By Dr Joe Kabyemela, MD
Can't deliver! Won't deliver!
When it comes to the crunch, quite a few women utterly believe this.
The second stage of labour when the mother-to-be has to summon all her energy reserves and is being exhorted by the midwife and her partner to "Push!" "Keep it coming!" "Again, again!" "Hold your breath" etc. can be an overwhelming experience.
Occasionally it all becomes too much, so she descends into full-blown maternal distress. This will normally happen after a prolonged first stage, especially if pain control was sub-optimal. She is exhausted, she is in a lot of pain and she is called upon to perform a monumental and very intensive task. It can be a tall order. Help is then offered in the form of instrumental delivery. This could be by one of a variety of designs of forceps or the ventouse, where a suction cup is used, as we shall explain shortly.
Maternal distress is, however, not the only indication for using instruments to facilitate delivery. It could be fetal distress in the second stage, an unfavourable position of the head for delivery, and a few other indications.
There are circumstances where instruments cannot be used, where the remaining option is caesarean delivery.
The instruments, in the right hands, are extremely safe and complications are rare and usually transient. Debate flares up from time to time among the obstetrics fraternity about which is a better instrument, the ventouse or forceps. In the UK, historically, the forceps were the most commonly used instrument. Since the mid-1980s the ventouse has made significant inroads into most labour suites and statistics towards the end of the '90s show that it is, by some margin, the most used instrument, a quiet creeping coup.
The general reasons for the take-over are more to do with the fact that it is regarded as kinder to the mother and probably easier to use even by relatively junior obstetricians. On the issue of safety, both the ventouse and forceps are extremely safe and the argument in comparison is largely an exercise in splitting hairs. Specific questions on these instruments are answered here.