Forceps are hinged, two-bladed instruments used across nearly every branch of medicine to grasp, hold, compress, extract, or guide tissue and objects that fingers alone cannot safely reach. Most people associate them with childbirth, but that is only one chapter in a remarkably long story. Surgeons use forceps to stop bleeding, neurosurgeons use them to coagulate vessels near the spinal cord, ophthalmologists use them to perform delicate maneuvers inside the eye, dentists use them to pull teeth, and emergency physicians use them to remove objects lodged in a patient’s airway. The basic mechanical idea is ancient and simple, yet the modern versions are extraordinarily specialized.
Obstetric Forceps and Assisted Vaginal Delivery
The use most people picture first is childbirth. Obstetric forceps are curved metal blades designed to cradle a baby’s head and guide it through the birth canal when labor stalls or the baby needs to come out quickly. They are used when a single baby in a head-down position fails to progress during the second stage of labor, or when fetal distress requires a fast delivery. In some situations forceps are the safest available option: delivering the head of an undiagnosed breech baby at full dilation, delivering a second twin, or assisting a mother whose cardiac, respiratory, or neurological condition prevents her from pushing effectively. Forceps are also the only instrument that can deliver a baby presenting face-first, because vacuum extraction is not safe in that position. And for premature babies, forceps are preferred over vacuum because vacuum carries a higher risk of bleeding inside the skull.1PubMed Central. Forceps delivery in modern obstetric practice
Some clinicians also use outlet forceps during a cesarean section itself, to control the delivery of the baby’s head through the uterine incision.1PubMed Central. Forceps delivery in modern obstetric practice That surprises many people, who assume forceps and cesareans are mutually exclusive. In practice, the two can complement each other.
Forceps Versus Vacuum Extraction
When an assisted vaginal delivery is needed, the two main tools are forceps and a vacuum cup. Each has a different risk profile, and the choice matters for both mother and baby. A large population-based analysis found that vacuum delivery was associated with fewer birth injuries and fewer neonatal seizures than forceps, while neonatal mortality was comparable between the two. However, vacuum was more likely to cause postpartum hemorrhage in the mother and was associated with roughly double the risk of shoulder dystocia.2PubMed. Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis
The pattern of markings on the newborn differs as well. Forceps tend to leave more visible instrument marks and bruising on the baby’s face or head, whereas vacuum extraction produces more cephalohematomas, which are collections of blood between the skull bone and its membrane. One study found the odds of instrument marks and bruising were roughly four and a half times higher with forceps, while the odds of cephalohematoma were about half those seen with vacuum.3Obstetrics & Gynecology. Immediate Maternal and Neonatal Effects of Forceps and Vacuum-Assisted Deliveries A Cochrane review confirmed the general trend: vacuum was linked to more cephalohematomas and retinal hemorrhages, but serious neonatal injury was uncommon with either instrument.4Cochrane Database of Systematic Reviews. Vacuum extraction versus forceps for assisted vaginal delivery
For the mother, forceps carry a higher rate of major perineal and vaginal tears compared with vacuum. That same study found the odds of severe tears were nearly twice as high with forceps.3Obstetrics & Gynecology. Immediate Maternal and Neonatal Effects of Forceps and Vacuum-Assisted Deliveries None of this means one tool is categorically better. The right choice depends on the baby’s position, how premature the baby is, the mother’s medical conditions, and the clinician’s training and experience.
Pelvic Floor Effects After Forceps Delivery
One of the more significant long-term concerns is the impact of forceps on the mother’s pelvic floor. Forceps delivery exerts traction force and peak pressure on the birth canal that can be up to double what a spontaneous delivery produces, and the odds of injury to the levator muscles (the sling of muscle supporting the pelvic organs) can be as high as nearly six times greater.5PubMed Central. Pelvic floor injury during vaginal birth is life-altering and preventable; what can we do about it? A study comparing women who delivered with forceps to those who delivered spontaneously found that ten months later, about 20 percent of the forceps group had a weak pelvic floor, compared with 6 percent in the spontaneous delivery group.6PubMed. Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters
These findings have contributed to a broader conversation about informed consent during labor. A literature review found that new mothers frequently have inaccurate recollections of obstetric procedures that occurred without much explanation, and that the physical trauma from delivery can contribute to psychological trauma and post-traumatic stress disorder.7PubMed. Psychological and somatic sequelae of traumatic vaginal delivery: A literature review The connection between physical injury and psychological distress after an instrumental delivery is still not well understood, but it is an area that matters to patients and that more clinicians are paying attention to.
The Decline in Obstetric Forceps Training
Despite their unique clinical advantages, obstetric forceps are used far less often than they once were, and the decline has been steep. Both resident training in forceps use and the number of forceps deliveries performed are experiencing what one review called “precipitous declines” in the United States, with current minimum training requirements insufficient to ensure competency.8PubMed. Obstetric Forceps: A Species on the Brink of Extinction This matters practically, because one study found that residents who performed more than thirteen forceps deliveries during training had a 95 percent probability of continuing to use forceps in independent practice, while those who did fewer often stopped using them entirely.9American Journal of Obstetrics and Gynecology. Does the number of forceps deliveries performed in residency predict use in practice?
The worry is not just nostalgia for an old tool. There are clinical situations where forceps remain the best or only option, like premature deliveries or face presentations. If fewer obstetricians know how to use them safely, those patients may end up with unnecessary cesarean sections instead. The debate over how to keep forceps skills alive in training programs is ongoing and has no easy resolution.
A Brief History of the Obstetric Forceps
The story of how obstetric forceps came into existence is one of the stranger tales in medical history. The instrument was invented in the early 1600s by the Chamberlen family, a dynasty of male midwives in England. The Chamberlens kept the design secret for five generations, using it to build a lucrative practice while competitors had no idea how they were achieving such successful deliveries.10PubMed. The Chamberlen family (1560–1728) and obstetric forceps The timing of the invention turned out to be critical: rickets was becoming widespread in England, causing pelvic deformities in women that made normal childbirth difficult or impossible. Without forceps, many of those deliveries would have ended in the death of the baby or the mother or both.
The secret eventually leaked out in the early 1700s, and the design evolved rapidly from there. The progression from the Chamberlens’ concealed prototypes to the sophisticated instruments used in modern practice spans centuries of iterative improvement.11PubMed. The history of obstetric forceps – evolution of the instrument that transformed obstetrics Today, dozens of named forceps designs exist for obstetric use alone, each with different blade curvatures and handle configurations suited to particular fetal positions.
Surgical Forceps for Stopping Bleeding
Outside the delivery room, one of the most common uses of forceps is hemostasis, which just means stopping bleeding. Hemostatic forceps, sometimes called hemostats, clamp onto blood vessels to compress them shut. In traditional open surgery, a surgeon clamps a bleeding vessel with forceps and then ties it off with a suture. In modern practice, many hemostats also deliver electrical current to cauterize the vessel, combining grasping and sealing in one step.
Bipolar electrosurgical forceps, which pass current between two tips rather than through the patient’s body, are widely used. In gynecologic surgery, a multicenter trial found that using bipolar coagulation forceps during vaginal hysterectomy reduced blood loss significantly and saved an average of nearly eight sutures per operation compared with conventional suture ligation.12PubMed. Bipolar coagulation with the BiClamp forceps versus conventional suture ligation: a multicenter randomized controlled trial in 175 vaginal hysterectomy patients In gastrointestinal endoscopy, hemostatic forceps are used during tumor removal to coagulate visible vessels in the tissue wall before cutting through them, reducing the risk of dangerous bleeding during the procedure.13PubMed Central. Efficient hemostatic method for endoscopic submucosal dissection of colorectal tumors
Neurosurgery and the Problem of Heat Spread
In neurosurgery, bipolar forceps are essential for coagulating tiny blood vessels on or near the brain and spinal cord. The challenge is that neural tissue is extraordinarily sensitive to heat. When a surgeon uses bipolar forceps to seal a vessel, heat spreads outward from the tips into surrounding tissue, and even a small amount of thermal damage in the wrong spot can cause permanent neurological harm. Research using animal spinal cord models has focused on comparing different cooling mechanisms built into bipolar forceps tips to limit that thermal spread.14PubMed Central. Comparison of thermal coagulation profiles for bipolar forceps with different cooling mechanisms in a porcine model of spinal surgery Some designs use irrigation, flushing saline over the tips to carry heat away, while others rely on thermally conductive materials that dissipate heat more quickly.
A related innovation involves shape memory alloys, metals that change stiffness at a specific stress threshold. A prototype hemostatic forceps embedded with superelastic alloy wires was designed to cap clamping pressure in a safe range, preventing the surgeon from accidentally crushing delicate tissue while still achieving a secure grip. Testing showed the critical pressure could be held between roughly 200 and 800 mmHg using wires of different diameters.15Smart Materials and Structures. The application of superelastic SMAs in less invasive haemostatic forceps These are still research-stage concepts, but they illustrate how much engineering goes into making a seemingly simple tool safe for high-stakes procedures.
Ophthalmic Surgery
Eye surgery demands perhaps the finest precision of any medical specialty, and forceps used in this field are correspondingly tiny. During cataract surgery, micro-capsulorhexis forceps are used to create a small circular opening in the lens capsule, allowing the surgeon to access and remove the clouded lens. In a technique for managing particularly swollen cataracts, the forceps gradually expand a puncture into an opening of about 2 to 3 millimeters, decompressing dangerous internal pressure before the main surgical steps begin.16PubMed Central. Micro-rhex-pression technique: A novel approach for safe and predictable rhexis in intumescent cataracts
Even the choice of which forceps design to use for this step affects the stability of the eye during surgery. A study comparing the commonly used Utrata forceps against a bent cannula technique found that the Utrata forceps produced a larger drop in internal eye pressure during the capsule-opening step, meaning the surgeon needs to account for that fluctuation when planning the procedure.17PubMed. Effects on anterior chamber stability during the capsulorhexis using utrata forceps vs. a bent 26G cannula Small differences in instrument design ripple through the entire surgical workflow at this scale.
Dental Extractions
Tooth extraction is one of the oldest and most recognizable uses of forceps. Dental extraction forceps work by gripping the tooth at or below the gum line and rocking it loose from its socket. The traditional technique involves squeezing the beaks around the crown and working the tooth back and forth, which occasionally fractures the crown or root. A newer design, often called “physics forceps,” rethinks the mechanics entirely. Instead of two opposing beaks, one side is a plastic-covered bumper that rests against the bone in the vestibule, creating a fulcrum. The other side has a single beak that grips the tooth. The surgeon applies steady rotational force rather than the intermittent squeezing of traditional extraction.
The advantage is mechanical and biochemical. The steady pressure traumatizes the periodontal ligament continuously rather than intermittently, which releases more of the enzyme that breaks down the ligament’s attachment to bone. Combined with the lever advantage, the result is an extraction with less force and a lower rate of crown and root fracture.18PubMed Central. Comparison Between Physics and Conventional Forceps in Simple Dental Extraction The physics forceps design also avoids squeezing the tooth, which is what causes it to split or crush under traditional techniques.
Emergency Airway Management
In emergency medicine, Magill forceps are a standard tool for removing foreign bodies from the throat or upper airway. Named after the Irish anesthesiologist Sir Ivan Magill, these forceps are angled so the surgeon can reach around the tongue and into the pharynx while maintaining a clear line of sight. They are the go-to instrument when back blows, abdominal thrusts, and other first-line maneuvers fail to dislodge a foreign object. In a recent case report, a foreign body was successfully removed using Magill forceps under video laryngoscopic guidance after a patient presented with a complete airway obstruction that was not responding to standard techniques.19PubMed Central. Managing Foreign Body Airway Obstruction with Magill Forceps: A Case Report Beyond foreign-body removal, Magill forceps are routinely used during intubation to guide the tip of a nasotracheal tube into the trachea.
Laparoscopic and Robotic Forceps
Minimally invasive surgery, where instruments enter the body through small incisions, introduced a unique problem for forceps: the surgeon cannot feel what the tissue feels like. In open surgery, you can sense through the instrument how firm or soft a structure is, whether you are gripping too hard, whether something has the rubbery quality of a tumor versus normal tissue. Laparoscopic forceps strip away most of that feedback because of the long shafts and the indirect contact.
This loss matters. When researchers tested surgeons using a grasper system that could toggle between vision-only feedback and combined vision-plus-force feedback, the average rate of correctly identifying tissue types jumped from about 52 percent with vision alone to 83 percent when both vision and force feedback were available.20PubMed Central. Force Feedback Plays a Significant Role in Minimally Invasive Surgery That gap has driven significant investment in “smart” laparoscopic forceps equipped with sensors. One prototype integrates a force-sensitive resistor on the grasping jaw and a sensor on the handle joint to measure both gripping force and jaw angle in real time. The system can detect differences in tissue stiffness and even identify hidden lumps during palpation by looking for sudden variations in the measured stiffness.21PubMed Central. Stiffness Assessment and Lump Detection in Minimally Invasive Surgery Using In-House Developed Smart Laparoscopic Forceps Restoring that sense of touch, even artificially, could make laparoscopic surgery both safer and more effective.
What Forceps Are Made Of
Most surgical forceps are made from stainless steel, specifically grades chosen for their hardness, corrosion resistance, and ability to survive repeated steam sterilization. Titanium is used for specialty instruments, particularly in microsurgery and ophthalmology, where lighter weight and non-magnetic properties are valuable. The surfaces of these instruments are increasingly being engineered at a microscopic level. Dark anti-reflective coatings made from titanium-based compounds can be applied to reduce glare under surgical lights, which is especially helpful during microscopic procedures.22Surface and Coatings Technology. Bio-compatible low reflective coatings for surgical tools using reactive d.c.-magnetron sputtering and arc evaporation — a comparison regarding steam sterilization resistance and nickel diffusion
A more recent development involves ceramic coatings designed to repel biological material. A hierarchical ceramic coating tested on titanium microsurgical forceps reduced bacterial colonization by about 74 percent and blood adherence by roughly 46 percent compared with uncoated titanium. Fibroblast cell adhesion dropped by about half as well.23PubMed. Hierarchical Ceramic Coating Reduces Adherence of Cells, Blood, Bacteria, and Tissue on Titanium Microsurgical Instruments These coatings could make instruments easier to clean between uses and reduce the risk of infection transfer, which is a persistent concern with instruments that are sterilized and reused hundreds of times over their lifespan.
Forceps in Veterinary Surgery
Veterinary medicine uses many of the same forceps designs found in human operating rooms, sometimes with minor modifications for animal anatomy. Bipolar electrosurgical forceps, for example, have been studied extensively for use in spay and neuter procedures. A large study covering more than 3,700 surgeries in dogs and cats found that using bipolar forceps for hemostasis during open ovariectomy and castration reduced surgical time by an average of about ten minutes in female dogs and three minutes in female cats.24PubMed. The use of bipolar electrosurgical forceps for haemostasis in open surgical ovariectomy of bitches and queens and castration of dogs In high-volume spay and neuter clinics, those time savings add up to a meaningful increase in the number of animals that can be treated in a day, which has practical implications for animal welfare programs.