An Update on the Status of Assisted Vaginal Delivery in Lower and Middle Income Countries

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Assisted vaginal delivery with vacuum extraction or obstetric forceps is used to expedite a birth when maternal and fetal conditions are indicated. This presentation aims to show to what extent assisted vaginal delivery (AVD) is available at different levels of the health system and explores systemic reasons why it is not practiced.

Methods: National and subnational needs assessments in emergency obstetric and newborn care (EmONC) are health facility surveys that include detailed information on the provision of AVD. Of 40+ countries, at least 10 have data from two points in time. Assessments include information on whether AVD was performed in the past 3 months, and if not, why not; what health worker cadres perform the procedure(s); whether equipment is present; and recent assessments include the number of institutional births delivered with vacuum extraction/forceps as well as by cesarean. Where data are available changes over time are described.

Results: Over the past 15 years, AVD is the EmONC signal function least likely to have been performed, however, between the two instruments vacuum extraction is more common than forceps. The majority of African and Asian hospitals provide AVD while only a minority of health centers do so. The primary reasons reported for not providing AVD are lack of trained human resources and lack of equipment. Regional differences in the provision of AVD and which professional health workers actually provide it will be discussed, as will changes over time. Finally, we will include the percentage of institutional deliveries delivered by AVD and cesarean.

Conclusions: Policies to limit the use of AVD in Latin America are born out in the limited data from that region but its use continues in much of Africa, and furthermore, is practiced widely by non-specialists. AVD is underutilized in the face of rising cesarean delivery rates.