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 examines instrumental vaginal births for selected women giving birth for the first time.
Key findings
In 2023, just over 1 in 5 (22%) selected women giving birth for the first time had an instrumental vaginal birth.
This proportion:
- increased from 23% in 2004 to 26% in 2019, before decreasing to 22% in 2023
- was highest for women living in Major cities (22%) compared with other remoteness areas in 2023
- was higher in private hospitals than public hospitals from 2004 to 2022, however, this difference has decreased over time, and proportions were similar in private and public hospitals in 2023 (22%)
- was higher for women living in areas of least disadvantage compared with women living in areas of most disadvantage (23% compared with 20% in 2023).
The trend data presented include years for which the COVID-19 pandemic was considered a public health emergency (2020–2022). The pandemic coincided with changes in the birth rate and changes in the experience of pregnancy and childbirth for many women and their families, though due to the complex nature of the pandemic, its impacts on maternal and perinatal outcomes are still unclear. For more information on instrumental vaginal birth during the COVID-19 pandemic, see Method of birth in Maternal and perinatal outcomes during the 2020 and 2021 COVID-19 pandemic.
The interactive data visualisation (Figure 7) presents data on assisted (instrumental) vaginal birth for selected women giving birth for the first time. Use the drop-down menu to view data by selected characteristics and the latest year button to explore data for 2023.
Figure 7: Instrumental vaginal birth
This data visualisation presents data on instrumental vaginal birth. Interactive charts show proportions for the most recent data and over time, for selected demographic and birth characteristics.
Clinical commentary
Instrumental delivery is used 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; Murphy et al. 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; Murphy et al. 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 (Murphy et al. 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 Data.
For more information, refer to Data specifications and Methods.
RANZCOG (2020) ‘Instrumental vaginal birth (C-Obs 16)’, RANZCOG Statements and guidelines, Obstetrics, Intrapartum care, labour and birth, RANZCOG, accessed 6 October 2021.
Murphy DJ, Strachan BK and Bahl R (2020) ‘Assisted Vaginal Birth’, BJOG, 127(9):e70–e112, doi:10.1111/1471-0528.16092.