Occasionally, such as when there is suspicion of fetal distress, the obstetrician may advise the use of forceps to facilitate delivery. Under such circumstances, it may be important for delivery to take place as soon as possible even if the mother has not had a chance to push the baby out on her own. Forceps may also be applied to improve the position of a baby's head in the birth canal to allow for vaginal delivery when it might otherwise be impossible. The use of forceps is an art which obstetricians spend many years in training to cultivate. As with all procedures in obstetrics, it is the responsibility of the physician to take into account the possible risks versus expected benefits in considering a forceps delivery.
Vacuum extraction is another form of assisted vaginal delivery.
This procedure involves the application of a soft suction cup to the fetal scalp to aid the mother's pushing efforts. Vacuum extraction may be associated with bleeding into the scalp, a minor problem which generally resolves spontaneously. There is considerable controversy concerning how often and to what extent an episiotomy should be performed. Further, a clean incision in the perineum preempts a more complex laceration of the vaginal opening which may be associated with damage to the rectal sphincter or urethral opening. Opponents of the liberal use of episiotomy feel that it is a rarely necessary procedure and an obvious source of discomfort.