Obstetrical forceps are intended to be a life-saving tool used during assisted delivery. This procedure introduces mechanical factors not present in a spontaneous vaginal birth and carries risks that must be weighed against the dangers of prolonged labor. This article provides information regarding the necessity, risks, and management of forceps-assisted delivery.
Understanding Forceps Delivery and Their Necessity
Obstetrical forceps are a medical instrument consisting of two curved metal blades. These blades are carefully positioned around the baby’s head to assist in a vaginal delivery when the mother’s pushing efforts are insufficient. The instrument serves two primary functions: applying gentle traction to guide the baby through the birth canal and, in some cases, rotating the baby’s head into a more favorable position.
Forceps are used only after strict criteria are met, including the mother’s cervix being fully dilated and the baby’s head having descended significantly into the pelvis. The procedure is necessary when the health of the mother or baby is at risk. This often occurs due to a prolonged second stage of labor, defined as a lack of progress after two to three hours of pushing. Other indications include maternal exhaustion, pre-existing conditions like severe heart or lung disease that make strenuous pushing dangerous, or fetal distress characterized by a non-reassuring heart rate pattern.
The Direct Risk of Neurological Injury
A forceps delivery carries an elevated, though still low, risk of neurological injury compared to an unassisted vaginal delivery. The potential for harm arises from the mechanical application of the blades, which exerts pressure on the delicate structures of the baby’s head. Trauma can occur from excessive or misapplied compression during the maneuver, particularly if the blades are improperly placed or too much force is used for traction.
The mechanism for direct neurological injury involves external pressure causing trauma to the skull or underlying brain tissue. While severe traumatic brain injury is uncommon, the rate of minor complications is higher than in spontaneous delivery. Modern obstetrical practice has seen a significant decline in forceps use, partly due to increased reliance on Cesarean sections. Current data indicates that forceps deliveries make up only a small percentage of all vaginal births, typically reserved for the least complicated situations, such as when the baby’s head is very low in the pelvis.
Specific Traumatic Birth Injuries
Specific medical diagnoses resulting from mechanical trauma or oxygen deprivation during a complicated delivery include Intracranial Hemorrhage (ICH), or bleeding within the skull. ICH occurs when compression forces rupture blood vessels surrounding the brain. These hemorrhages, such as subdural or subgaleal hematomas, create a pooling of blood that increases pressure on the brain tissue, potentially leading to cell damage.
Another serious, distinct condition is Hypoxic-Ischemic Encephalopathy (HIE), which is brain injury caused by a lack of oxygen and blood flow. HIE is not directly caused by the forceps themselves, but it is a risk of a prolonged, difficult, or failed assisted delivery attempt. In these scenarios, the baby’s oxygen supply is compromised during the delay, and the injury results from the underlying complication that necessitated the instrument’s use.
Traumatic injuries that signify excessive force include facial nerve palsy and brachial plexus injuries. Facial nerve palsy, a temporary weakness or drooping of the face, results from the pressure of the forceps blades on the facial nerve, but typically resolves on its own. Brachial plexus injuries involve damage to the nerves that control the shoulder and arm, indicating significant traction or twisting force was used during delivery.
Managing Risk and Choosing Alternatives
The decision to use forceps involves a risk-benefit analysis, aiming for a rapid and safe delivery to prevent further harm from labor complications. Medical professionals mitigate risks by adhering to strict criteria for application, ensuring the baby’s head position is correctly identified, and confirming there is no disproportion between the baby’s head size and the mother’s pelvis. Physician skill and experience are essential, as improper placement or excessive force greatly increases the risk of injury.
The vacuum extractor, or ventouse, is often the primary alternative to forceps for an assisted vaginal delivery. The vacuum uses suction to guide the baby out and is generally easier to apply, requiring less specialized skill than forceps. Forceps may be chosen over a vacuum in specific situations, such as when the baby needs rotation or during the delivery of a premature infant, where the vacuum’s suction cup poses a greater risk of skull injury. If the assisted delivery attempt is not successful after a defined number of pulls, the procedure must be immediately abandoned, and an emergency Cesarean section performed.