Ventouse delivery should be attempted with 3 pulls - if unseuccesful following this - delivery should be converted to a lower segment C-section

The procedure can usually be carried out on the labour ward. However, if there are concerns about whether it will be successful, the woman may be moved to theatre so that rapid delivery by caesarean section can be performed if necessary.

A single dose of co-amoxiclav is recommended after instrumental delivery to reduce the risk of maternal infection.

Indications for a forceps delivery include

• fetal distress in the second stage of labour
• maternal distress in the second stage of labour
• failure to progress in the second stage of labour
• control of head in breech deliver

Increased risk of requiring instrumental delivery when an epidural is in place

The requirements for instrumental delivery can be easily remembered by the mnemonic FORCEPS:

• Fully dilated cervix generally the second stage of labour must have been reached
• OA position preferably OP delivery is possible with Keillands forceps and ventouse. The position of the head must be known as incorrect placement of forceps or ventouse could lead to maternal or fetal trauma and failure
• Ruptured Membranes
• Cephalic presentation
• Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally
• Pain relief
• Sphincter (bladder) empty this will usually require catheterization