Many pregnant women are able to deliver their babies in the hospital normally and without medical assistance. This is called spontaneous vaginal childbirth. However, there are some situations in which a mother may need help during delivery.
In these cases, doctors will perform an assisted vaginal delivery, which is sometimes referred to as an operative vaginal delivery. The doctor will use forceps or a vacuum to help get the baby out safely.
What are forceps?
Forceps are a medical tool that resemble large salad tongs. During a forceps delivery, your doctor will use this tool to grasp your baby’s head and gently guide your baby out of the birth canal. Forceps are usually used during a contraction when the mother is trying to push the baby out.
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.
Risks for the baby
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
Most babies do fine with a forceps delivery. Babies delivered with forceps will usually have minor marks on their faces for a short period after delivery. Serious injuries are uncommon.
Risks for the mother
Some 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 (both are extremely rare) 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
Situations where forceps might be used include:
- when the baby isn’t traveling down the birth canal as expected
- when there are concerns about the baby’s health and the doctor needs to get the baby out more quickly
- when the mother can’t push or has been advised not to push during childbirth
It's hard to predict what your labor and delivery will be like. But in general, the best thing you can do to have a complication-free delivery is to try to maintain a healthy pregnancy. That means exercising regularly, following your doctor's recommendations for weight gain and healthy eating, and attending a childbirth class so that you know what to expect from delivery. Being prepared can help you to stay more calm and relaxed during labor and delivery. If you’ve had more than one child, are older, or have a larger-than-normal baby, you are also at a higher risk of needing forceps.
In other cases, however, there may be too many things that can complicate a labor. Your baby may be larger than expected or in a position that makes giving birth completely on your own impossible. Or your body may simply get too tired.
There are actually two ways to help a woman deliver vaginally. The first way is to use a vacuum to help pull the baby out; this is called a ventouse delivery. The second way is using forceps to help the baby out of the birth canal.
According to the World Health Organization, it's generally better for doctors to use a vacuum to help a baby out if necessary. It’s associated with lower rates of complication for the mother. Studies that compare the two can be confusing, because forceps have a higher success rate in actually getting the baby out. But they also have a higher emergency cesarean delivery rate. What these numbers mean, however, is that usually doctors use a vacuum first, then forceps. And if those still don't work, a cesarean delivery is necessary.
Vacuum-assisted births have less risk of injury to the mother and less pain. There are some situations, however, when a doctor can't use a vacuum. If your baby needs help and is coming out of the birth canal with their face first, instead of the top of the head, a doctor will not be able to use a vacuum. Forceps will be the only option, outside of a cesarean 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 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.
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.
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 depends partly 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 also 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.
Types of forceps
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.
- 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.
Labor is unpredictable and that's why doctors have tools to help when necessary. Some doctors don’t use forceps, so you should check with your doctor ahead of time on their policy for using forceps during birth. Always talk to your doctor about your concerns.
What should a woman write in her birth plan if she doesn’t want a vacuum or forceps-assisted delivery?
First, you might want to talk to your doctor and confirm they are trained and comfortable doing these types of procedures before you make your decision. Any woman seeking to avoid operative vaginal deliveries should discuss this ahead of time with her doctor. It can be simply stated in the birth plan as ‘I would like to decline operative vaginal delivery.’ By declining this option however, most women should understand that she may now require a cesarean delivery instead, as forceps and vacuums are usually only used when spontaneous vaginal delivery requires assistance to be successful.Dr. Michael WeberAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.