Assisted vaginal birth: what is best practice?

Abstract

Assisted vaginal birth (AVB) is the vaginal birth of a baby performed with the help of a medical device. In the United Kingdom, 10–15% of birthing people will have an AVB for maternal and/or fetal indications. Devices for AVB most commonly include forceps and vacuum, with differing risks and benefits. However, complications can include maternal and fetal morbidity. The decision-making in AVB is complex and multi-factorial to ensure a safe AVB is achieved. Technical and non-technical skills including: communication, situational awareness and human factors, are crucial for holistic care. Safety considerations comprised of a thorough assessment, intrapartum care and postnatal aspects of management. Training needs to cover all aspects of a competent AVB, including understanding the different devices and evaluating which to use in varied clinical settings. With rising rates of second-stage caesarean AVB continues to be an essential skill in obstetric care.