Assisted vaginal delivery using obstetrical forceps is a medical procedure that helps guide a baby through the birth canal when labor encounters complications. Forceps are specialized instruments, often resembling large, curved tongs, designed to cradle the baby’s head while a healthcare provider applies gentle traction to assist with delivery. This intervention is generally considered a last resort before a Cesarean section, and it is performed only when the mother or baby is at risk from prolonged labor.
When Doctors Use Forceps
The decision to use forceps is based on specific medical circumstances that indicate an immediate need to expedite delivery. These reasons are broadly categorized into those related to the mother and those related to the fetus. A primary maternal indication is a prolonged second stage of labor, which is the pushing phase, especially when a mother is exhausted and can no longer push effectively.
Forceps may also be used to shorten the second stage of labor for mothers with pre-existing medical conditions, such as certain cardiac or pulmonary diseases, where strenuous pushing could be dangerous. Fetal indications for the procedure center on signs that the baby is not tolerating the stress of labor well. A non-reassuring fetal heart rate pattern suggests the baby might not be receiving enough oxygen and requires immediate delivery. Forceps are also sometimes necessary to correct an unfavorable fetal head position, such as when the baby needs to be rotated to fit through the pelvis.
Immediate Risks to the Infant
The most direct answer to whether forceps hurt the baby is that the procedure carries a risk of injury, though most are minor and temporary. Forceps work by applying pressure to the baby’s head, which can result in superficial trauma to the scalp and face. Common injuries include bruising, abrasions, and mild lacerations where the instrument blades were positioned, but these marks typically disappear within a few days or weeks.
A temporary complication that sometimes occurs is facial nerve palsy, which results in muscle weakness or drooping on one side of the face. This condition is caused by pressure on the facial nerve during the delivery process and usually resolves completely as the nerve recovers.
More serious complications are rare but can include skull fractures or bleeding within the skull, known as intracranial hemorrhage. The risk of these severe injuries is low because of strict criteria for the procedure and the experience of the medical team. Intracranial hemorrhage requires immediate treatment and has the potential for long-term effects.
Safety Measures During Operative Delivery
The performance of a forceps delivery is highly dependent on meeting specific prerequisites to minimize the risk of harm to the infant:
- The cervix must be fully dilated, and the membranes must be ruptured before the instrument is applied.
- The baby’s head must be engaged, and its exact position in the birth canal must be known by the physician.
- A thorough clinical assessment of the mother’s pelvis must confirm that there is no major disproportion between the size of the baby’s head and the mother’s pelvic capacity.
- The procedure should only be attempted when the baby’s head has descended far enough into the birth canal, which is categorized by fetal station.
The training and experience of the healthcare provider are paramount for a safe outcome. In the hands of a skilled operator, the risk of severe injury is significantly reduced. The operator must be competent in selecting the correct type of forceps and applying the blades appropriately to cradle the fetal head, ensuring that traction is applied only during contractions and in the correct direction.
Forceps Versus Vacuum Extraction
Forceps delivery is one of two primary methods for assisted vaginal delivery, the other being vacuum extraction, which uses a soft or hard cup attached to the baby’s head with suction. The choice between the two instruments often depends on the specific clinical situation and the provider’s training. Forceps may be preferred when the fetal head needs to be rotated to a more favorable position for delivery, a maneuver that is less successful with the vacuum device.
The vacuum extractor, while generally associated with less severe maternal trauma, carries distinct risks for the infant. These include a higher incidence of cephalohematoma, which is a collection of blood under the baby’s scalp, and retinal hemorrhages. Forceps, in contrast, are less likely to detach during the procedure and are sometimes preferred for preterm babies whose skulls are softer.
Both methods of operative delivery are considered safer than an emergency Cesarean section in many cases where rapid delivery is required. The ultimate decision balances the need for immediate delivery with the relative risks of each instrument to both the mother and the baby.