Forceps look like two large salad spoons together.
Forceps look like two large salad spoons together.

During a normal vaginal delivery, the doctor may apply an instrument, called forceps, to the baby’s head to aid in the delivery of the baby through the birth canal. This is also called forceps-assisted vaginal delivery. Forceps look like two large salad spoons together. This procedure augments the process of delivery, helps reduce the risk of injury to the baby, and helps avoid cesarean delivery because it has a high risk of maternal morbidity. Forceps delivery may be combined with other techniques to augment vaginal delivery, like a vacuum applied to the baby’s head (vacuum-assisted vaginal delivery). During forceps delivery, a surgical cut called episiotomy is made by the doctor into the perineum and vaginal wall to create more space for the instrument and the baby. If a forceps assisted delivery fails, a cesarean delivery would be required, hence a forceps delivery is always performed in a hospital, which has the resources and the experience to perform an emergency cesarean delivery.

The recovery period of forceps delivery and the stages of recovery is the same as that of a normal vaginal delivery because the use of forceps is not a separate procedure by itself, but a technique used to assist and augment normal vaginal delivery. The time taken to recover is usually 6-8 weeks, but some women may take longer to recover. Most patients can resume light daily activities in a few days. Patients experience vaginal bleeding for a few days to weeks after delivery for which they would have to wear a sanitary napkin. Patients may start gentle exercises, such as walking in the first 6 weeks and gradually increase their fitness levels after 6 weeks, returning to sports, and normal exercise after around 12 weeks. Patients can resume sexual intercourse and other specific activities after consulting with the doctor.

Why is forceps delivery done?

Forceps assisted delivery is indicated in the following:

  • Prolonged labor: The labor doesn’t progress despite the mother pushing. There are two stages of normal labor. The first stage of labor is characterized by regular contractions and ends with complete dilation of the cervix. It usually lasts between 12 and 20 hours if it’s a woman’s first pregnancy. If not, then it lasts only 7 to 10 hours. The second stage of labor begins with complete dilation of the cervix and ends with the delivery of the baby, which lasts 1-2 hours. The prolonged second stage of labor may require forceps assisted delivery. The prolonged second stage may occur due to:
    • Use of epidural anesthesia
    • Large size and inappropriate position of the baby
    • Small birth canal
    • Maternal exhaustion
  • Maternal exhaustion: When the mother has been continuously pushing, she may lose strength and become exhausted. Hence, forceps can help deliver the baby.
  • Maternal medical conditions: Maternal medical conditions that affect labor and/or decrease her ability to push include:
  • Fetal problems: If the heart rate of the baby drops due to a decline in the oxygen supply, the fetus can go into distress causing irreversible damage to the baby. Hence, forceps delivery can speed up delivery.
  • Abnormal position of the baby’s head: The baby’s head may be positioned abnormally, causing prolonged labor. Forceps may be used to turn the baby’s head to a favorable position. Abnormal positions of the baby’s head include:
    • Head tilted to one side
    • Head facing to the side
    • Head facing the front when the mother is lying on her back

When can forceps delivery be done?

The following criteria must be met to undergo a forceps assisted delivery safely:

  • The cervix should be completely dilated: If forceps are used when the cervix is not fully dilated, there is a risk of injuring or tearing the cervix, which would then require surgical repair and affect future pregnancies.
  • The position of your baby’s head should be known: The forceps should be placed on the sides of the head. Hence, forceps delivery is less likely to succeed if the baby is facing straight up.
  • The baby’s head must be engaged: The baby’s head should be engaged (fixed), meaning the baby’s head should have entered the pelvic brim or inlet. The success of using forceps increases when the baby’s head is visible at the vaginal opening when the mother is pushing.
  • The membranes must be ruptured: The amniotic membranes must be ruptured (also called water breaking) to perform a forceps delivery.
  • The baby should be able to fit through the birth canal: Sometimes, the baby may be too big for the birth canal, for example in gestational diabetes (diabetes diagnosed during pregnancy). If a forceps assisted delivery is attempted, it would result in serious complications.

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When is forceps delivery not done?

The doctor may be against a forceps delivery if:

  • The baby has a condition that affects the strength of their bones, such as osteogenesis imperfecta
  • Bleeding disorders in the baby, such as hemophilia
  • The baby's head has not moved past the midpoint of the birth canal
  • The position of your baby's head is not known
  • The baby's shoulders or arms pass through the birth canal first before the head
  • The baby is too large to fit through the pelvis

Is forceps delivery safe?

A forceps delivery is relatively safe but there are some possible risks for both the mother and baby.

Possible risks to the mother:

  • Lower genital tract tears
  • Injury to the bladder or bowels
  • Difficulty urinating
  • Uterine rupture
  • Weakening or tearing of the muscles and ligaments supporting your pelvic organs, causing pelvic organs to prolapse (sag downwards)
  • Transient pain due to the episiotomy

Possible, but rare risks to the baby:

  • Minor or major facial injuries due to the forceps
  • Temporary weakness in of the facial muscles due to facial nerve damage (facial palsy)
  • Injuries to the eye
  • Skull fracture
  • Bleeding within the skull
  • Seizures

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Medically Reviewed on 11/10/2020
References
https://www.sciencedirect.com/topics/medicine-and-dentistry/forceps-delivery

https://medlineplus.gov/ency/patientinstructions/000509.htm