Dr. Melka returns to Healthful Woman to discuss forceps and vacuum deliveries, which are known medically as operative vaginal deliveries. In this episode, she and Dr. Fox cover common concerns and misconceptions, explain why obstetricians turn to forceps or vacuum deliveries, and more.
“The Push and Pull of Forceps and Vacuum Deliveries” – with Dr. Stephanie Melka
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Dr. Fox: Hey, welcome to the “Healthful Woman” podcast, the fastest-growing podcast in women’s health. Today’s Monday, May 23rd, 2022. Stephanie Melka joins me today to talk about “Forceps and Vacuum Deliveries,” or what we call in the business “Operative Vaginal Deliveries.” Both of us trained in forceps and vacuums, and we both feel strongly that they’re valuable and that they can help someone avoid a cesarean but sadly, a lot of this has become a lost art. So, enjoy today’s podcast on “Operative Vaginal Deliveries.” Thanks for listening. Have a great week.
Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, Melka, welcome back to the podcast. It’s been a while.
Stephanie: It’s been way too long.
Dr. Fox: Too long. We did re-drop one of your podcasts because listeners were just clamoring, “I want Melka. I want Melka.”
Dr. Fox: No, I think we did re-drop that but the one we re-dropped recently was the one on “Teaching Hospitals and why Residents are Our Friends!”
Stephanie: I know “Fasting” got re-dropped recently.
Dr. Fox: “Fasting” was re-dropped by Yom Kippur.
Stephanie: That was a smart move on my part. It keeps me popular every time there’s a fasting holiday. You keep re-dropping that. I get my name out to more and more people.
Dr. Fox: When I think fasting, I think Melka.
Stephanie: Oh, yeah.
Dr. Fox: Excellent. And today we’re talking about a topic that I know is near and dear to your heart, again. We call it “Operative Vaginal Delivery,” but I think locally, people know that as “Forceps and Vacuum Delivery.” So, we’re gonna talk about them. Let’s just go very, very high level here. What are these things?
Stephanie: So, basically, it’s a way to get a baby out fast in certain circumstances to avoid a C-section.
Dr. Fox: When your patients ask about them, potentially, or if you’re bringing them up and then they’re asking follow questions, what has been your experience in terms of their either attitude towards them or maybe their knowledge about them, or maybe some misconceptions people have?
Stephanie: Most of the time, it tends to come up when reviewing a patient’s birth plan, which is another good podcast we do. So, you should listen to that one. And it’s usually, “I do not want forceps. I do not want vacuum.” And that usually leads into a good sort of segue of like, “Why don’t you want that? What have you heard about it?” What I find is people hear a lot of different stories. They’ll hear sometimes it’s a bad outcome. “Oh, my friend had a forceps delivery, and this, that. The other thing happened.” Or, “Don’t let your doctors do a vacuum. They just do it so they could deliver fast and go home.” That type of stuff.
Dr. Fox: Yeah. I think that those all do exist. I mean, there’s clearly bad outcomes from forceps or vacuum just like there could be from a C-section or vaginal delivery or walking down the street. And there probably are doctors who still do things like forceps and vacuum just to get out earlier. I don’t really know those people. They don’t practice around us. I don’t see them day-to-day but I’m sure they exist somewhere in the world. And I think there was a time when they were done more routinely, and I don’t think it was because of an issue of impatience per se. I think it was just sort of that’s how people were training. Baby is low enough. You put on the forceps or the vacuum, deliver the baby. Like, it was the right thing to do, the healthy thing to do to get the baby out quicker when there was a lot of concern that a long labor or long time pushing be very dangerous for the baby.
I think that we’ve sort of learned a lot about what we call the second stage of labor in pushing and that it may not be as dangerous as we thought. And so we’re not as, you know, itchy to deliver the baby right away when it can be done. But I do think that the misconceptions out there are problematic because I think people sometimes think that these are, like, barbaric or they’re unsafe or they’re unhealthy when, in fact, so the way we look at them is they’re, like, amazing. They’re, like, such useful and valuable tools to deliver a baby safely vaginally without having to do a C-section because that’s usually what’s gonna happen, otherwise. They’re gonna have a C-section and I think not everyone realizes that, and then when you’re going over the birth plan, you’re like, “Oh.” Like, “Yeah, no I’d much rather have that than a C-section.” And that’s sort of how the conversation frequently ends. Not always. Some people don’t want, and that’s fine. Why would someone need forceps or vacuum, or in what situations might you recommend it?
Stephanie: The two most common are either someone that’s been pushing for a long time and is either getting tired or just not pushing effectively, pushing for a long time and the baby is not coming and you need to do something to help the baby out, or they’re fully dilated and the baby is low and the heart rate drops. There’s some sort of emergency where you need to deliver the baby quickly.
Dr. Fox: Those circumstances are obviously a little bit different in terms of the reason why we do it, but the procedure is the same.
Dr. Fox: Right. So, it’s the same thing that we do. And, you know, before we do forceps or vacuum or recommend it or talk about it, whatever is, there are certain criteria that have to be met, meaning there are ways to use these instruments unsafely, right? And we’re not gonna do that. So, for example, if the baby is too high up in the pelvis, like, then it’s not really safe and we’re not gonna do it. That’s one of the things we assess, how low is the baby?
Stephanie: Yeah. If you think the baby is exceptionally big, if you don’t think there’s room in the pelvis to fit through, you wouldn’t do it. Certain positions of the baby, like you’re not turning the baby too much and then pulling a ton.
Dr. Fox: These are assessments we do. And then one of the main differences between those two situations is in the first one where you said sort of that idea that this is taking a very long time and either we just don’t think the baby is gonna come out because she’s just not able to push anymore or push very strong anymore or for whatever reason, the baby is not coming down. There’s time. Like, that can be more of a discussion because you can have this conversation over 10 minutes, 20 minutes, a half-hour, an hour while she’s pushing because there is no urgent need to do it, and such you’re thinking this might be the overall better thing to do. The other one frequently is either urgent…
Stephanie: Fast. Yeah.
Dr. Fox: …or emergent. Right. Sometimes it’s like we have to do this within minutes. And I think one of the things that’s important to realize is that in that circumstance, if the baby is low enough again, everything is sort of appropriate for forceps or vacuum and an emergency occurs. With a forceps or vacuum, the baby is gonna be, from the time that happens, born within, I don’t know, three minutes, four minutes, two minutes, like a matter of a couple of minutes. Whereas at the same decision point you said, “All right, let’s go and do a C-section,” it’s probably 10 to 30 based on exactly what happens, how long it takes to get from there and, you know, out of the room, down the hallway, anesthesia, all these things have to happen.
And so it’s one of the reasons for those of us who do them, it’s almost like a safety blanket over the labor that you know that once the head is low enough, if something horrible happens, I can get this baby out within a couple of minutes. When we’re pushing with someone in labor, there’s always that sort of point we’re like, “All right. We hit that point. Whatever happens, we know that this baby can come out from below,” and that’s a big deal because it really changes maybe your tolerance, for example, for a fetal heart rate tracing, let’s say “borderline.” Right? It’s okay. It’s not perfect. You know, you sort of have some concerns and you’re much more likely to continue pushing if you know I could get this baby out within a couple minutes if I had to. Whereas if the baby is let’s say a little bit higher and you say, “The only way to get the baby out is for a C-section.” You have to be more careful because you can’t push it as much.
Stephanie: When you need more time. Yeah.
Dr. Fox: Yeah. That second one is really the one that’s more, I guess, acute in that setting. Okay. So, what are forceps? How would you describe them to somebody? And you can Google images.
Stephanie: Sort of like salad spoons. They’re like little spoons that you put on the side of the baby’s head and while mom is pushing, we’re sort of giving a little pull and a lift from below to help the baby out.
Dr. Fox: Yeah. And I think that it’s also a lot of what we call torque, so to speak. You know, in order for the baby to deliver, they have to sort of maneuver through the pelvis and they have to come, like, down under the pubic bone and then come up, almost like a J shape. And when they’re pushing, sometimes it doesn’t happen so well. And the forceps are kind of shaped with a curve on the bottom that you can… It’s not just like force of a pull. You’re also trying to maneuver the head through the pelvis. And so, you know, we sort of gear the head in different directions. And, again, it’s part of when you’re training you learn how to do it. They’re a little bit freaky to look at if you’re a patient because, you know, they’re metal and they’re shiny and they’re kind of big in a sense and people get really worried about them. They’re like, “What? Like, you’re gonna use these?”
Stephanie: “That goes where?”
Dr. Fox: Yeah. And what are the risks of using forceps? Right? When you see these things, you’re like, “Oh, my God.”
Stephanie: Interesting fact that I love when we talk about this is explaining forceps are more risky to the mom and not the baby. You’re gonna see… Because it’s going on the side of the baby’s head, you’re gonna see more in terms of tearing for the baby. The way we use them most of the time if there’s any issue, it’s temporary little marks, a cut on the side of the baby’s head. Not even a cut, like a little bruise almost. Almost like a little bit of, like, an indent that goes away within a few hours or a day. The rare things you see, things like fractures, nerve damage, usually it doesn’t happen the way we use them now. You know, like, we talked about years ago when people used them when the baby was really high, you saw a lot more of that but much less in these cases.
Dr. Fox: People think that these are, like, gonna hurt the baby’s head but they actually fit nice and snug around the baby’s head. I mean, it’s almost like a helmet so to speak and they’re unable to sort of squeeze the baby’s head too much, like they can’t get… The two sort of… They’re called blades but they’re not sharp but the two, like, hands on the end of them can’t get close enough together that you would sort of squeeze the baby’s head too hard. They sort of stop at a certain point. And yet, the risk tends to be the mom has a bigger tear, or we have to do an episiotomy to sort of avoid that tear going in a certain place. And that recovery for the mother might be a little harder with a forceps than a vacuum might be, but it’s a lot easier, typically, than a C-section, right? The forceps tear is usually gonna be less of a recovery than a C-section would by many orders of magnitude.
The risk to the baby, and you can have those with a vaginal delivery or a C-section because, again, these are put on when the baby is already gone through the pelvis most of the way. And I know that of the two instruments it’s the one that I prefer and I know it’s the one that you prefer. What is it about forceps that are really useful?
Stephanie: I find it very high success rate, meaning…and we’ll talk about this in terms of the vacuum, but you don’t have to worry about it falling off or anything. Like, you put them on, you pull, the baby is gonna come out. And the baby might not. There’s always a chance that, you know, the baby is not gonna fit through and it doesn’t work at all. I really like the high success rate.
Dr. Fox: Yeah. It gives you a lot more maneuverability I find.
Stephanie: I think more control.
Dr. Fox: Yeah. Definitely more control. It is rare for them to “fail,” whereas vacuums, they do. So, why is it that more people don’t do them? I would say nowadays very few obstetricians train in forceps in the U.S. at least.
Stephanie: Yeah. It’s who trains you. You know, they’ve fallen out of favor a little bit, so you have fewer people that do them and then fewer people to teach them. We are at Sinai. We have so many people that do them that the residents get a lot of exposure. And then you’ll have other hospitals where nobody does them or you only have one person that does them and everyone else does a vacuum, and then that’s what they learn.
Dr. Fox: Right. I think there’s this misconception that forceps are hard and vacuums are easy. I think vacuums are easier in a sense to place, but to do them right, it’s not that easy. And forceps, it definitely takes more training to figure out exactly how to put them on in what position in what way and sort of the angle that you’re, you know, directing the force. But part of the reason the more effective is you really understand where you’re going and what you’re doing. Whereas the vacuum is, you know, we’ll talk about you can just sort of put anywhere and it’s one of the reasons they’re gonna fail.
Stephanie: Yeah, I think the vacuum is a little more sort of forgiving if the placement is a little bit off, but then you see that in a failure or it might not work as well.
Dr. Fox: Right. So, let’s talk about the vacuum. So, describe what it is.
Stephanie: It’s basically a suction cup that goes on the baby’s head. Probably about what? Two inches in diameter.
Dr. Fox: Yeah.
Stephanie: A little suction cup, you put on the baby’s head and then sort of, you know, push a button that gives you a little bit of suction. And then again, as mom is pushing you kind of pull and sort of lift the head up and out.
Dr. Fox: Right. And so when you said earlier that it’s a little more forgiving, so what do you mean by that?
Stephanie: The difficult thing about forceps or vacuum is knowing the right position of the baby’s head. These have to be put on in a very specific way. You know, and the vacuum, there’s sort of a more wide area where it can be placed. So, if it’s like off by half centimeter here or there, you’ll still get the same outcome, whereas you don’t get that with the forceps. Like, it’s much more exact.
Dr. Fox: Yeah. I think that, you know, when we think of the baby’s head coming out, it’s almost like a clock. And there’s like a point in the baby’s head that could be pointing at 12:00, it could be pointing at 9:00 or 6:00, and we need to know exactly where that is because the forceps have to go on in a very specific way. You know, if the head were pointing at 12:00, one goes at 3:00 and one goes at 9:00. And so if the head is rotated, the forceps have to rotate, you know, to the same degree.
The vacuum, you technically can just put it on anywhere. Now, it won’t work if you put it on anywhere. In order to be most effective, it has to be placed in a very particular point. But, you know, you can actually put it anywhere, right? And it’s not like it’s necessarily more dangerous to put it somewhere else. Forceps if you put it in the wrong place could be more dangerous, so you have to really know what you’re doing. Vacuum, not so much, but what happens is for the vacuum, if you don’t put it on the correct spot or right near the correct spot when you’re pulling you’re not getting the right part of the head coming out of the pelvis and so it’s gonna pop off, right? The vacuum is…so you lose your suction and it pops off. And that is one of the reason it fails because you can’t keep doing that indefinitely. After two or three times it happens, it’s called a failed vacuum, and you sort of say, “We’re done here.” What would be the risk of a vacuum?
Stephanie: So, again, it’s going on sort of the top of the head, so nothing into the vaginal canal, so less in terms of internal tearing, but you’re gonna get more for the baby in terms of bruising. Bruising under the scalp. Sometimes even underneath the skull. Yeah. So more for the baby.
Dr. Fox: Yeah. I think people are definitely surprised when they look at the two instruments and forceps are these sort of, like, big metal things and the vacuum is this little white suction cup that look so pretty and pleasant and they say…
Stephanie: “I want that one.”
Dr. Fox: Yeah. And you say that little tiny white plastic thing is the one that’s more dangerous to the baby. I mean, they’re both safe, but that could be more dangerous to the baby and not the metal ones really. And like, yeah, actually that’s the case because when you’re just sort of using suction to pull on the scalp essentially, and so you can envision a scenario where the head stays still and you’re just pulling the scalp and you’re pulling. And so all those little blood vessels under the skin can sheer and then you can get bleeding under the scalp, and that’s definitely a complication.
But I would say that in U.S., most OBs know how to use these vacuums to some degree, if not excellently. They know how to use them, like, enough. How would you decide which one of those two to use if you’re in that situation that you think is appropriate?
Stephanie: I always do forceps. I trained in vacuum. I could do it but when you do them and you have those pop-offs and then you’re like, “Oh, it didn’t work. Did it not work because it popped off? Or is this really…?” The baby is just not fitting through and you have that, like, indecisiveness and then you’re doing the C-section. Like, that’s why I go for the forceps.
Dr. Fox: Yeah. I mean, I’m the same way. I’m one of the people who trained you, so I had a feeling we think similarly about this. But one of the tenets here is that it’s been determined whether correctly or incorrectly that it is unsafe to use both instruments on the same baby, meaning if you use a vacuum and it fails, it’s unsafe to then do forceps. Now, the study that proved that, it’s unclear if that’s actually the case, but okay, pretty much nobody does it. Pretty much nobody uses two instruments unless you couldn’t actually get the first one on, like you didn’t get a real attempt at it. And so since the vacuum, if it fails and it pops off two or three times, you really don’t have an option to then say, “Okay, vacuum didn’t work, now let’s do forceps. Like, let’s try the one that has, you know, less tearing for the mom. And if that doesn’t work, do the forceps.” So, that’s really not an option. So, if it fails, you’re going to C-section essentially.
So, since the success rate forceps, like you said, is higher, I agree. I pretty much almost always will choose forceps. I would say the one exception for me, you know, one of those cases where the head is like a third of the way out already and you really need to deliver the baby quickly and, you know, like, “All right, I could put the vacuum on without doing anything. It’ll just come out one, two, three,” but in those circumstances, you probably did’t need the vacuum anyways. You can just sort of…you know, whatever. So, that would be the exception. But I would say, in all these years, it’s unusual that I use a vacuum. It happens but it’s pretty unusual. Usually, it’s forceps.
And then I think that for most people who are comfortable using both, they feel the same way. At least the people I know. The ones who use vacuum and say, “Listen, I wasn’t trained in forceps. I’m not comfortable using them.” And you definitely don’t want your doctor using them if you’re not comfortable using them. That’s bad. And okay, not everyone trains in everything. That happens. Like, it’s not the end of the world. But for those of us who use both, again, I typically would choose the forceps as well. And then what are the things that you discuss with someone before you’re gonna place a forceps, let’s say? Because, you know, as you said, it’s not usually gonna be a vacuum. So, how does that conversation go?
Stephanie: Pushing, pushing. And usually, at some point, the patient is asking like, “How much longer? How is it going?” You know, and you sort of, you know, do the, “Well, you’ve made progress. The head is nice and low, you know.” And then, you know, you sort of find a supportive way to say, like, “Look, the head is low enough. If we needed to help the baby out from below, I could do forceps and help the baby out and not need a C-section.”
Not saying we need that but it’s nice to know we have that out. And then if she’s still pushing and the head’s not coming down, or you’re seeing the heart rate dropping, you start saying, like, “Listen, I don’t think this is happening on its own. I think we need to talk about helping the baby out.” Again, I brought up forceps before and then, you know, sort of explain like I said, you know, I call them the salad spoons. I don’t know. I don’t have another good analogy for it. I don’t like calling them blades. That doesn’t work better. They’re like little spoons, you know, that I put on the side of the head. And while you’re…
Dr. Fox: A couple of shoehorns. Yeah.
Stephanie: While you’re pushing sort of pull and help the baby to come out from below. And before I can even say anything else, you know, usually the patient or the partner is like, “Is it safe?” You know, and then I’ll be like, “Of course, it’s safe. Like, I’m not gonna do anything unsafe.” And then, you know, explain, like, “If there’s any risk, it’s, you know, temporary, you know, a little mark or a little scratch on the face. Very uncommon to have the, you know, broken bone, nerve damage, anything.” Yeah. And then sort of just, like, leave it there as an option but not, like, push it at that second.
Dr. Fox: Yeah.
Stephanie: Sometimes you just have the conversation and it’s like a relief for the patient to be like, “Oh, thank God. I don’t need a C-section.” And then sort of they stop worrying about that and then their pushing gets better.
Dr. Fox: Right. Or they see those forceps.
Stephanie: Or they see the forceps and they’re like, “Okay, I’m gonna push this baby out.”
Dr. Fox: Yeah. They can be very motivating when you… Yeah. When I bring them in the room, I usually show people what they look like and frequently the…
Stephanie: I see on the opposite I don’t.
Dr. Fox: No, I put them on the side. Depends on I’m really gonna use them. I think one of the other things I frequently warn them about before forceps is not all the time but, more often than not, they’re gonna need an episiotomy when we do forceps. And that’s just because, you know, if they’re gonna tear a lot, we wanna direct it away from their bottom. And so I just do that. Yeah.
Stephanie: I think that happens with vacuum too often because when you’re…unless it’s like what you said, where the baby is a third of the way out. Like, you’re pulling quickly through the natural stretching and tearing that would happen. And I find, in that case, they often benefit from an episiotomy as well.
Dr. Fox: Yeah. It’s one of those instances when people sort of talk about, and we shared but we have a separate podcast on episiotomies. But when people say they should never be done, that has to really be taken into context of what that means because that’s not correct that it should never be done. It should be done in certain circumstances, but not routinely. And so one of those circumstances where it’s probably better to get an episiotomy than not have one is in operative vaginal deliveries, again, based on the circumstances. There’s some people who I won’t do it. You know, if they’ve had multiple children, I think there’s plenty of room, you know. Okay. But for someone certainly their first baby, it’s almost always gonna be the case. How would you have that conversation with them if it’s more emergent? That’s when it gets a little bit more sweaty.
Stephanie: You just kind of look at them and you say, “All right, listen, the baby’s heart rate is dropping. This is an emergency. I need to get the baby out fast. I can do a C-section or I can use forceps to help pull the baby out from below. I think forceps are safer.”
Dr. Fox: Right. And quicker.
Stephanie: And quicker. And I will commit to it. You know, I know we’ve talked about this before, like, you know, presenting patients with options and this and that. Like, in that moment I will just say, like, “We should do forceps.” You know, and typically they’ll say, “Okay.” And, like, you’ve got a minute or two while you’re calling for them and you’re getting everything and you can kind of give that same quick explanation of, like, you know, “We’re increasing the epidural so you’re comfortable. I’ll get you…you know. We’ll put them on. You’re gonna push. I’m gonna pull. You may notice a little mark on the side of the face. It’s gonna go away in a day or two.” And in that moment, people are typically fine with it.
Dr. Fox: I agree. And it works the same way. I think what I try to do in the moment is sometimes these things are completely unexpected, right? Everything is fine and then, boom, emergency. But sometimes we can smell them coming, right?
Dr. Fox: The things. We just…you know. You get a sense. You do this enough, you sort of figure out when things may be going downhill. And so I’ll start having that conversation. Or like you were talking about with the person who’s pushing for a long time and maybe we don’t have to do them now but let’s sort of talk about it. They know it’s an option and we can get it off. The same thing if I’m in a situation where like, all right, something might be brewing. I’ll say, “Listen, you know, things are okay now. The baby is okay. We could continue to push. You know, I’m seeing this, I’m seeing that. It may come to an emergency. Let me tell you what our options would be at that time.” And we can have that conversation in advance. Now, it doesn’t always happen that way, or sometimes we forget to do that or sometimes we don’t have time to do that or whatever it is.
And I think that one of the really important takeaways about forceps and vacuum is not necessarily that it has to be discussed during the prenatal visits, like, for every person. Because, you know, they’re used 5% of the time, you know, 10% of the time. And it’s sort of in that number. But if you, the patient, pregnant, have a lot of concerns about them or fears about them or at least you think you know that you don’t want them, this is something that should be discussed during a prenatal visit when you have plenty of time, you’re not in labor, there’s no emergency and, you know, speak to your doctor like, “Is this something you use? Do you use forceps? Do you use vacuums? Do you use neither? Under what circumstances? And if you believe you don’t want them used, say why and talk about it so we can have that discussion.”
And absolutely, I’ve had people who spoke to me about it and I explained to them. I said, “Listen, I hear what you’re saying, ‘I don’t want them.’ Fine.” Then we know that, you know, and that’s something that we need to know about because it may change potentially how we think about your labor and your pushing and this, or it gives us an opportunity to discuss it and maybe explain it a little better and that we can figure out the circumstances that it would be okay for you and which instrument and this or that.
But that’s a conversation that if you think you have a lot of concerns about you should try to have before labor, or if you forget, at least at the very beginning of labor before it starts getting ugly because when you’re pushing for two hours and the heart rate is dropping, not a great time to have a prolonged conversation, right? It’s just not the right thing to do at that time. We will if we have to, but this is a period in time where every minute counts. And so you don’t wanna be talking for 10 minutes if you don’t have to be. And I just think that’s a really big takeaway. It’s part of the reason we’re doing this podcast that people can hear it and say, “Oh, I didn’t realize it,” or, “Let me ask more questions with my own doctor. Curious, you know, do you use forceps? Do you use vacuum?” And it’s a great conversation to have when you’re not, you know, 22 hours into labor.
Stephanie: I think we talked about this in my birth story. My 27-hour induction with forceps. I was one of the few patients looking at my doctor. I was like, “How low is the head?” And she’s like, “Not low enough for forceps.” I was like, “Shit. Damn it.” I was like, “All right. Keep going.”
Dr. Fox: Yeah. Yeah.
Stephanie: Allison was forceps. She had the same thing. She had a little mark on the side of her head. Turned out fine. And I tell patients that a lot. Not, like, before I do the forceps because I don’t like to be selling something to somebody, but, like, afterwards, I’ll be like, “Oh, my daughter was forceps, you know. You’re gonna look back at this and, like, not even remember it happened.” And everyone is like, “Oh, I’m so glad you told me that.”
Dr. Fox: Yeah. My third, Neely, was forceps also. Charlie Bacall, put him on, one, two, three. Was all good. Her head’s been beautiful ever since. All is well. In terms of recovery, how would recovery be for forceps or vacuum compared to a vaginal birth, let’s say?
Stephanie: A lot of it depends on the circumstances of the delivery. I mean, if you have a fast labor and forceps, like, I think you’ll have a little bit more tearing or an episiotomy. But, like, a long labor pushing for three hours, it’s gonna be a tough recovery, forceps or not.
Dr. Fox: Yeah.
Stephanie: So, again, maybe a little bit more tearing. A lot of the tears tend to be more internal vaginal tears, so there’s not a ton more pain. Little bit more discomfort. I don’t find people need narcotics or anything going home. Like, maybe Tylenol, Motrin on a regular schedule for a few more days than somebody else, but dramatically better than C-section.
Dr. Fox: I agree. I don’t think that the variables, whether forceps or vacuum were used. It’s how hard was your labor? How long were you pushing, right? Those are both related to your recovery and how big of a tear did you have? So, yes, if the forceps led to a bigger tear, then that tear will require more of a recovery. You know, if two people delivered babies without any tearing and one had forceps and one didn’t, they probably would recover exactly the same. They wouldn’t notice the difference. And there are rare circumstances where, you know, a vaginal delivery with forceps or even without can have a harder recovery than a C-section would have been. That does happen from time to time. And, you know, if you could go back in time, you might say, “All right. I wish I could have done a C-section.” That’s very unusual.
Dr. Fox: That’s really the exception. Almost always, even with a tough recovery from a vaginal delivery, it’s gonna be easier than a C-section would have been just because however big an episiotomy is, a C-section scar is gonna be much bigger. Yeah. And that’s generally the reason most people would prefer one of these to a C-section, though, and not everyone but that’s how most people would be. Great. Melka, forceps, vacuum.
Dr. Fox: Forceps. Good times. All right. We’ll have you back. Thanks for coming on.
Stephanie: Happy to be here.
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