What Is a Forceps Delivery?

Many pregnant women are able to deliver their babies in the hospital normally without medical assistance. This is called spontaneous vaginal childbirth. However, there are some situations in which a mother may need help during delivery. These include:

  • when the baby isn’t traveling down the birth canal as expected
  • when there are concerns about the baby’s health
  • when the mother can’t push or has been advised not to push during childbirth

In these cases, doctors will perform an assisted vaginal delivery, which is sometimes referred to as an operative vaginal delivery. One type of assisted vaginal delivery is called a forceps delivery.

The forceps is a medical tool that resembles a pair of large, curved tongs. During a forceps delivery, your doctor will use this tool to grasp your baby’s head and gently pull your baby out of the birth canal. A forceps is usually used during a contraction when your mother is trying to push the baby out.

Types of Forceps

More than 700 types of obstetric forceps have been developed to perform assisted vaginal delivery. Some forceps are most appropriate for certain childbirth situations, so hospitals usually keep several different types of forceps on hand. Even though each type is made for a specific situation, all forceps are similar in design.

Forceps have two prongs that are used for grasping the baby’s head. These prongs are called “blades.” Each blade has a differently sized curve. The right blade, or cephalic curve, is deeper than the left blade, or pelvic curve. The cephalic curve is meant to fit around the baby’s head, and the pelvic curve is shaped to fit against the mother’s birth canal. Some forceps have a rounder cephalic curve. Other forceps have a more elongated curve. The type of forceps used partly depends on the shape of the baby’s head. Regardless of the type used, the forceps should grasp the baby's head firmly but not tightly.

The two blades of a forceps sometimes cross at a midpoint called an articulation. The majority of forceps have a lock at the articulation. However, there are sliding forceps that allow the two blades to slide along each other. The type of forceps used depends on the position of the baby. A forceps with a fixed lock is used during delivery if the baby's head is already facing downward and little or no rotation of the baby is needed. If the baby’s head isn’t facing downward and some rotation of the baby’s head is required, then sliding forceps are used.

All forceps also have handles, which are connected to the blades by stems. A forceps with longer stems is used when a forceps rotation is being considered. During delivery, your doctor will use the handles to grasp your baby’s head and then to pull the baby out of the birth canal.

There are hundreds of different types of forceps. The most commonly used forceps include the following:

  • Simpson forceps have an elongated cephalic curve. They’re used when the baby’s head has been squeezed into a cone-like shape by the mother’s birth canal.
  • Elliot forceps have a rounded cephalic curve and are used when the baby’s head is round. They also have an adjustable pin at the end of the handles, which can be used to control pressure on the handles.
  • Kielland forceps have a very shallow pelvic curve and a sliding lock. They’re the most commonly used forceps when the baby needs to be rotated.
  • Wrigley’s forceps have short stems and blades that can minimize the risk of a serious complication called uterine rupture. It’s most often used in deliveries in which the baby is far along in the birth canal. It might also be used during a cesarean delivery.
  • Piper’s forceps have downward-curving stems to fit around the underside of your baby’s body. This allows the doctor to grasp the head during a breech delivery.

During a forceps delivery, you’ll be asked to lie on your back on a slight incline with your legs spread apart. Your doctor may ask that you grasp handles on either side of the delivery table to support you while you push.

In between contractions, your doctor will place several fingers inside of your vagina to feel the baby’s head. Once the doctor locates the baby, they’ll slide each forceps blade around either side of the baby’s head. If it has a lock, the forceps will be locked so that they can gently grip the baby’s head.

As you push during the next contraction, your doctor will use the forceps to guide your baby out through the birth canal. Your doctor may also use the forceps to rotate your baby’s head downward if it’s facing up.

If your doctor can’t grasp your baby safely with a forceps, they might use a vacuum cup attached to a pump to pull your baby out. If forceps and a vacuum cup aren’t successful in pulling your baby out within 20 minutes, your doctor will likely need to perform a cesarean delivery.

Risks of Forceps Deliveries

All forceps deliveries pose some risk of injury. After delivery, your doctor will examine and monitor both you and your baby for any injuries or complications.

Some risks to the baby during a forceps delivery include:

  • small facial injuries caused by the pressure of the forceps
  • temporary facial muscle weakness, or facial palsy
  • skull fracture
  • bleeding in the skull
  • seizures

Babies delivered with forceps will usually have minor marks on their faces for a short period after delivery. Serious injuries are uncommon.

Potential risks to the mother during a forceps delivery include:

  • pain in the tissue between the vagina and anus after delivery
  • tears and wounds in the lower genital tract
  • injuries to the bladder or urethra
  • problems urinating or emptying the bladder
  • short-term incontinence, or loss of bladder control
  • anemia, or a lack of red blood cells, due to blood loss during delivery
  • uterine rupture, or a tear in the wall of the uterus, which may cause the baby or placenta to be pushed into the mother’s abdomen
  • weakness of the muscles and ligaments that support the pelvic organs, resulting in pelvic prolapse, or the dropping of pelvic organs from their normal position

Women who undergo forceps delivery can expect some pain and discomfort for up to several weeks after a forceps delivery. However, you should contact your doctor right away if the pain is very intense or doesn’t go away after a few weeks. Severe or persistent pain may indicate a serious condition that needs immediate treatment.