even if they try vacuuming,it might not work on some heads.
Um, if there's really squishycap it, they might be kind of
concerned about hooking to youknow attaching onto that, they
want a good deal of the crown ofthe head um available.
(09:53):
So we have more of the head Um.
Forceps are metal and vacuum,are like one use things, like
they're disposable basically.
So they open them from a youknow, a sterile package, they
use them, they're done Umforceps.
Babies can be a touch bithigher with forceps Um, and they
are a reusable instrument thatgets of course sterilized um
(10:15):
between uses in an autoclave andthen put in sterile packaging.
But they are metal kind oftongs or spoons if you will.
There's different kinds offorceps and they slide in to the
vaginal opening and go aroundthe baby's head hook to each
other and also a handle isfashioned after that, you know,
at the end of them.
So these tongs go in cup on thebaby's head hook together and
(10:39):
then creates a handle for theprovider to pull on.
Like I said, sometimes we justrotate a baby into a better
position with one use of aninstrument like one pull.
Sometimes we just rotate a babyinto a better position with one
use of an instrument like onepull.
Sometimes we pull the baby justto the perineum so the baby's
like right there, then we removethe instruments and then the
baby's born over the perineum bythe mom's own power and
(10:59):
sometimes the instruments pullthe baby entirely out altogether
.
Um, I will tell you, when ateam is looking at doing
instruments, they're, of course,very cautious.
Everything has to work out well, but and they do have an
operating room ready there'salways an operating room at the
ready when instruments areoffered and used.
(11:20):
Because if things don't go well, if baby doesn't respond well,
if it didn't work, because it'snot going to work, if this, if
this last effort isn't going tobring the baby either down and
out or down so that can then getout, then they have to go
pretty quickly, sometimes reallyquickly, to a cesarean delivery
, and there's other parametersaround the use of those that
(11:45):
limit the amount of times adoctor or provider can pull.
And, by the way, this is notsomething midwives do.
This is something that an OBwould do.
So if you have a midwife in ahospital and this is the
direction things are going thenan obstetrician would come in to
do this.
Your midwife would remain inthe room and be with you.
But this maneuver and procedureis done by an obstetrician and
(12:05):
they're're of course, monitoringthe baby's heart rate very
carefully while they do this.
No one prefers this right.
This is not a preferred methodof delivery, but we're going to
talk about some cases where itmight be preferred over other
options.
So they have a limited numberof pulls.
They can do three pulls withthat, so pull through three
contractions while monitoringthe baby closely.
They're not going to sit andpull and pull and pull for long
(12:27):
periods of time, but it's aquick effort, a last effort and
sometimes a very effectiveeffort to get that baby either
turned or descended enough to beborn or born.
Sometimes, as you can imagine,this increases what's coming out
of the vaginal opening,especially with forceps.
Like we have the baby's headand then we've just put
(12:49):
something metal at that on theoutside of the baby's head.
So we've kind of made thediameter larger.
Vacuum doesn't necessarily dothat, but some providers will do
an episiotomy before they placeforceps.
So that's a vaginal like a cutin the vaginal opening, a
surgical incision to make itwider.
Some don't.
(13:09):
But the likelihood of tissueseparation does go up with use
of forceps, not as much withvacuum, but it does go up
through use of forceps.
So why would we want this?
Like we said, if mom's justtuckered out and needs a little
oomph, a little dip, push at theend.
If baby's just littlecattywampus in the pelvis, we
(13:30):
can turn, rotate the baby, bringthe baby down a little bit and
it's a choice.
Like nobody has to useinstrument assisted delivery.
Their other option is, ifeverything's fine, keep going a
while, see what the body's ownpower does, and or do a cesarean
.
And I have seen clients who areoffered an instrument assisted
delivery and they decline.
(13:51):
They say no, thank you, I'm noteven going to try, I'd rather
do a c-section.
Others say absolutely we'll doanything to avoid a c-section.
That's a individual and acase-by-case decision, of course
.
Kind of, look at the wholesituation, the whole scenario,
and see what's going on there.
I have someone near and dear tome had a baby this summer which
(14:11):
got to be a tough, really toughsituation and five day long
labor, five hours of pushing, alot more interventions than this
person had originally plannedon, and after five hours of
pushing the doctor offeredinstrument assisted delivery.
(14:32):
The mom declined and said Nope,I'd rather take risk to my body
than to the baby's body, I'drather do a C-section.
I don't know that I would makethat same choice for myself or
my baby.
But again you got to look atthe whole picture and every
situation is very different.
But it is an effort to avoid acesarean, which is, of course,
major abdominal surgery for themom, recovery, everything that
(14:54):
goes with that, additional riskfactors in the future that come
from cesarean delivery.
Sometimes I have seen this too,where we do an instrument
assisted delivery and we wishedwe would have done a C-section,
we wish we would have chosen aC-section, assisted delivery and
we wished we would have done ac-section, we wish we would have
chosen a c-section.
And this is one of manyindicators where we make the
whole team.
The whole team makes the bestdecisions that they can in the
(15:16):
moment with the information thatthey have.
So this includes the personhaving a baby, those supporting
her, the provider as well.
But sometimes there's beenpretty severe tissue trauma that
has pretty lasting impactsafter use of forceps.
Sometimes there has beeninjuries to babies.
(15:37):
When we look at vacuum, therecan be cephalohematomas, which
is a pretty like.
The diameter of a vacuum isprobably like I don't know six,
seven centimeters and somebabies will have a pretty good
size hematoma, which is a lookslike a giant blood blister.
A bruise could cause internalbruising.
(15:57):
Bleeding on the baby's headcould increase likelihood of
jaundice because we have somerelease of red blood cells are
bleeding on the inside.
I can definitely tell when ababy's been born by instrument.
When we go to breastfeed thatbaby makes a unique kind of cry.
They like every, they have aheadache kind of, if you will.
(16:18):
When the babies make a suctionwith their mouth, there's
suctioning going on, there's apressure change in their head.
And if they have a hematoma orthey have been delivered by
instruments, you can tell theykind of whimper and cry when
they try to make a seal and alatch at the breast for that
first little while Healable.
Yes, babies born by forcepshave been known to have marks on
(16:39):
their face.
It's very rare.
Some have had nerve damage.
Like, depending on where theforceps are placed, there could
be nerve damage.
And then we also get into thepressure that is applied on the
handle.
The handle that's, you know,created, that handle created for
pulling.
(16:59):
There's an incredible amount ofpressure put on that baby.
And guess where that pressureis being put?
It's, of course there'ssomething on the baby's head, at
the pressures on their neck.
So those tiny little neck bones, you know, I've spoken to
chiropractors and infantchiropractors over the years and
, gosh, they want to see thosebabies right away.
Or craniosacral therapists torelease a lot of that pressure
(17:19):
and kind of get babies back backin alignment and undo some of
the trauma that might have beendone to their bodies during the
birth process.
That adds quite a bit morepressure and I've seen some
pretty traumatic traumatic to me, maybe not traumatic to the
client, but traumatic to meinstrument deliveries where
(17:40):
we've got a provider, a grownman, grown woman, just pulling
with all their might, tremblingarms, to get that baby out.
I've seen some doctors placeforceps or try to say I'm not
comfortable with this placement,let's move to a C-section.
I've seen some pull once andvacuums, by the way, can pop off
.
So they also get a limitednumber of what we call pop-offs,
(18:01):
like if they pull and thesuction didn't keep the vacuum
on the baby's head, they canonly work with two or three
pop-offs before they also call aC-section.
So something definitely to beaware of.
Every time there's aninstrument assisted delivery I
am going to really suggest notforce, because that's not my
role, but really suggest thatthat baby gets some quality body
(18:24):
work done pretty quickly, thatthat baby gets some quality body
work done pretty quickly, andmom too, whether that's pelvic
floor PT afterwards to helpeverything to recover.
So that's kind of the low down.
On instrument assisted delivery,again we have vacuums, forceps,
and vacuums are preferred.
Some of the information thatI've recently researched says
(18:45):
one in eight deliveries in theUnited States are done by
instrument assisted delivery.
I feel like that's a littlehigh.
I probably see, I don't know,one in 20 is what I feel like,
just anecdotally, like thinkingback on the bursts that I've
been at, you know, kind ofrecently, well, over the last 20
years too, and so, like I said,some people regret it, some
(19:06):
people are very grateful forthat because they did avoid a
c-section.
So, taking into account thatthis may come up, I just kind of
want you to know what theoptions are.
Hopefully it's not a decisionyou have to make and not a
decision you're faced with, butkind of want you to understand
what that means, what thatentails.
So, if this comes across yoursituation and your realm of
(19:29):
awareness, that you kind ofunderstand what's going on and
can make a decision from there,um, I'd love to hear what, what
you um, what you think aboutthis, if you want to visit us um
at birthlearningcom and connectwith us Love to hear any
stories you have aboutinstrument assisted deliveries.
(19:49):
There's a lot, yeah lots ofdifferent birth.
I'm a birth story junkie so I'dlove to hear your stories.
But now you have maybe a littlemore information than you did
and hopefully that's notsomething that you need to make
a decision about in your laborand birth.
But we want empowered birth andknowledge is power and so when
you know all your options, youhave options.
(20:11):
Thank you so much for being withus here today on the Ordinary
Doula, and hope you have a greatday today.
I don't know where you are orwhen you're listening to this,
but it's a beautiful, crisp fallday here when I'm recording
this and I hope you can feel thechange in the air.
That's that's here this season.
Hope you have a good one andwe'll see you next time.
Speaker 1 (20:46):
Thank you for listening to the Ordinary Doula
podcast with Angie Rozier,hosted by Birth Learning.
Episode credits will be in theshow notes Tune in next time as
we continue to explore the manyaspects of giving birth.
Thank you.
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