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Forceps Delivery - An Overview

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Forcep delivery is a kind of instrumental vaginal delivery performed. This article explains the indications, contraindications, and risks of forceps delivery.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Richa Agarwal

Published At December 8, 2022
Reviewed AtDecember 8, 2022

Introduction -

Many women can deliver their babies generally in the hospital without medical assistance during labor. But, in some situations, a few pregnant women may require help during delivery. So the doctors may perform assisted vaginal delivery such as forceps delivery, vacuum delivery, etc. Read this article to know more about forceps delivery.

What Is a Forceps Delivery?

A forceps delivery is a kind of assisted vaginal delivery that might be required during vaginal childbirth. A forceps is an instrument that consists of two metal ladle-like devices shaped like a pair of salad tongs or large spoons with a curve to fit around the baby's head comfortably. This instrument helps to grasp the baby's head and guide the baby out of the birth canal.

In some deliveries, during the contraction, while the mother pushes, the doctor applies forceps to the baby's head to guide the baby through the birth canal. Forcep delivery is often recommended during the second stage of labor if labor is not progressing or the baby shows any fetal distress. If a forceps delivery fails, then a C-section might be recommended.

Why Is the Forceps Delivery Done?

A forceps delivery is usually performed during the second stage of labor (the pushing phase) after the baby has reached the birth canal's midpoint. If the baby is still struggling to come out, and there is a delay in the labor, the doctor may use forceps to speed up the delivery. The doctors may also opt for a forceps delivery to avoid a C-section. A forceps delivery might be done if the labor meets specific criteria like:

  • If the cervix is fully dilated.
  • If the membranes have ruptured.
  • If the baby has descended into the birth canal, the mother cannot push the baby out.
  • The doctors might recommend a forceps delivery if:
  • The mother is pushing, but labor is not progressing.

Your baby's heartbeat suggests a problem. If the cervix is fully dilated and the baby is low in the birth canal, the doctors may be concerned about changes in the baby's heartbeat. In such situations, immediate delivery may be needed so that the doctors might recommend a forceps delivery.

  • If the baby is in an unfavorable position during the pushing stage, then the forceps are used to rotate the baby's position.

  • If the baby is stuck in the birth canal, forceps are used to deliver the baby.

Suppose the mother has certain medical conditions like heart disease or high blood pressure. The health care provider might decrease the amount of pushing time.

When Are Forceps Delivery Contraindicated?

Forceps delivery is contraindicated in the following situations:

If the mother is 34 weeks pregnant.

If the baby's head position is not clear.

If the baby is larger than normal.

If the mother's pelvis is small and the baby cannot fit in the pelvis.

If the baby has any health conditions, such as bleeding disorders or bone defects.

If the baby's feet, shoulder, or buttocks come first.

If the position of the baby's head has not moved from the midpoint of the birth canal.

What Happens During the Procedure?

During a forceps delivery, the patient will lie on their back, slightly inclined, with their legs spread apart. Healthcare professionals may suggest gripping on handles on each side of the delivery table to have support while pushing. Between contractions, The health care provider will place two or more fingers inside the vagina and beside the baby's head. Then the forceps are slid gently to one side of the baby's head, followed by placing another portion of the forceps on the other side of the baby's head. Then the forceps are locked together to cradle the baby's head.

The health care provider will guide the baby out of the birth canal using the forceps in the following contractions. If the baby's head is facing up, the healthcare provider will use the forceps to rotate the baby's head between contractions. As the labor progresses, the doctor may unlock and remove the forceps before the wide part of the baby's head passes out of the birth canal, or the healthcare professionals may retain the hold of the forceps. And during the next contraction, the healthcare professionals gently guide the baby out of the birth canal using forceps.

What Are the Risks of Forceps Delivery?

1) Risks for Babies - If the forceps are used correctly by an experienced doctor, the complications of forceps delivery to the baby can be prevented. The complication caused to the baby include:

  • Bruising on the baby's scalp can happen during the delivery, which will normally go away within a few days after birth.

Cone-shaped temporary swelling on the head of the baby may appear soon after the delivery, but it goes away and becomes normal a few days after birth.

  • Temporary eye injury for the baby due to the pressure exerted by the forceps.

  • In some cases, skull fractures can happen.

  • In very rare cases, temporary nerve damage in the facial muscles can happen to babies.

Another rare cause is an injury that can occur from the forceps causing bleeding inside the head (internal bleeding).

2) Risk for Mothers - Forcep delivery can cause some risks in the mothers, too, that includes:

  • Pain in the region between the vagina and anas after the delivery.

  • Wounds and tears in the lower genital tract may take time to heal.

  • Injuries to the bladder or urethra.

  • Trouble urinating or emptying the bladder after the delivery.

  • An episiotomy may be required to enlarge the vaginal opening for delivery.

  • Incontinence or loss of bladder control in the short term.

  • In some rare cases, uterine rupture or a tear in the uterus walls may cause the placenta or the baby to be pushed into the mother's abdomen.

  • Anemia can occur due to blood loss during delivery.

  • Muscles and ligaments that support the pelvic organs can become weak, resulting in the dropping of pelvic organs from their actual position or pelvic prolapse.

Conclusion -

In some pregnancies, doctors may use instruments such as forceps to make the delivery fast and avoid any complications. Forcep delivery is believed to have many risks, but on the experienced hand, this method will not have any risks and will be beneficial for the mother and the baby.

Frequently Asked Questions

1.

Is Forceps Delivery a Safe Type of Delivery?

With the healthcare provider’s assistance and the decision according to the condition, it is safe. When labor is not advancing despite pushing or the baby is in an unfavorable condition, forceps delivery, which is safe, is typically favored.

2.

Is a C-Section Preferable to Forceps?

Based on the condition of the mother and child, the healthcare provider determines the better option for safe delivery. Therefore, if the medical team decides based on the condition of the mother and the baby, either type of delivery is preferable.

3.

What are the risks of using forceps to deliver a baby?

In certain instances, doctors who use forceps during childbirth use them with extremely unavoidable pressure to assist the baby through the birth canal, which may lead to marks on the head that should fade in 48 hours. Bruising, facial paralysis, even brain damage, and cerebral palsy (inability to move or maintain balance) in neonates are among the side effects of forceps delivery. One in ten babies delivered by assisted delivery gets minor wounds on their face or scalp; these cuts heal fast.

4.

When and Why Did Doctors Stop Using Forceps?

Although just 1% of vaginal deliveries include the use of forceps, these birth injuries—which include skull fractures, convulsions, skull hemorrhage, facial palsy, brain damage, and more—are caused by forceps in roughly 30% of cases. Although been used since the Middle Ages, forceps became obsolete in the mid-1900s. Many contemporary obstetricians have little to no experience utilizing forceps during birth because they have become the last-resort delivery technique.

5.

What Challenges Happen Following a Forceps Delivery?

Third-degree or fourth-degree tears in the rectum muscle or wall in 10% of forceps births, urinary incontinence, and difficulty urinating after birth are some of the difficulties after forceps delivery.

6.

What Type of Delivery Is the Most Painful?

It depends on the type and post-delivery recovery. For example, using a type of regional anesthesia that relieves pain during normal labor can result in painless delivery. However, the agony of a cesarean section may ultimately be greater than that of a vaginal delivery. Yet, the anguish of labor itself may be outweighed by the pain you will experience following your cesarean section and the increased dangers to both the mother and the baby. Yet, a cesarean delivery usually results in a more difficult recovery. Since it involves significant abdominal surgery, recovery is far more painful, protracted, and frequently challenging than after a vaginal delivery.

7.

Are Forceps Used during C-Sections?

Based upon the circumstances and challenges during the C-section, the baby will be pulled out through the cut during a cesarean section using forceps occasionally. Assisting delivery with forceps during the C-section could be a life-saving measure for both the mother and baby.

8.

How Long Does Forceps Delivery Recovery Take?

With a forceps delivery, the stay in the hospital may be a bit longer, but the recovery period will be approximately the same as it would be for an unassisted birth. Usually, it takes six weeks.

9.

Can You Have a Normal Delivery After Forceps?

If the mother delivered with the assistance of forceps, it doesn't always follow that she won't be able to deliver the baby normally in the next. Therefore, it is possible to have a normal delivery after forceps. However, if the medical team is convinced that forceps delivery is the safest and life-saving measure, there may be the possibility of using forceps, considering the challenges.

10.

What Are the Advantages of Forceps Delivery?

It is advantageous with the help of the healthcare expert and the choice made in accordance with the challenges and difficulties during childbirth. Assisting the baby in unfavorable conditions towards the birth canal, thereby preventing fetal distress and helping with labor progression are the advantages of forceps delivery.

11.

Is Forceps Delivery Illegal?

Based on the difficulties posed by both the mother and the infant, the medical professional is permitted to utilize forceps. Forceps delivery is not illegal. However, obstetricians today might not be familiar with using forceps because it was only used as a last resort and became obsolete in the mid-1900s.
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Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology

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