Forceps are metal obstetrical instruments that look like salad tongs, sometimes used in assisted vaginal deliveries to guide the baby out of the vaginal canal. A study, published in the August 2021 issue of the journal Obstetrics & Gynecology, looked at how Austrian, Canadian, Norwegian, and Swedish births were affected by forceps use. Research showed that a longer, more painful, and complicated recovery process occurred when births didn’t go as planned and the healthcare provider uses forceps to get the baby out. This can result in lifelong implications for the mother, specifically with poor healing or ongoing pain, sexual dysfunction, incontinence, pelvic organ prolapse, or infections. The study has prompted doctors and birthing parents to re-examine if forceps in childbirth are safe.
How and Why Forceps Might Be Used in Childbirth
Forceps may be used in a variety of instances, usually resulting from an unexpected complication during birth. “The primary reasons for [forcep] use include maternal exhaustion from pushing," says Kecia Gaither, MD, MPH, FACOG, double board-certified in OB/GYN and Maternal-Fetal Medicine, Director of Perinatal Services at New York City Health + Hospitals/Lincoln. “[They can also be used because of] fetal distress, if the fetal head is not positioned correctly, or if the mother has an underlying medical issue, like cardiac disease, which precludes her from pushing.” Dr. Gaither explains that forceps are rarely utilized in the U.S., with only around 1% of births utilizing forceps.
The Dangers of Forceps
Though U.S. doctors are more reticent to use forceps, the recent study reveals that Canada has an alarmingly high use of forceps and therefore related injuries. In Canada, 24.3% of mothers who delivered with forceps were injured. This is compared to 6.2% in Norway, which introduced a program in 2004 called the “Perineal Protection Program” to educate health care providers were on methods for minimizing injury to the mother during birth. Yen Tran, DO, an OB/GYN at Memorial Care Orange Coast Medical Center in Fountain Valley, California and author of “Baby Behind Mommy’s Belly Button,” says the study’s results are concerning. “Forceps deliveries are to be avoided," she says. “If it is known that a woman will be unable to push, a Caesarean section should be performed.” She also says there are very specific protocols that must be followed, such as using the minimal amount of necessary traction to move the baby’s head or stopping using forceps if no movement happens after two contractions. She says the physician’s experience and skill using the forceps may impact the outcome. The perineum, or the area between the vagina and the anus, is especially at risk during a forceps delivery. Dr. Gaither says there is the potential for vaginal or anal lacerations.
Potential Risks for the Baby
The parent isn’t the only person who can be injured by forceps use—the baby can as well. “Potential risks to the infant include facial injuries and weakness, skull fractures, and bleeding,” Dr. Gaither explains. Dr. Tran adds that since forceps grasp the side of the head, around the baby’s ears, it can cause damage, adding that forceps can break the baby’s clavicle, injure their facial nerves, and increase the risk of infection.
Making Decisions About Forceps During Childbirth
Although active labor is not the ideal time to make decisions, parents often have to make choices about forceps during the final stages of delivery. Dr. Tran says patients are alerted of the risks (and should be in all cases) before forceps are used. “If the patient declines, it may be necessary to do a Caesarean section,” she says. Other times, providers and patients will opt for trying vacuum extraction, when a vacuum is applied only to the top of the baby’s head. This also has risks, and Dr. Tran says this shouldn’t be attempted if forceps use has already failed. Additionally, the use of forceps can be uncomfortable for the birthing parent, so Dr. Tran says it’s recommended that they have an epidural during this procedure. The Centers for Disease Control and Prevention (CDC) report that the use of epidural or spinal anesthesia was more common in vaginal deliveries assisted by forceps. Ironically, women who opt for an epidural also have a higher rate of needing assistance, such as the use of a vacuum or forceps. Patients should talk to their healthcare provider before and during birth about the safest route to take, and any associated risks if they will or are dealing with the potential use of forceps, vacuums, or Cesarean sections.
