What is a Forceps Delivery? A Complete Guide

Safe Delivery

Introduction: In the field of obstetrics, forceps have long been invaluable tools used to assist in difficult deliveries. While their usage has declined with the advent of other techniques such as vacuum extraction and Caesarean Section, forceps delivery still holds a significant place in obstetric practice. This article aims to explore the history, indications, techniques, complications, and controversies surrounding the use of forceps in obstetrics.

History of Forceps: Forceps have a rich history dating back to the 16th century. The invention of forceps is attributed to surgeon Peter Chamberlen (c.1560-1631). Initially, forceps were shrouded in secrecy and were considered a closely guarded family secret among the Chamberlens. However, their effectiveness gradually led to wider acceptance and adoption across Europe and eventually worldwide. By the middle of the 18th century, William Smellie was probably the most significant obstetrician of the time, developing his own forceps. Over the centuries, forceps designs have evolved, with various modifications aimed at improving safety and efficacy.

Indications for Forceps Delivery: The decision to use forceps in obstetrics is guided by several factors, including foetal distress, maternal exhaustion, prolonged second stage of labour, and certain foetal malpresentations such as occiput posterior position. Additionally, forceps may be preferred in cases where expeditious delivery is necessary to reduce the risk of maternal or foetal complications.

Statistics: In the UK – about 1 in 9 births are forceps deliveries.  In the USA forceps deliveries involve less than 1% of total deliveries.

Techniques of Forceps Delivery: Obstetrical forceps are curved to fit around the baby’s head inside the birth canal and help guide them out. They are carefully positioned and with a contraction and pushing, an obstetrician gently pulls to help deliver the baby. The successful use of forceps requires proficiency in obstetrical skills and a thorough understanding of foetal positioning and maternal anatomy. The choice of forceps type and the position of the foetal head determine the specific technique employed. Proper positioning of the forceps blades, careful traction, and coordination with maternal expulsive efforts are essential for a safe and effective delivery. Obstetricians must adhere to established guidelines and receive adequate training to minimize maternal and neonatal complications associated with forceps-assisted deliveries. Unfortunately, these days many obstetricians have not had the appropriate training.

Controversies Surrounding Forceps Use: Despite its efficacy in certain clinical situations, the use of forceps remains a topic of debate in obstetrics. Critics argue that forceps deliveries carry a higher risk of maternal and neonatal trauma compared to alternative methods such as vacuum extraction or caesarean section. However, proponents emphasize the importance of judicious use of forceps in preventing adverse maternal and neonatal outcomes, particularly in resource-limited settings where access to caesarean section may be limited. Also, the importance of preserving the skill of forceps delivery and its role in preventing unnecessary caesarean deliveries. In my experience the main concern is operator proficiency, in skilled hands they are safe and effective. Being trained in England, forceps delivery and vaginal breech delivery were essential and regularly used skills. I was amazed to find that this was not the case in North America.

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Current Practices and Guidelines: Modern obstetric practice emphasizes a multidisciplinary approach to childbirth, incorporating evidence-based guidelines and individualized patient care. The American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) provide comprehensive recommendations regarding the use of forceps in obstetrics. These guidelines emphasize the importance of proper patient selection, thorough evaluation of foetal well-being, adequate training and adherence to standardized techniques to optimize maternal and neonatal outcomes.

Conclusion: Despite advancements in obstetric practice, forceps remain valuable tools in managing complicated deliveries. When used judiciously and by skilled practitioners, forceps delivery can help prevent maternal and foetal complications. However, careful consideration of indications, thorough training, and adherence to established techniques are essential for ensuring the safe and effective use of forceps in modern obstetric practice. The decreased use of forceps is mainly due to lack of adequate resident training. As technology continues to evolve, the role of forceps in modern childbirth will likely remain a topic of ongoing research and discussion. With increasing concern about the rate of Caesarean Section it is likely that forceps delivery will again play a more significant role in safe obstetric care.

References:

  1. Bofill, J. A., Rust, O. A., Perry, K. G., Roberts, W. E., & Martin, R. W. (2000). Forceps delivery: A guide for outcomes analysis. American Journal of Obstetrics and Gynecology, 182(6), 1360–1370.
  2. Green-top Guideline No. 26. (2011). Operative vaginal delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 118(Suppl 1), 1–20.
  3. Murphy, D. J., Liebling, R. E., Patel, R., Verity, L., Swingler, R., & Cohort study of maternal and neonatal morbidity in relation to use of episiotomy at instrumental vaginal delivery. (2001). British Medical Journal, 322(7297), 1271–1275.
  4. Royal College of Obstetricians and Gynaecologists. Instrumental Vaginal Birth. Green-top Guideline No. 26. London: RCOG; 2011.
  5. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 154: Operative Vaginal Delivery. Obstet Gynecol. 2015;126(5):e56-e65.
  6. Patel, R.R., Murphy, D.J. Forceps delivery in modern obstetric practice: BMJ. 2004 May 29; 328(7451): 1302–1305.

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