**2. Types of vaginal delivery**

There are different types of vaginal deliveries [5]; these are:


### **3. Operative vaginal deliveries**

#### **3.1 Types of operative vaginal deliveries**

As seen earlier (section 2b), Assisted vaginal delivery (AVD), also called instrumental vaginal delivery or operative vaginal delivery occurs when a pregnant woman goes into labor, with or without the use of drugs or other techniques to induce labor and then delivers vaginally but with the use of special instruments such as forceps or a vacuum extractor.

Henceforth, operative vaginal delivery involves application of forceps or a vacuum extractor to the fetal head to assist during the second stage of labour and facilitate delivery.

In United States of America (USA), assisted vaginal delivery is done in about 3% of all vaginal deliveries as per 2016 report of American College of Obstetricians and Gynecologists [6].

There are two main types of operative vaginal deliveries;

#### *3.1.1 Vacuum extraction*

Vacuum-assisted deliveries or vacuum extractions [6] involve attaching a soft cup, which has a handle, to the head of the baby when the baby is in the birth canal or vagina

#### *Vaginal Delivery DOI: http://dx.doi.org/10.5772/intechopen.96097*

and a hand-held pump is then used to create suction that will help to facilitate delivery [5]. The doctor or midwife pulls the baby gently with each uterine contraction to facilitate delivery. In other words, a vacuum device is a suction-cup with a handle attached to it. This suction-cup is the one placed in the vagina and applied to the top of the baby's head. The doctor or midwife applies a gentle, well-controlled traction to help guide the baby out of the vagina as the mother keeps pushing with each uterine contraction [6].

The advantage of vacuum-assisted delivery is that this birth option has a lower risk than a Cesarean section in case of prolonged fetal distress.

However, the method carries the risks of minor scalp injuries or trauma and sometimes, bleeding of the scalp.

## *3.1.2 Forceps delivery*

Forceps-assisted deliveries mean that curved instruments are to be used to facilitate delivery progress of the baby in the birth canal or vagina. Forceps which look like two large spoons are inserted into the vagina and are placed around the baby's head. They are then used to apply gentle traction to help guide the baby's head out of the vagina while the mother keeps pushing, with each uterine contraction [6]. Forceps delivery cannot be used if the baby is breech [5]. It can be an option if the mother is too tired or exhausted during pushing or if the baby has to be delivered more speedily than the naturally occurring process.

## **3.2 Pre-cautions for choice of operative vaginal delivery**

The choice of devices used in operative vaginal delivery depends predominantly on the doctors or midwife's preference and experiences and these vary greatly. Operative vaginal deliveries are performed when the station of the fetal head is low, usually two centimeters below the maternal ischial spines [station +2] or lower than that. Minimal traction or rotation is then required to deliver the head [8].

Therefore, before starting an operative vaginal delivery, the doctor or midwife must do the following [9]:


The doctor or midwife need obtain informed consent, have adequate support and personnel as well as adequate analgesia or anesthesia. Neonatal care providers or nurses must have been alerted so that they can be ready to manage any neonatal complications that may arise. Anything less of the above requirements is very risky for operative vaginal delivery [9].
