Factors Influencing Instrumental Assisted Births: A Retrospective Study

ABSTRACT Objective To evaluate the rate of instrument‐assisted deliveries among parturient patients hospitalized for live, vaginal births across 5 years and test for factors influencing the use of this procedure. Methods Hospitalizations of pregnant people age 18 years or older presenting for a live vaginal birth between October 2017 and 2022 were included for gestational ages between 35.0 and 42.0 weeks. The outcome measured the presence of neonatal instrument‐assisted birth utilizing forceps or a vacuum. Independent variables tested as influencing the outcome included hospitalization year, maternal age, BMI, parity, gestational age, admission to birth time, labor induction, neonate weight, intrapartum analgesia, gestational diabetes and preeclampsia. Descriptive, bivariate and multivariate statistics were conducted in Excel to compare those with and without instrument‐assisted birth. Results The descriptive analysis demonstrated that cases receiving an instrument‐assisted birth had significantly longer admission to birth time (17.8 h [SD = 11.0] vs. 14.1 h [SD = 14.5], p < 0.001) and received intrapartum analgesics as follows: continuous labor epidural (92.1% vs. 80.6%, p < 0.001), opioids (12.6% vs. 5.9%, p < 0.001) and acetaminophen (20.3% vs. 11.1%, p < 0.001). Multivariate logistic regression model demonstrated that intrapartum analgesics were significantly associated with instrument‐assisted births as follows: continuous labor epidural (OR 2.12, 95% CI 1.63−2.75), opioids (OR 1.37, 95% CI 1.10−1.72) and acetaminophen (OR 1.50, 95% CI 1.24−1.80). Conversely, multiparous status demonstrated decreased odds of having an instrument‐assisted birth (OR 0.32, 95% CI 0.27−0.37). Conclusion Among pregnant patients, having a longer admission to birth time or receiving an intrapartum analgesic (continuous labor epidural, opioids and/or acetaminophen) was significantly associated with an instrument‐assisted birth, whereas multiparity reduced the odds of the procedure.