Common, safe, and your consent is always needed

Assisted delivery using forceps or ventouse is used in around 1 in 8 births in the UK. It is a safe and sometimes necessary way to help your baby be born when pushing alone is not progressing. You will be fully informed, and your consent obtained, before anything is done.

This information is for general guidance only.

It does not replace advice from your midwife or obstetric team. Read more about our approach.

Assisted delivery: forceps and ventouse birth explained

What is assisted delivery?

An assisted delivery (also called an instrumental or operative vaginal delivery) is when a doctor uses forceps or a ventouse suction cup to help guide the baby out during the pushing stage of labour.

Assisted delivery is used in around 1 in 8 births in the UK, almost always during the second stage of labour. It is performed by an obstetrician (or a senior midwife for straightforward ventouse deliveries) and your consent is always required before the procedure begins. An episiotomy during assisted birth is common, particularly with forceps. You can note your preferences in your birth plan in advance.

The two types

Ventouse (vacuum cup)

A soft or hard cup is attached to the baby's head using suction. During contractions and with your pushing, the obstetrician applies gentle traction to guide the baby out.

Temporary scalp swelling (chignon) resolves within 48 hours.
Lower risk of severe perineal tears than forceps.
Not used before 36 weeks as the baby's skull is softer.

Forceps

Two smooth, curved metal instruments (resembling large spoons) are positioned around each side of the baby's head inside the vagina, joined together at the handles. With contractions and pushing, the obstetrician applies traction.

Some forceps can rotate baby into the optimal position first (rotational forceps).
May leave temporary marks on baby's cheeks, which fade within 48 hours.
RCOG recommends forceps over ventouse for babies under 36 weeks.

Why an assisted delivery may be needed

Baby showing signs of distress on CTG (heart rate changes suggesting oxygen supply is compromised)
Labour not progressing after a prolonged pushing stage — first baby 2+ hours; second or subsequent 1+ hour
Baby in a difficult position (such as back-to-back, occiput posterior), where rotation with forceps may help
A maternal medical condition where prolonged pushing is inadvisable (e.g. heart disease, severe hypertension)
Premature birth where forceps protect the baby's head
Exhaustion and inability to push effectively

What happens before an assisted delivery

Your obstetrician explains why it is recommended and obtains your verbal consent.
You have the right to ask questions and to decline.
You will be given local anaesthetic (or your epidural will be topped up) to numb the area.
You may be moved to an operating theatre for safety — so a caesarean can happen immediately if the assisted delivery is not successful (“trial of instrumental delivery”).
A catheter is inserted to empty your bladder.
An episiotomy is likely, particularly for forceps.
A paediatrician is usually present at the birth.

What happens during the delivery

You will be asked to push with each contraction while the obstetrician applies traction.
It usually takes 3 to 4 pushes to deliver the baby once the instrument is in position.
If several pulls are unsuccessful, the obstetrician may switch from ventouse to forceps, or proceed to caesarean section.
Your baby will be handed to you as soon as safely possible.
A paediatrician checks the baby immediately after birth.
Any tear or episiotomy will be repaired with dissolvable stitches.

Risks to mother

Most assisted deliveries are safe and uncomplicated. Risks include:

Perineal tears: higher risk of significant tearing than with spontaneous birth. See episiotomy and perineal tears.
Blood clots (DVT): higher risk after assisted delivery. Compression stockings and heparin may be given. See DVT in pregnancy.
Urinary incontinence: more common after instrumental birth, usually improves with pelvic floor exercises.
Anal incontinence: if a third or fourth-degree tear occurs. Specialist physiotherapy is effective.
More significant perineal pain in the first days.
Some women find assisted birth distressing. Support is available, including mental health resources.

Risks to baby

Most babies born by assisted delivery are completely fine. Possible temporary effects:

Ventouse: chignon (scalp swelling), resolves within 48 hours.
Forceps: temporary marks on face, fade within 48 hours.
Cephalhaematoma (a bruise under the scalp), resolves over weeks.
Jaundice: slightly more common after ventouse or forceps. Monitored by midwife and health visitor.
Small cuts on scalp: affect around 1 in 10, heal quickly.
Serious injury (skull fracture, nerve damage) is very rare.

Recovery after assisted delivery

Pain relief: take regular paracetamol and ibuprofen alternated for the first week. Do not wait until pain is severe.

Perineal care: follow the advice in our episiotomy and perineal tears guide.

Bladder care: a catheter may remain for 12 to 24 hours. After removal, staff will check you can pass urine normally.

Blood clot prevention: wear compression stockings and take heparin injections (if prescribed) as directed. Stay mobile.

Pelvic floor exercises: begin as soon as comfortable.

Emotional recovery: it is normal to need time to process an assisted birth. Talk to your midwife, health visitor or GP.

Birth trauma after assisted delivery

Some women experience birth trauma following an assisted delivery, particularly if it was an emergency or unexpected. Flashbacks, nightmares, avoidance and anxiety about future pregnancies are recognised signs of birth-related PTSD. Support is available. Try the Birth Trauma Association (birthtraumaassociation.org.uk) and Mind (mind.org.uk), or speak to your GP.

The stages of labour→ Episiotomy and perineal tear recovery→ Pain relief options→ Include your delivery preferences in your birth plan→

A note from our team

This guide reflects NHS UK and RCOG guidance on assisted vaginal birth. Your obstetric team is the best source of advice for your situation. Read more about us.

Frequently asked questions

What is the difference between forceps and ventouse?

Ventouse uses a soft or hard cup attached to the baby's head with suction to guide the baby out during contractions. Forceps are two smooth, curved metal instruments placed around each side of the baby's head. Both are safe when used by a trained obstetrician. Forceps can also be used to rotate a baby in an awkward position. Ventouse usually causes a temporary scalp swelling (chignon) that resolves in 48 hours, while forceps may leave temporary marks on the cheeks.

Will an assisted delivery hurt?

You will be given local anaesthetic, or your epidural will be topped up, before the procedure. You should feel pressure but not sharp pain. An episiotomy is usually performed, especially with forceps. Afterwards, perineal soreness is common for a week or two and is managed with regular paracetamol and ibuprofen.

What happens if forceps or ventouse does not work?

If the attempt is not successful after a few pulls, the obstetrician will reassess. Occasionally they switch from ventouse to forceps. If delivery still does not progress, a caesarean section is performed. For this reason, many assisted deliveries are done in an operating theatre (a “trial of instrumental delivery”) so that a caesarean can happen immediately if needed.

Are there long-term effects of assisted delivery?

Most women and babies are completely fine. Some women experience temporary urinary or anal incontinence, which usually improves with pelvic floor exercises and physiotherapy. Perineal pain is more common in the early weeks. Babies occasionally have mild, temporary effects such as scalp swelling, bruising or marks, which fade quickly.

Can I request a caesarean instead of an assisted delivery?

Your obstetrician will discuss the options with you and explain why one approach is being recommended. In many situations you can decline an assisted delivery and request a caesarean instead. It is important to have the discussion in the moment because decisions sometimes have to be made quickly if your baby is showing signs of distress.

Will my baby be harmed by forceps or ventouse?

Most babies are completely unharmed. Temporary marks, bruising or scalp swelling are common and resolve within days. Serious injury (such as a skull fracture or nerve damage) is very rare. Your baby will be checked by a paediatrician immediately after birth and monitored for any signs of problems, such as jaundice, in the days that follow.

💚 Common, safe, and your consent is always needed