Labour & birth Pregnancy Essential guide to assisted births Our midwife guides you through what to expect when your baby needs some help arriving in the world 1 of Ad break If there’s one thing guaranteed to be on the mind of a mum-to-be approaching her due date, it’s how the delivery’s going to go. As you’re probably aware, there’s quite a lot of baby to come out of a fairly small opening. However, the vagina is an extremely elastic muscle so there’s really no need to worry about whether the baby will ‘fit’. Most babies arrive just fine by themselves, but if they’re in distress, you’re exhausted or the contractions don’t seem to be effective, doctors can step in to ease the passage. When they do, it’s known as an assisted birth. One of the ways they can assist, of course, is by recommending an emergency c-section. But before that there are a few things they’ll try to get your baby out safely. Here’s the lowdown on each… ForcepsAny mums who’ve seen forceps will agree they look more like salad servers – or even two large shoehorns – than medical instruments! They’re inserted into the vagina and cradle your baby’s head, so the doctor can then guide your baby out of the birth canal by gently pulling down on the arms of the forceps while you push with each contraction. Will it hurt? You’ll have your feet put in stirrups and the doctor will ensure that you have effective pain relief before the procedure. As for the baby, forceps can leave marks on the side of your baby’s head or face but they should disappear within hours, very occasionally there’s some damage to the baby’s facial nerves. But don’t panic, this rights itself within days. Mum’s story “I’d put in my birth plan that I didn’t want forceps or an episiotomy, but when Dylan’s heart rate started to drop, I wasn’t going to argue. I was just grateful that he was born safely thanks to the fantastic care from the team.” Cheryl Davini, 28, Solihull, mum to Dylan, 4 weeks VentouseA ventouse is a small ‘cup’ placed on your baby’s head. Suction is then applied to help encourage your baby out as you push with each contraction, working with the doctor. If you’ve had an epidural there’s an increased likelihood of needing forceps or ventouse as the second stage can last longer. Will it hurt? Ventouse will leave a bruise on the baby’s head that looks like a skull cap, but this will go down in hours. Usually a paediatrician would be in the room ready to check your baby over afterwards. As with a forceps delivery, you’ll have your feet in stirrups so the doctors can see what they’re doing during the delicate procedure. Mum’s story “Hearing the word ventouse halfway through labour was pretty scary, as I had no idea what it was. But the doctor showed me it before they used it. I’d recommend mums talk to their midwife before their due day and even ask to see equipment. Jack had a bit of a lump on his head for a while, but a few hours after the birth it went down.” Jane Collan, 34, from Brighton, mum to Jack, 4 months EpisiotomiesIf you need forceps or if the baby’s in distress an episiotomy will be used to enlarge the opening. Occasionally, a midwife might decide that a cut will prevent a bad tear, but this is unusual. An episiotomy involves a small cut, made with sterile scissors, in the perineum (the area between the vagina and the anus). Don’t panic, the cut really is very small. It’s made at the height of a contraction, when the perineum’s stretched and thin, and the baby’s head is visible, stretching the vaginal opening. Will it hurt? Local anaesthetic is injected into the area before the cut is made, so an episiotomy is rarely felt. It can be done by a midwife or doctor – whoever makes the cut usually repairs it. You’ll have stitches afterwards and sitting down can be painful. If they sting when you pee, pouring warm water down there to dilute the urine helps. There’s nothing you can’t do after stitches, but the area must have a chance to heal so maybe avoid running a marathon! Mum’s story “My daughter arrived by forceps and they gave me an episiotomy and stitches. After about two weeks, it still hurt so I went to the doctors. They told me the area was infected and gave me antibiotics, which cleared it up. I was properly healed after about eight weeks.” Cat Lane, 26, from Northampton, mum to Bethanie, 5 months Continue slideshow > TearingMany mums think that they’ll be given an episiotomy instead of being allowed to tear naturally. So it might come as a shock to hear that actually, you’re better off tearing than being cut if no other intervention’s being used. The evidence is that tears heal better and cause less discomfort than cuts because a cut will go through skin and muscle where as often a tear will only involve the skin. Will it hurt? Around 90 per cent of women experience some degree of injury down below, but for many it might just be a small graze or slight tearing of the skin of your perineum. You won’t always need stitches as the area can heal on its own if kept clean. If a tear involves some muscle, you’ll probably be stitched up. Your midwife should be able to do this, and the stitches dissolve within two to four weeks so they don’t have to be removed. Mum’s story “To be honest as the head was coming out, everything stings down there anyway so I wasn’t even aware that I’d torn until the midwife told me. It really wasn’t a big deal, she put the stitches in while I continued to cuddle Jessica.” Phoebe Butler, 20, Balham, mum to Jessica, 3 months Did you know... Massaging the perineum from 36 weeks of pregnancy can reduce the risk of tearing that needs stitches by around 9% and episiotomy by 15% Squatting or going on all fours can help avoid the need for forceps or ventouse. By Practical Parenting’s Anne Richley Comments Latest on MadeForMums Toy Sales for Christmas 2018 – from Argos, Smyths Toys, The Entertainer, Amazon, Hamleys and more New warnings about the dangers of WiFi-connected toys and kids' smart watches MadeForMums Awards 2019 shortlist announced! 2018's celebrity babies - who gave birth this year?