What can go wrong with assisted deliveries?
Whilst most vaginal deliveries proceed without intervention, approximately 10-15% of vaginal deliveries are assisted. Assisted births are also called instrumental deliveries. In women who have already had a vaginal birth, the rate of intervention is lower. The two forms of assisted delivery are by forceps and vacuum delivery, which many people refer to by the term “ventouse”.
What happens during a ventouse or a forceps delivery?
The obstetrician or midwife should discuss with the mother the reasons for having an assisted birth, as well as the choice of the instrument and how the procedure will be done. Consent is therefore an important part of this process. A local anaesthetic is usually applied to numb the vagina and the perineum (the area between the vagina and the anus). However, if there are concerns, the obstetrician may move the mother to an operating theatre where a caesarean section may be performed if needed. To make the vaginal opening bigger, an episiotomy (a cut) may be needed. If there is a tear or a cut, this will require repair using stitches.
How does a ventouse delivery happen?
A ventouse is a vacuum cup which is attached to the baby’s head by suction. The cup sits firmly on the baby’s head. Following a contraction and with the aid of maternal pushing, the obstetrician or midwife gently pulls to help the mother deliver the baby.
Why might forceps be chosen over ventouse?
If the mother requires an assisted birth and is less than 36 weeks pregnant, forceps may be chosen instead of ventouse. Forceps are less likely to cause damage to the baby’s head at this stage in pregnancy when the baby’s head is softer.
Forceps are positioned around the baby’s head and like with a ventouse delivery, the obstetrician will gently pull following a contraction and whilst the mother pushes. There are different types of forceps which enable different movements to be performed such as rotating a baby which is facing upwards in the mother’s body.
When are instrumental deliveries required?
An instrumental delivery, or assisted birth, may be needed in situations such as:
- The mother cannot push because of an underlying health condition (such as having very high blood pressure)
- There are concerns about the baby’s heart rate
- The baby is in an awkward position
- The baby is becoming tired and there are concerns that they may be in distress
- Where a premature vaginal delivery is needed and forceps are the needed to protect the baby’s head from the perineum)
What are the risks of a ventouse or forceps birth?
Although vacuum-assisted deliveries and forceps are safe ways to deliver a baby, there are known risks, which include:
- Third or fourth-degree vaginal tears
- Higher risk of blood clots
- Urinary incontinence
- Anal incontinence
- A temporary mark to the baby’s head caused by the vacuum cup (a “chignon”)
- A cephalohaematoma (a bruise to the baby’s head which goes in time)
- Marks to the baby’s face from the forceps
- Neonatal jaundice
- Trauma to the baby’s head
- Brain damage to the baby
What complications may arise from brain damage during an assisted-delivery?
Although trauma to the head is most often superficial and limited to bruising and transient marks, in a small number of cases, the baby may sustain brain damage. Damage to the baby’s brain can result in loss of mobility, speech and other functions. In such cases, it is not only the baby who sustains loss; the parents of a baby who is brain damage during an assisted-delivery are likely to experience emotional distress including depression, anxiety, adjustment disorder and post-traumatic stress disorder.
How can expert witnesses assist in cases of injury related to assisted vaginal delivery?
Firstly, a midwifery expert witness will be required to provide expert evidence to establish whether there has been breach of midwifery duty. In cases of breach of duty, midwifery expert evidence will also be required to establish whether the breach of duty caused or contributed to the harm to the baby or mother. Other experts may also be required including obstetricians, paediatricians, paediatric neuroradiologists, psychiatrists and psychologists.
How can Expert Court Reports Ltd help?
At Expert Court Reports, we have several experts who specialise in matters around traumatic vaginal assisted-births. Jayne Utting, is an experienced midwife who has over 23 years of experience of midwifery practice and is an accredited expert witness. We have several psychiatrists and psychologists who can establish psychiatric and psychological harm to the parents. We are also able to provide highly specialised evidence from a well-respected paediatric neuroradiologist, Dr Kish Mankad.