Instrumental birth

An ‘instrumental birth’, is when your doctor helps you birth your baby by using instruments such as a ventouse (vacuum) suction cup or forceps on the baby’s head.

Doctors only use instruments to assist a mother to birth when necessary. If a doctor recommends instrumental assistance, it is because they believe the risk is higher to wait than to be born.

Some reasons why your doctor or obstetrician may recommend an instrumental birth are:

  • foetal distress (concerns about the baby’s heart rate)
  • malposition (your baby has gotten itself in an awkward spot)
  • maternal exhaustion (you’re too tired to jump that last hurdle)

What happens with an instrumental?

If the baby’s head is in an awkward position, it may need turning (rotating) or straightening to allow the birth. A paediatrician may be present to make sure your baby copes with the whole process after birth. A local anaesthetic is usually given to numb the vagina and perineum (the skin between the vagina and anus) if you haven’t already had an epidural. If the doctor has any concerns, they will move you to an operating theatre for a ‘Trial of Instrumental”.

This location is the safest option if they are unsure if your baby can be born safely through your vagina. In the operating theatre, they can perform a caesarean section necessary. A caesarean section is a safer and preferred option if they can’t help you birth your baby with the forceps or ventouse. As with any vaginal birth, they will need to repair any deep tear or cut. If you and your baby are both well, birthing this way should not prevent skin to skin with your baby.


Forceps are smooth metal instruments that look like large spoons or tongs. They’re curved to fit around the baby’s head. The doctor positions the forceps around your baby’s head, which are then connected at the handles.  The blades lock together at a set distance apart, designed so not to exert too much pressure on baby’s head. This lock acts as a safety mechanism so that they can not be accidentally closed, causing injury. When you get a contraction, and you are pushing an obstetrician, gently pulls to help deliver your baby.

There are many different types of forceps. Some forceps turn the baby to the correct position for birth. An example is a baby facing upward rather than down (known as ‘occiput-posterior’ or OP position – see Which Way’s Up?). Other forceps are of different lengths and used depending on how low in the birth canal your baby’s head is sitting.

Forceps can leave small marks or bruises on your baby’s face, but these will disappear quite quickly.


A ventouse (vacuum) attaches to the baby’s head by suction. The doctor attaches a plastic or metal cup to the baby’s head between contractions and stays there by way of by a tube connected to a suction device. During a contraction and while you are pushing, the doctor will help by pulling to deliver your baby.

The suction cup leaves a small swelling on your baby’s head, called a ‘chignon’. This mark disappears quickly. The cup may also leave a bruise on your baby’s head (called a ‘cephalohaematoma’). Doctors will not use a ventouse if you’re giving birth at less than 34 weeks pregnant, because your baby’s head is too soft. This instrument is ideal when your baby’s head is quite low in the birth canal.

To read more about instrumental birth, please click here.

Dr Janelle McAlpine (PhD), Clinical Midwife
L0050178 Plate showing the birth of a baby, using forceps (1 of 4) Credit: Wellcome Library, London. Wellcome Images Plate showing the birth of a baby, using forceps (1 of 4) 1781 L’art des accouchemens / Jean Louis Baudelocque Published: 1781. Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0