Forceps Delivery

Forceps delivery is a mode of operative vaginal delivery in which the forceps are placed around the fetal head in order to permit the application of traction. Traction is applied during a forceps delivery to direct and assist the fetus’ descent through the birth canal.

It has been estimated that as many as 10% of all vaginal deliveries involve the use of forceps. More recently, however, many obstetricians frequently utilize vacuum extractors instead of forceps, in part due to the emphasis during medical school training on the use of vacuum extractors.

Forceps deliveries are classified as outlet, low, mid or high, according to the level and position of the fetal head in the birth canal. In general, forceps deliveries from higher levels in the birth canal are associated with higher rates of fetal and maternal traumatic injury; true “high forceps” deliveries fall below the generally accepted standard of care.

A forceps delivery may be indicated if there has been a prolonged second stage of labor – where maternal pushing efforts extend over several hours, and regardless of whether there has been any progress in fetal descent. Forceps delivery may also be indicated if other factors, such as maternal exhaustion or fetal distress, require an expeditious delivery. In some situations, a forceps delivery will be attempted in the operating room, where an expeditious cesarean delivery can be performed if the forceps delivery is not successful.

A negligently performed forceps delivery can be associated with numerous complications, for both the mother and her baby. It has long been recognized that the severity of complications associated with a forceps delivery varies with the skill, judgment and experience of the health care provider who performs the forceps delivery.

Maternal complications can range from excessive blood loss to lacerations of the cervix, vagina, perineum, bladder or uterus.

Other maternal complications may include incontinence of bowel or bladder, anal sphincter injuries and pelvic organ prolapse, all of which have been associated with traumatic forceps deliveries.

Fetal complications of a negligently performed forceps delivery may include injury to the baby’s head, ranging from bruising and simple lacerations, to cephalohematoma, skull fractures, intracranial hemorrhage and brain damage.

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