Fortunately, most pregnant women experience a normal labor and delivery. However, during the course of labor, situations may arise requiring urgent delivery to prevent problems for mother or baby. In these cases, the doctor may choose to perform an assisted vaginal delivery in order to avoid cesarean section and its associated risks. Vaginal delivery is preferable to cesarean delivery in most respects. Risks to the mother such as infection, excessive blood loss requiring blood transfusion, surgical complications, and problems with future pregnancies are lower with a vaginal delivery when compared to cesarean delivery. Your baby can also benefit from a vaginal delivery, as passage through the birth canal can remove excess fluid from the lungs. Thus, in the hands of an experienced physician, the assisted vaginal delivery may be beneficial and can avoid significant complications. Recent evidence suggest that a cesarean delivery may be beneficial for the mother in terms of retaining pelvic support, logistics regarding timing of delivery, and avoiding the risk of fetal injury in certain situations.
Assisted vaginal delivery refers to the use of forceps (metal instruments specially designed to guide the baby's head) or a vacuum extractor (a suction device applied to the baby's head) to assist in the mother's efforts of pushing the baby out of the birth canal. With the forceps or the vacuum extractor, the doctor may provide additional force (in the form of outward traction or pulling) to deliver the baby more quickly.
Studies to evaluate the long-term effects of vacuum-assisted vaginal delivery versus spontaneous vaginal delivery on the mental and physical development of children have failed to show any differences between these two groups. Children have been followed and evaluated through 14 years of age and there has been no evidence of intellectual or neurologic impairment associated with use of the vacuum extractor.
A Brief History of Development of the Forceps
There is evidence that instruments for the delivery of the human fetus were known well before the time of Christ, with recorded references in Hindu, Tibetan, Egyptian, and Greek medical practice. In most, if not all of these cultures, these instruments were reserved for the delivery of a dead fetus. There is also evidence that such devices were known in the Arab world during the eleventh century.
However, most midwives or physicians when asked who invented the obstetric forceps mention the Chamberlen family. The use of forceps for the delivery of a living child is generally credited to a physician named Peter Chamberlen who lived and worked around the turn of the seventeenth century in . This technique was a closely guarded Chamberlen family secret for several generations, being sold to only a few select practitioners in the late seventeenth century. The basic design was two curved blades, which fit around the baby's head, and held together by short handles. The technique did not become generally known until 1732, when a description was published by Rathlaw of Amsterdam.
Over the next two hundred years, the basic design was gradually refined: the handles were lengthened and the concept of the pelvic curve was incorporated (the forceps blades were curved to follow the contour of the birth canal). Thereafter, improvements were made in the mechanisms for applying traction and specialized forceps were developed for rotation of the baby's head and for delivery of the after-coming head of a breech baby (a baby who is delivered rear-end first).
Prerequisites for a vacuum-assisted vaginal delivery:
- The cervix must be completely dilated.
- The baby must be low enough in the birth canal.
- The membranes must be ruptured.
- The baby must be average-sized (not too big).
- The mother's pelvis must be sufficiently sized.
- The baby must be close to term.
Clinical Trials on Difficult Assisted Vaginal Deliveries
At this time, there is no adequate research addressing the safety and effectiveness of the more difficult operative vaginal deliveries. Although perinatal researchers have been among the most active and experienced groups in the use of randomized clinical trials (RCT) for developing safe and effective care plans, there are still no RCT data on which to base clinical decisions when potential life-threatening complications develop in the second stage of labor. Today there remains no substitute for skilled and experienced providers who are capable of intervening in a safe and effective manner on behalf of laboring women and their babies. Such providers can, and do, accomplish difficult vaginal deliveries with forceps techniques. It would certainly be beneficial for these techniques to be evaluated in appropriate clinical trials, so we can know as precisely as possible where to draw the line between operative intervention and continued labor. It is equally imperative to know, as precisely as possible, at what point operative intervention can be safely performed vaginally and at what point delivery should take the form of a cesarean birth. The definition of these lines will determine the place of forceps in twenty-first century American obstetrical practice. However, ethical and logistic issues make these sorts of RCTs difficult, if not impossible, to accomplish in a well-designed fashion.