Forceps delivery

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An assisted birth with the aid of forceps. These are designed to cradle the baby's head as traction (pulling) on the handles assists the baby to be born.

Research has shown that vacuum extraction (see below) is preferable to forceps in almost all cases as it causes less trauma to mother and baby. The decision to choose forceps or vacuum will often depend on caregiver preference and training, rather than being based on scientific evidence.

When is it necessary?
Forceps are used only during second stage, and for these reasons

• A delay in second stage, perhaps due to an unfavourable position of the baby. The forceps can be used to rotate the head so it can be more easily born.
• To enable the baby to be born if an epidural has left the mother with no urge to push especially if she is lying on her back.
• Fetal distress, when it is necessary to have the baby born quickly.
• To protect the head if the baby is premature or in the breech position.
• Maternal exhaustion or a condition where pushing would be detrimental to the mother, for example a maternal heart condition or a very high blood pressure.
• Sometimes forceps are used to lift the baby out if second stage is considered to be taking too long. If progress is slow then a change of positions (preferably to an open, upright position) should be tried before forceps are used to speed up the birth.

It should be noted that the use of analgesia, especially epidurals, leads to increased likelihood of a forceps birth. The anaesthetic numbs the pelvic floor muscles making it difficult for them to guide the baby's head into a favourable position for birth. Having to lie down for the birth also removes the effect of gravity and makes if difficult to push up hill, especially when the urge to push is severely diminished or absent and a forceps lift-out' is the likely outcome.

How is it done?

• The cervix must be fully dilated.
• The bladder should be empty - a catheter may be used to achieve this.
• The mother is placed in the lithotomy position (on her back with her legs supported in stirrups).
• Some form of local anaesthetic is administered, if an epidural is not already in place.
• The forceps blades are inserted one at a time and locked into position around the baby's head.
• If necessary the doctor rotates the head into a favourable position.
• The head is then pulled right down onto the perineum.
• An episiotomy is performed.
• The baby's head is lifted out and then the body.
• The baby is treated and observed as necessary.
• The placenta is delivered, following an injection of Syntocinon or ergometrine.
• The episiotomy wound is sutured.

Effects on the mother
Advantages:

	1.	When the mother is exhausted or unable to push it allows the baby to be born without her physical effort.
	2.	When pushing is contra-indicated, for example with severe pre-eclampsia, the baby can be born.

Disadvantages:

	1.	Because the birth is assisted, the mother misses the experience of pushing the baby out herself.
	2.	The local or epidural anaesthetic numbs the perineal area so that the mother doesn't feel the baby emerging.
	3.	An episiotomy is usually routine.
	4.	The need for analgesia, often a pudendal block, or an epidural.
	5.	Bruising of internal tissues, and additional strain on pelvic floor muscles.

Effects on the baby
Advantages:

	1.	Where fetal distress is present, a forceps delivery may be life-saving, or prevent the baby from becoming very hypoxic (oxygen-starved) which, if severe, can lead to brain damage or death.
	2.	May be necessary to protect the baby's head, for example a premature birth or breech presentation.
	3.	May be the only way that birth can be achieved, if the baby is malpositioned.

Disadvantages:

	1.	In the hands of an experienced doctor there should be little trauma to the baby. There may be some bruising or temporary markings on the baby's face.
	2.	The baby may suffer from the effects of the increased need for analgesia.
	3.	There is always some degree of force used in a forceps delivery and it is difficult to know what effect this force has on the baby's head and spine. If your baby has been born with the aid of forceps and is very irritable, it might be worthwhile having its neck checked for misalignment of the vertebrae in its spine.