What is Forceps Delivery?
Forceps delivery is an assisted type of delivery. A pair of forceps is used by doctors during the time of labor. They are two large tongs that help to give guidance to the baby’s head throughout the birth canal. Doctors decide to use these tongs during the time of delivery to speed up the labor. Forceps are used typically at the time vaginal childbirth during the time of contraction while the mother keeps on pushing. The use of forceps during delivery is not very common in our country but one must know the details of this delivery.
When and Why is a forceps delivery done?
A forceps delivery is generally done when there is an involvement of pushing. The pushing phase is when the baby has already passed the midpoint of the mother’s birth canal.
Sometimes a baby struggles a lot to make his way out of the mother’s womb at the same time the labor is prolonged. Therefore, the doctor decides to use these tongs or forceps so that the delivery speeds up. Doctors may also sometimes use forceps for delivery to avoid cesarean delivery.
Doctors may recommend forceps if:
- When the baby is stuck in the mother’s birth canal
- When there is an issue while pushing the baby forceps makes it easy for the mothers. This normally happens when the mother is exhausted or when the mother has some heart problem or high blood pressure. These conditions generally hamper the pushing and become dangerous for the mother’s health.
- When the baby needs to be delivered in a short time because the baby might experience fetal distress.
- When the position of the baby is unfavorable during the pushing stage. Forceps helps to rotate the head of the baby.
- Sometimes there is a problem regarding the heartbeat of the baby. Doctors at that time decide to opt for a forcep delivery.
- When the position of the head of the baby is unknown
- Sometimes the condition of the baby is responsible for the strength of the bones. For example osteogenesis imperfecta or sometimes the baby has some bleeding disorder for example hemophilia.
- Sometimes the baby finds difficulty in fitting through the pelvis due to the size of your pelvis.
How is forceps delivery performed?
The procedure involves:
- Two or more fingers of the doctors are inserted inside the vagina. The fingers are just beside the head of the baby.
- One part of the forceps is slid between the doctor’s fingers and the head of the baby. The tong is slid by following the other side of the head of the baby.
- The two parts of the tong are lock against each other to secure the baby’s head safely between them.
- The baby may sometimes face upwards during the contractions of the mother. Thus, the doctors then use the tongs to shift the head of the baby in position.
- During the progression of the labor, doctors prefer to remove the forceps before the head of the baby goes along the birth canal.
- The doctor then uses the forceps to guide the baby gently through the birth canal when the mother is experiencing the next contraction.
Benefits of forceps delivery
There are many benefits of forceps delivery. Some of them are:
- Faster delivery
- The vaginal delivery success rate is much higher using forceps delivery
- The chances of fetal scalp injuries for example subgaleal hematomas and cephalhematoma are much lower when there is the use of these forceps.
- The head of the fetal can have the rotation using the forceps and rightly position, thus enhancing normal delivery
- The forceps do not detach from the head of the fetal if applied appropriately during traction
- General anesthesia is common
- During the second phase cord prolapsed
- They are a safer method that is when comparison happens to cesarean or vacuum delivery.
Risks of forceps deliveries
Some of the risks are:
- Minor injuries in the face due to the extreme pressure by the forceps
- Some of the marks would be found on the face of the baby which is very normal for a forceps delivery and these marks are also temporary.
- Injuries in the urethra
- Urinary or fecal incontinence can be both long-term and short-term
Types of forceps deliveries
There are different types of forceps to conduct the process of assisted vaginal delivery or forceps delivery. Some forceps are most appropriately common for specific childbirth situations. Therefore, hospitals prefer to keep different types of forceps available.
Each of the forceps is perfect keeping in mind specific situations but if you look at the designs of they are all equal. There are two prongs that a forcep has and they are compelling keeping in mind that they can grasp the head of the baby properly. These prongs are the blades of the forceps.
The blades are curves of different sizes. The right side blade is a cephalic curve and the left side blade is a pelvic curve. The right one is much deeper than the left blade. This is perfect to fit around the head of the baby and the left side blade has such a shape that it fits against the birth canal of the mother.
Some of the forceps also have a rounder cephalic curve while other forceps have a more extended curve. The shape of the head of the baby is use to decide which forceps will be helpful during the time of delivery. There is a midpoint- articulation where the two blades of a forceps cross.
Maximum of the forceps has a lock at the midpoint. There are some sliding forceps which leads the two blades to slide. The position of the baby is also important to decide which forcep will help. Forceps that consist of fix locks are helpful when the head of the baby is facing downwards and when there is minimum to no requirement of rotation.
All the forceps consists of handles that have a connection by stems to the blades. Longer stems of the forceps help when there is a requirement for forceps rotation.
Types of forceps used for delivery
Some of the commonly used forceps are:
- Elliot forceps
They consist of cephalic curves that are rounded and often used when the head of the baby is round.
- Simpson forceps
They have extended cephalic curves and are common when the head of the baby gets squeeze by the birth canal of the mother.
- Wrigley’s forceps
They consist of short blades and stems that reduce the risk of some serious complication also known as uterine rupture. This is mostly when the babies are far along the mother’s birth canal. It is also common during the time of c-section delivery.
- Kielland forceps
They consist of a sliding lock and a shallow pelvic curve. They are most common when the baby requires rotation.
- Piper’s forceps
These forceps have curving stems that are downward and can fit around the underside of the body of the baby. Doctors usually grasp the head of the baby during the time of delivery.
Forceps delivery technique
The techniques used for different forceps are:
- Without separating labia scalp at introitus
- Skull at the pelvic floor
- In AP diameter sagittal suture
- On the perineum, there is the fetal head
- Less than 45 degrees of rotation
- The skull is larger than +2 station
- Less than 45 degrees of rotation
- Greater than 45 degrees rotation
- Head engaged, above +2 station
Forceps delivery indications
The indication for forceps delivery is both from the fetal and maternal side. None of the indications are absolute. Some of the indications of forceps delivery are:
- Engaged fetal head or vertex presentation
- Fully dilated cervix
- Membranes ruptured
- Knowledge about the position of the fetal
- The estimated weight of the feta
- Administration of anesthesia
- Adequate size of the maternal pelvis for a normal vaginal delivery
- Empty maternal bladder
- In case the operative delivery method fails, this is a backup plan
- Obtain consents when doctors will explain the benefits and risks are thoroughly
- Maternal neurologic and cardiac disease in case pushing is not advisable
What to expect with forceps deliveries
You need to lie on your back during the forceps delivery, inclining yourself and your legs must spread apart. Doctors will ask to grip the handles of the sides of the delivery table to get support while pushing. In between the contractions, the experts will insert two or more fingers inside the vagina and beside the head of the baby as well.
One of the portions of the forceps will gently slide between the hand and the head of the baby. Another part of the forceps will be simultaneously place on the other side of the head of the baby. To support the head of the baby the forceps will get lock together.
You need to push and at the same time, the health care provider will be using the forceps during the next contractions to guide your baby gently throughout the birth canal. In case the head of the baby is facing upwards, doctors will use forceps for rotating the head of the baby during the time of contractions.
In case the delivery of the baby is for sure, doctors will remove the forceps by unlocking them before the widest portion of the head of the baby passes through the mother’s birth canal. Doctors prefer to keep the forceps in place so that the baby’s head has control.
After the delivery, doctors will examine whether there are any kinds of tears or not that might be due to the use of forceps. If any tears are there, doctors will repair them. Doctors will monitor the baby for any serious symptoms of serious complications.
Recovery from a forceps delivery
It is never too late to get assistance if you are struggling after a forceps delivery. You will be having lots of questions about the process of delivery. Ask your doctor and get proper guidance.
Do not forget to ask questions as the nurses are also fine to answer these questions. If you are still having pain ask your doctor or nurses. You will have regular painkillers to get rid of the pain in case of any soreness that is due to the stitches. Doctors will also prescribe anti-inflammatory drugs or paracetamol on a regular basis for a few days.
You have to change the maternity pad as often as you can and wash the hands prior to and after you do so. One must have a bath daily so that your stitches remain clean. Inform your doctor if you find any signs of infection. You can find out that you are having an infection if you have issues while urinating or find bad smells from the stitches.
As soon as you are at home, your comfort of lying on the bed will also increase. This will help to get relief from pressure and pain. Try squatting on the toilet rather than opting to sit as it will help to decrease the stinging.
You can also opt to sit in a tub full of warm water so that the antiseptic that is for inclusion in the tub can help to soothe the areas of the stitches and help with the swelling as well. At the same time the germs and the infections will also stay away. The stitches need to be dry so that they can heal faster.
If you have any severe tears, doctors will prescribe a liquid laxative that will help to solve the problem. The laxative will be gentle in nature. You will also follow a suggestion to drink one to three liters of fluid and good nutritious food as well.
Practice some pelvic floor exercises to control your urination. Your baby may also have some bruises after the forceps delivery, but those are temporary and may go away soon. Your baby will not have any long-term issues due to forceps delivery.
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Dr. Jay Mehta
Fertility and IVF Specialist
Dr. Jay Mehta is the Scientific Director of Shree IVF Clinic. He is a well-known Fertility and IVF Specialist and also among few doctors in the country who specializes in Embryology and Andrology.