Forceps in childbirth

Overview
Forceps can be used to assist the delivery of a baby as an alternative to the ventouse method.

Technique
The cervix must be fully dilated and the bladder emptied, perhaps with the use of a catheter. Since mid-forceps and high forceps are rarely performed in this era, the station of the head must be at least +2. The woman is placed in the lithotomy position and a mild anaesthetic is administered (unless an epidural has been given). It is very important that adequate pain control is achieved. After ascertaining the precise position of the fetal head (by accurately feeling the posterior fontanelle), the two sections of the forceps are individually inserted and then locked into position around the baby's head. The fetal head is then rotated to occiput anterior position if it is not already in this position. An episiotomy is performed and then the baby is delivered.

Possible indicating factors

 * Fetal or maternal distress
 * If the baby is not delivering despite maternal effort
 * When (further) pushing is contra-indicated
 * Arterial hypertension (high blood pressure)

Positive aspects

 * Can be performed even if the baby is not in the correct position, although not if the head is presenting high in the vaginal canal
 * Can be used to avoid caesarean delivery
 * Delivery of the infant can occur more quickly than with emergency caesarean surgery

Negative aspects

 * An episiotomy is usually required which itself involves anesthesia
 * The internal tissues, particularly the pelvic floor muscles, are bruised
 * Women with a previous history of sexual abuse have reported feeling as though they were raped after instrumental deliveries
 * A rectovaginal fistula can result, where fecal material leaks from the bowel into the vagina
 * Facial bruising or temporary marks on the baby
 * Nerve damage
 * Skull fractures
 * Cervical cord injury to the baby that results in the baby being unable to breathe unassisted
 * Brain damage which can cause mild to severe mental retardation

History
Modern obstetrical forceps were invented by Peter Chamberlen around 1600 and kept a family secret for several generations. About 1730 the secret leaked out and a public design of the instrument became available. The first illustration of the forceps was published by Edward Hody in 1734. Forceps had a profound influence on obstetrics as it allowed for the speedy delivery of the baby in cases of difficult or obstructed labor. Kedarnath Das of Calcutta described over 550 varieties of the intrument in 1929 In the last decades, however, with the ability to perform a cesarean section relatively safely, use of forceps and training in the technique of its use has sharply declined.