Rebecca Beesley
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Solicitor | Medical Negligence
What is an instrumental delivery?
An instrumental delivery is also sometimes known as an operative delivery or an assisted vaginal birth. It is when an obstetric doctor uses medical instruments, namely forceps or a vacuum extractor (which is sometimes known as a Ventouse device), to help deliver the baby.
When used appropriately and correctly by an experienced medical practitioner, an instrumental delivery is an effective way of expediting the baby’s birth.
When is an instrumental delivery necessary?
An assisted delivery may be considered when there are concerns during labour about a mother’s or baby’s health and wellbeing, and/or if there is slow or delayed progress during the second stage of labour—when the baby descends through the birth canal and the mother is tiring or struggling to push. It can sometimes be an alternative to Caesarean section, but only if a vaginal delivery is still considered to be safe and an appropriate option.
What are the risks of an instrumental delivery?
As with any medical procedure, an instrumental delivery is not without risk. However, in most cases, that risk is far outweighed by the risk of harm arising from not carrying out an assisted delivery.
Common risks to the baby include bruising and small cuts, most of which resolve within a few days or weeks with no long-term effects. The commonly occurring maternal risks include vaginal or perineal tears, nerve damage, and bleeding.
Occasionally, however, things can go wrong, and there can be more serious consequences, including:
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Cephalohematoma: This has the appearance of a lump or swelling on the baby’s head and will usually get better on its own, but can be more serious if left untreated.
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Subgaleal haemorrhage: This is a rare but very serious and potentially life-threatening condition in which blood collects between the scalp and the brain. It is more likely to occur with vacuum extraction than with forceps deliveries.
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Skull fractures: If too much pressure is applied through forceps, this can cause the baby’s skull to fracture and may cause bleeds on the brain requiring additional treatment.
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Intracranial haemorrhage: This is bleeding inside the brain or around the brain. It is potentially very serious and can cause seizures and permanent brain damage, leading to serious conditions such as cerebral palsy.
Negligence in instrumental deliveries
The treating clinician should give consideration to the gestation of the baby—because premature babies have more fragile skulls—and the position of the baby during labour when considering what method of delivery would be best.
An assisted delivery is not always appropriate, and sometimes an emergency C-section is required. In such circumstances, attempting an operative delivery may be negligent.
When an instrumental delivery is an appropriate option, it should only be carried out by an experienced practitioner.
There are clear clinical guidelines regarding instrumental deliveries, and clinicians can be criticised for not following these guidelines. That said, following the guidelines does not necessarily prevent a baby or mother from suffering harm as a result of an instrumental delivery, as there are risks even in the absence of any negligence. However, following the guidelines reduces the likelihood of negligence and harm arising.
Examples of negligence in instrumental deliveries include:
- The guidelines clearly set out that in vacuum extraction deliveries, there should be a limited number of “pulls” to deliver the baby. If an obstetrician carries out more attempts than recommended in the guidelines and the baby is harmed during the course of those additional attempts, this is likely to fall below the acceptable standard of care.
- Applying too much force through the forceps, causing a fracture to the baby’s skull and brain damage.
- Carrying out a forceps delivery during which the mother suffers a serious laceration to the vagina and bladder damage—potentially affecting her sexual function and continence—in circumstances in which an instrumental delivery should not have been attempted and the baby should have been delivered by Caesarean section.
- Attempting an instrumental delivery unsuccessfully when it would have been more appropriate to proceed to Caesarean section, resulting in a delay in delivery of the baby during which time the baby has suffered serious brain damage due to hypoxia (insufficient oxygen).
Compensation for substandard assisted delivery
If you or your baby has suffered harm as the result of a substandard assisted delivery, we may be able to help you bring a claim for compensation. The effects of substandard care during an instrumental delivery are not always serious, but occasionally, the mother or baby can suffer serious injury.
Please contact us on 0151 306 3694 to speak to a member of our empathetic and professional team to see how we can assist you.
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