Forceps are curved metal instruments that fit around a baby’s head to help guide it through the birth canal during a vaginal delivery. They look something like large, specialized tongs with two separate branches that lock together. A doctor uses them when the baby needs help moving down or out during the pushing stage of labor, either because labor has stalled or because there’s a concern about the baby’s wellbeing.
How Forceps Are Designed
Every pair of obstetric forceps has four main parts: the blades, the shanks (the connecting bars), a lock that holds the two halves together, and the handles the doctor grips. The blades are the business end. Each blade has two built-in curves: one that matches the rounded shape of the baby’s head, and another that follows the curve of the mother’s pelvis. This dual-curve design lets the instrument cradle the baby’s head securely without squeezing it.
Some forceps have openings in the blades (called fenestrations) that reduce pressure and improve grip. Others have solid, smooth blades better suited for a rounder head shape. The specific type a doctor chooses depends on the baby’s head shape and position in the birth canal. Simpson forceps, for example, work best when a baby’s head has been slightly elongated by a long labor, while Elliot forceps are designed for a rounder, less molded head. Kielland forceps have a special sliding lock that allows the doctor to gently rotate a baby who isn’t facing the ideal direction. Piper forceps have an extra-long shank and are reserved for breech deliveries, where the baby’s body comes first and the head follows.
When Forceps Are Used
Forceps come into play only during the second stage of labor, which is the pushing phase. They’re considered when the baby is close to being born but needs a little help getting the rest of the way. Common reasons include a prolonged pushing stage where the mother is exhausted and contractions alone aren’t enough, or a non-reassuring fetal heart rate pattern that suggests the baby would benefit from a faster delivery.
Certain conditions have to be met before a doctor can use forceps. The cervix must be fully dilated, the membranes (the “water”) must have already broken, and the baby’s head must be low enough in the pelvis, at least at the level of the ischial spines (the narrowest bony point inside the pelvis) with no more than one-fifth of the head still felt above the pelvic brim. If these criteria aren’t met, a cesarean section is the safer route.
What the Experience Feels Like
If you’re told forceps are needed, you’ll typically already have an epidural or another form of pain relief in place. The doctor inserts one blade at a time, positioning each along the side of the baby’s head so the tips rest over the baby’s cheeks. Once both blades are locked together, the doctor applies gentle traction timed with your contractions to guide the baby out. The whole process usually adds only a few contractions’ worth of time to the delivery.
You may feel pressure, and if you’ve had an epidural, you might feel tugging sensations. An episiotomy (a small surgical cut to widen the vaginal opening) is sometimes performed alongside a forceps delivery, though this isn’t always necessary.
Risks for the Mother
The most common complication is tearing. Severe perineal tears, known as third or fourth degree tears that extend into the muscle around the rectum, occur in about 10% of forceps deliveries compared to roughly 3% of unassisted vaginal births. These deeper tears take longer to heal and can contribute to urinary incontinence or pelvic organ prolapse down the road, though both of those issues can also happen after any vaginal birth.
One study of over 5,000 deliveries found that 50% of forceps-assisted births had no maternal complications at all. Among those that did, third-degree tears were the most frequent (about 17%), followed by fourth-degree tears (roughly 9%) and cervical lacerations (about 6%). These numbers vary depending on the baby’s size, position, and how long the pushing stage lasted before forceps were applied.
Risks for the Baby
Babies delivered by forceps commonly have temporary marks or bruising on the sides of the face where the blades sat. This fades within days. Less common but more serious complications include facial nerve injury (usually temporary) and bleeding under the scalp. In the study mentioned above, 2% of forceps deliveries were performed for concerning fetal heart rate patterns, and none of those newborns had complications, suggesting that a timely forceps delivery can actually prevent harm when the baby is in distress.
Long-Term Outcomes for Children
Parents often worry about whether forceps could affect their child’s brain development. A large cohort study published in JAMA Network Open tracked over 23,000 children delivered by forceps and compared their rates of ADHD, autism spectrum disorder, and intellectual disability to children born by cesarean section during the same stage of labor. The results were reassuring: forceps-delivered children had essentially the same rates of all three conditions. There was no statistically significant increase in ADHD, autism, or intellectual disability associated with forceps compared to a cesarean performed at the same point in labor.
Vacuum-assisted delivery, by contrast, showed a small increase in intellectual disability risk in that same study, though the absolute numbers were very low (about 0.3 per 1,000 children per year versus 0.2 for cesarean). The takeaway: forceps delivery does not appear to carry meaningful long-term neurodevelopmental risks for the child.
Recovery After a Forceps Delivery
Recovery time is roughly the same as after an unassisted vaginal birth, typically around six weeks. You may spend a slightly longer time in the hospital for monitoring, particularly if you had significant tearing. Stitches from any repairs generally dissolve within about a month. Normal vaginal bleeding continues for several weeks, and you’ll likely need pads during that time.
If you experienced a severe tear, healing can take longer than six weeks, and pelvic floor physiotherapy is often helpful for rebuilding strength and addressing any incontinence. Residual soreness can usually be managed with over-the-counter pain relievers. Most women find that by the six-week mark, they’re feeling substantially better, though full pelvic floor recovery, especially after a deeper tear, can be a more gradual process.
How Common Are Forceps Today
Forceps deliveries have become much less common over the past few decades. In many hospitals, they account for fewer than 3% of all deliveries, and many younger obstetricians have limited training with them. Vacuum extraction and cesarean sections have largely taken their place. Some experts argue this is a loss, since forceps, in experienced hands, can safely prevent a cesarean and its associated surgical risks, particularly for future pregnancies. The skill is increasingly concentrated among more senior practitioners, and some teaching hospitals are making deliberate efforts to keep forceps training alive.