Assisted Vaginal Birth: Ventouse, Forceps and What to Expect
Key message: Ventouse or forceps can help complete a vaginal birth when the baby needs to be born…
Key message: Ventouse or forceps can help complete a vaginal birth when the baby needs to be born sooner or pushing is not enough. The team should explain why, alternatives, likelihood of success, pain relief and what happens if the attempt is unsuccessful.
Get urgent help: After birth, urgent review is needed for heavy bleeding, fainting, severe or increasing pelvic pain, inability to pass urine, fever, wound breakdown, chest pain, breathlessness or one swollen painful leg. A baby who is very sleepy, feeds poorly, has abnormal breathing or unusual movements needs urgent newborn assessment.
Why may assistance be recommended?
- Concern about the baby’s heart-rate pattern near the end of labour.
- The pushing stage is prolonged or progress has stopped.
- Maternal exhaustion or inability to push effectively.
- A medical condition in which prolonged pushing should be shortened.
- The baby’s head needs help to rotate or descend.
What must be checked before an attempt?
- The cervix is fully open and the membranes have ruptured.
- The baby’s head position and level are known and low enough.
- The bladder is emptied.
- Adequate pain relief is available.
- There is a clear backup plan, including immediate caesarean if necessary.
- The patient understands and consents unless an immediate emergency limits discussion.
What is ventouse?
A suction cup is placed on the baby’s head and traction is coordinated with contractions and pushing. It is not generally used at very early preterm gestations because the scalp and skull are more vulnerable.
A temporary swelling or mark on the baby’s head is common and usually resolves.
What are forceps?
Forceps are smooth curved instruments placed around the baby’s head to guide birth during contractions. They may be preferred when birth needs to be expedited, rotation is required or ventouse is unsuitable.
Small facial marks are common and usually temporary.
Will an episiotomy be needed?
An episiotomy is more commonly used with forceps and may be recommended to create space or reduce the chance of an uncontrolled severe tear in the circumstances. It is not automatic for every assisted birth.
Local anaesthetic or an effective epidural should be used before cutting or repair.
What are the maternal risks?
- Vaginal or perineal tears, including a higher chance of third- or fourth-degree tear with forceps.
- Pain, swelling and stitches.
- Difficulty passing urine or temporary bladder leakage.
- Postpartum haemorrhage.
- Pelvic-floor symptoms or painful sex, usually improving but sometimes needing physiotherapy or specialist care.
What are the newborn risks?
- Temporary scalp swelling, bruising or facial marks.
- Cephalohaematoma or jaundice after ventouse.
- Rare facial-nerve injury or skull injury.
- Rare subgaleal bleeding or intracranial injury, with risk depending on circumstances and instrument.
- Newborn examination and observation when indicated.
What if the attempt does not work?
The clinician should stop when safe limits are reached, progress is not occurring or the baby’s condition changes. A different instrument is used only after careful reassessment because sequential instruments increase trauma risk.
An urgent caesarean may be the safest next step. This is not a failure by the mother.
How is recovery supported?
- Regular pain relief, ice/cooling and gentle hygiene.
- Laxatives after significant tear or when prescribed.
- Pelvic-floor assessment and exercises when comfortable, with relaxation as well as strengthening.
- Review of bladder, bowel, pain and sexual symptoms.
- A debrief explaining why assistance was needed and implications for future birth.
What does it mean for a future pregnancy?
Many patients have an uncomplicated vaginal birth next time. The plan considers why assistance was needed, any severe tear, pelvic-floor symptoms, fetal size and personal experience.
A previous assisted birth alone does not require a planned caesarean.
Frequently asked questions
Can I refuse forceps or ventouse?
You should receive information and can decline, but the alternatives—including urgent caesarean and the risks of delay—need clear discussion.
Which is safer, ventouse or forceps?
Each has different strengths and risks; the safest choice depends on the baby’s position, urgency, gestation and operator experience.
Will the baby’s head return to normal?
Most swelling and superficial marks resolve over days.
Does assisted birth always need an episiotomy?
No, although it is more commonly recommended with forceps.
Will I need caesarean next time?
Not automatically; future planning is individual.
Your next step
Ask for a birth debrief if forceps or ventouse was used, and seek review for persistent pain, bladder or bowel symptoms, sexual pain or emotional distress.
Medical and content review: Dr Mohamed Abdelghany, Obstetrics & Gynecology Specialist, MRCOG (UK), MSc Obstetrics & Gynecology – Kasr Al-Ainy, Cairo University.
Last reviewed: 23 August 2026.
This information is for general education and does not replace individual medical assessment. Severe, sudden or concerning symptoms should not wait for a routine appointment.
