5 things to know:
- Ventouse delivery is a way of helping a baby be born at the end of labour
- It uses a small suction cup device placed on the baby’s head
- Around 1 in 5 to 1 in 10 women are delivered using either ventouse or forceps
- It is a common, safe and routine procedure and saves lives when it is needed.
- Ventouse often leave a small bruise or swelling on the baby’s scalp which settles quickly but more serious complications are very rare.
Why might I need a ventouse delivery?
A ventouse delivery is sometimes called a ‘suction cup’ or ‘vacuum’ delivery. It is sometimes needed at the end of labour to help baby be born quicker than you would be able to push baby out yourself.
There are two main reasons a ventouse delivery is needed. These are either the active second stage is getting too long, and mum is tired (usually after you have been pushing for an hour or more), or if the baby is showing signs of being short of oxygen. This is when the baby’s heart rate monitor, or CTG, is abnormal.
Should I be worried if i am told i need a ventouse delivery?
It is a safe and fairly common way to deliver a baby. In the most recent national audit of UK births which looked at births in 2022, 23% (nearly a quarter) of women having their first baby gave birth with the assistance of either forceps or ventouse. Overall, including women who were having their second or subsequent baby, it was 11% (maternityaudit.org.uk). 4% was ventouse and 7% forceps. I will talk about forceps in another blog, but forceps are another method of helping the baby out of the birth canal at the end of labour.
What is a ventouse?
The ventouse is, literally, a small suction cup which is placed on the baby’s head by a doctor. There are several different types and you may hear different names on the labour ward. These include a ‘kiwi cup’, a ‘Mitivac’ or a ‘silc cup’. These are all essentially the same thing. They use a small plastic or silicone cup which is placed on the top of the baby’s head (usually near the crown) by the doctor. Some of them are connected to an external pump type device which is used to generate the suction pressure. Some have a small hand held pump instead like in the picture below:
What will happen if I need a ventouse delivery?
Usually, the ventouse delivery will occur in the delivery room and the doctor will take verbal consent which does not need a form to be filled in. It is unusual to conduct a ventouse in the operating theatre, although it does sometimes happen. The doctor will explain why it is being recommended that baby is born using a ventouse.
The first thing that will happen is that you will be helped to lift both legs onto rests at the sides of the delivery bed. This is called the lithotomy position and makes sure that there is enough room for the baby to born by opening up the pelvis.
The doctor will examine you and clean your perineum gently with water. They will then place the cup onto the baby’s head in between contractions.
If you have got a working epidural this usually does not cause much discomfort, although you can sometimes feel pressure as it is placed. If you have not used an epidural, then the doctor will need to give you some local anaesthetic so that placing the cup is less painful. This is usually given as two injections inside, to numb the nerves which supply the vagina and perineum and also some into the skin. When this local anaesthetic is placed it can be uncomfortable so your midwife and doctor should support you, and using gas and air can help.
The doctor will also need to empty your bladder using a small tube placed quickly inside the urethra to the bladder. This tube, or catheter does not stay in during the delivery.
The pressure will then be increased using either the handheld or floor pump and when the correct safe pressure is reached, then the doctor will check the position of the cup. Once the cup is placed correctly, you will then be asked to push with the next contraction. At the same time, the doctor will help guide the baby out of the birth canal, so that gentle traction assists your pushing.
The ventouse cup needs good contractions and pushing, it won’t work without these. As the baby’s head crowns, you will be asked to push more slowly and then breathe as the baby delivers.
The baby’s head will then be out and the body will be born with the next contraction!
Usually the baby will be placed on your tummy and there will be at least a minute, as long as baby looks well, before the cord is cut. Often it is possible for your birth partner to cut the cord if this is what you would like.
For every ventouse delivery, the midwife will ask a member of the neonatal team to attend the delivery. Sometimes this is a doctor and sometimes it is an advanced nurse practitioner. They are there just in case the baby needs them. Mostly they do not.
What happens after my baby is delivered?
Usually, especially if this is the first baby, a ventouse delivery means that you will need to have an episiotomy. This is because the baby is being born a bit faster than it would be otherwise and having an episiotomy prevents any bad tears. If this is not your first baby, then you may not need an episiotomy.
After the placenta is delivered, then the doctor will examine the perineum and vagina for tears, and this also includes a quick check of the back passage. This is needed after pretty much all vaginal births.
The doctor or midwife (usually the doctor who did the delivery) will get on and do any stitching as soon as possible. At the end of the stitching, then the doctor will then need to check the back passage again.
The ventouse is a very safe way to deliver a baby and saves lives every year. Usually the ventouse is successful but occasionally, the ventouse does not deliver the baby successfully and there is a need to change instruments and use forceps instead. This should always involve a senior doctor who will explain what is happening.
Are there any risk of complications?
Like all interventions, there is a small risk of complications. Some complications affect the baby and include (Royal College of Obstetricians green top guideline No 26 Assisted Vaginal birth 2020):
The main risks to mum are the risk of vaginal and perineal tears. This includes the risk of a third degree tear (there is another blog on this) but this is a tear of the muscle around the back passage. There can also be some urinary and bowel incontinence in the short term which usually resolves. There is a risk of this with all vaginal births but it is more with ventouse compared to a normal birth. The risk with ventouse is reported to be between 1 in 100 and 4 in 100 (1-4%) . An episiotomy makes more severe tears less likely.
There are also risks to baby. The baby will always have a small swelling on the head where the cup was placed but this goes down very quickly. It usually leaves a small bruise which resolved quickly. More rarely there can be more significant bruising and haemorrage in the scalp (risk between 1 in 100 and 12 in 100, 1-12%), or even small bleeds inside the brain. The risk of this was reported to be 1:860 (RCOG).
There can occasionally be small grazes too in association with the use of the cup.
Overall, compared to forceps, ventouse tends to be associated with a higher risk of baby complications but a lower risk of complications to mum. In the main, complications rates are relatively low and resolve quickly. It is usually worth the risk of these complications to avoid the more significant risks to baby if the baby is not delivered promptly.
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