Operative Vaginal Birth
Publication Date: April 1, 2020
Last Updated: March 14, 2022
Recommendations
Forceps and vacuum extractors have low risk of complications and are acceptable for operative vaginal birth.
574
A vaginal birth is more likely to be achieved with forceps than with vacuum extractors. However, forceps are more likely to be associated with third- and fourth-degree perineal tears.
574
Routine episiotomy with operative vaginal birth is not recommended because poor healing and prolonged discomfort have been reported with mediolateral episiotomy and because of the association of midline episiotomies with increased risk of injury to the anal sphincter and extension into the rectum.
574
Operative vaginal birth is contraindicated if the fetal head is unengaged, the position of the fetal head is unknown, or a live fetus is known or strongly suspected to have a bone demineralization condition (eg, osteogenesis imperfecta) or a bleeding disorder (eg, alloimmune thrombocytopenia, hemophilia, or von Willebrand disease).
574
A trial of operative vaginal birth is an appropriate option in a situation in which the obstetrician or obstetric care provider feels the chances of success are high, but must be prepared to abandon the attempt if appropriate descent does not occur.
574
Sequential use of vacuum extractor and forceps has been associated with increased rates of neonatal complications and should not routinely be performed.
574
Cephalohematoma is more likely to occur as the duration of vacuum application increases.
574
Midforceps and rotational forceps deliveries are appropriate options in select clinical circumstances.
574
Vacuum extraction has been discouraged for gestational age less than 34 weeks, although a safe lower limit for gestational age has not been established.
574
For the fetus that manifests signs of compromise in the second stage of labor, the timely and skilled use of instrumental vaginal birth has the potential to decrease the exposure to intrauterine insults and could decrease the contribution of intrapartum factors leading to neonatal encephalopathy and hypoxic–ischemic encephalopathy.
574
Neonatal care providers should be made aware of the mode of delivery in order to observe for potential complications associated with operative vaginal birth.
574
Recommendation Grading
Overview
Title
Operative Vaginal Birth
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
April 1, 2020
Last Updated Month/Year
January 9, 2023
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Adolescent, Adult
Health Care Settings
Hospital
Intended Users
Nurse midwife, nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D036861 - Delivery, Obstetric, D050498 - Live Birth
Keywords
vaginal birth, labor management