Instrumental vaginal birth

The use of instruments – vacuum extraction cup or forceps – may be required to achieve a safe vaginal birth. Using instruments to assist birth is usually recommended when the condition of either the baby or the mother requires a hastened delivery (RANZCOG 2020). For more information, see Clinical commentary.

This indicator looks at Instrumental vaginal births for selected women giving birth for the first time.

Key findings

  • Assisted vaginal births among selected women giving birth for the first time slightly increased between 2004 and 2010 before stabilising in the next decade at around 26%.
  • The proportion of selected women having assisted vaginal first births decreased with increasing remoteness (from 27% in Major cities to 19% in Very remote areas in 2020).
  • Assisted births were more common in private hospitals than public hospitals (although the gap has decreased over time) and for women who lived in least disadvantaged areas.

The interactive data visualisation below presents data on assisted (instrumental) vaginal birth for selected women giving birth for the first time by selected maternal characteristics. Click the Data tables button to view the data between 2004 and 2020 and use the radio buttons to see how each characteristic has changed during this time.

Assisted (Instrumental) vaginal birth for selected women giving birth for the first time, by State/territory of birth and all Australia, 2004 to 2020.

This chart shows the proportion of women having an assisted instrumental vaginal birth for selected women giving birth for the first time, by state/territory of birth, 2004 to 2020.  Data can be viewed for each state/territory of birth, and for all Australia. The proportion of selected women having an assisted vaginal birth when giving birth for the first time increased from 23% in 2004 to 26% in 2020.

Clinical commentary

Instrumental delivery is employed to accelerate birth in the presence of suspected or anticipated fetal compromise, delay in the second stage of labour or when maternal pushing efforts may make blood pressure or heart problems worse (RANZCOG 2020). Both vacuum and forceps assisted delivery are associated with an increased risk of injury to the tissues of the vagina, perineum and anus. This may lead to long-term perineal pain and sexual difficulties; additionally, a very small number may have urinary or faecal incontinence (RANZCOG 2020; RCOG 2020). Specialist colleges of obstetrics and gynaecology recommend that episiotomy is used selectively, rather than routinely, in association with vacuum and forceps assistance to minimise that risk (RANZCOG 2020; RCOG 2020).

Although the overall rate of injury to the baby because of instrumental vaginal delivery is low, there is a risk of certain complications, including injuries to the baby’s scalp, head, and eyes; bleeding inside the skull; and problems with the nerves located in the arm and face (RCOG 2020). The choice of which instrument to use depends on the clinical situation, and the principles of informed consent require that the woman is provided with information regarding these risks and the proposed benefits of the procedure prior to embarking on assisted vaginal birth.

Indicator specifications and data

Excel source data tables are available from the Data tab.

For more information refer to Specifications and notes for analysis in the technical notes.