Overview

A forceps delivery is a type of assisted vaginal delivery. It's sometimes needed in the course of vaginal childbirth.

In a forceps delivery, a health care provider applies forceps — an instrument shaped like a pair of large spoons or salad tongs — to the baby's head to help guide the baby out of the birth canal. This is typically done during a contraction while the mother pushes.

Your health care provider might recommend a forceps delivery during the second stage of labor — when you're pushing — if labor isn't progressing or the baby's safety depends on an immediate delivery.

Although a forceps delivery may be recommended during delivery of your baby, it might be associated with certain risks. If a forceps delivery fails, a cesarean delivery (C-section) might be needed.

Why it's done

A forceps delivery might be considered if your labor meets certain criteria — your cervix is fully dilated, your membranes have ruptured, and your baby has descended into the birth canal headfirst, but you're not able to push the baby out. A forceps delivery is only appropriate in a birthing center or hospital where a C-section can be done, if needed.

Your health care provider might recommend a forceps delivery if:

  • You're pushing, but labor isn't progressing. Labor is considered prolonged if you haven't made progress after a certain period of time.
  • Your baby's heartbeat suggests a problem. If you are fully dilated, the baby is low in the birth canal, and your health care provider is concerned about changes in your baby's heartbeat, an immediate delivery may be necessary. In such a case, he or she might recommend a forceps delivery.
  • You have a health concern. If you have certain medical conditions — such as heart disease or high blood pressure — your health care provider might limit the amount of time you push.

Your health care provider might caution against a forceps delivery if:

  • Your baby has a condition that affects the strength of his or her bones, such as osteogenesis imperfecta, or has a bleeding disorder, such as hemophilia
  • Your baby's head hasn't yet moved past the midpoint of the birth canal
  • The position of your baby's head isn't known
  • Your baby's shoulders or arms are leading the way through the birth canal
  • Your baby might not be able to fit through your pelvis due to his or her size or the size of your pelvis

Risks

A forceps delivery can possibly cause risk of injury for both mother and baby.

Possible risks to you include:

  • Pain in the perineum — the tissue between your vagina and your anus — after delivery
  • Lower genital tract tears
  • Difficulty urinating or emptying your bladder
  • Short-term or long-term urinary or fecal incontinence (involuntary urination or defecation) if a severe tear occurs
  • Injuries to the bladder or urethra — the tube that connects the bladder to the outside of the body
  • Uterine rupture — when the uterine wall is torn, which could allow the baby or placenta to be pushed into the mother's abdominal cavity
  • Weakening of the muscles and ligaments supporting your pelvic organs, causing pelvic organs to drop lower in the pelvis (pelvic organ prolapse)

While most of these risks are also associated with vaginal deliveries in general, they're more likely with a forceps delivery.

Your health care provider may also have to perform an episiotomy — an incision of the tissue between the vagina and anus — before placing the forceps.

Possible risks to your baby — although rare — include:

  • Minor facial injuries due to the pressure of the forceps
  • Temporary weakness in the facial muscles (facial palsy)
  • Minor external eye trauma
  • Skull fracture
  • Bleeding within the skull
  • Seizures

Minor marks on your baby's face after a forceps delivery are normal and temporary. Serious infant injuries after a forceps delivery are rare.

How you prepare

Before your health care provider considers a forceps delivery, he or she might try other ways to encourage labor to progress. For example, he or she might adjust your anesthetic to encourage more-effective pushing. To stimulate stronger contractions, another option might be intravenous medication — typically a synthetic version of the hormone oxytocin (Pitocin).

You might also ask about alternatives to a forceps delivery, including trying a vacuum-assisted delivery or proceeding to a C-section.

If you haven't already been given a regional anesthetic, your health care provider will likely give you an epidural or a spinal anesthetic if the procedure is not done for an emergent reason (the baby's heart rate is dropping). A member of your medical team will place a catheter in your bladder to empty it of urine. Your health care provider might also make an incision in the tissue between your vagina and your anus (episiotomy) to help ease the delivery of your baby.

What you can expect

During the procedure

During a forceps delivery, you'll lie on your back, slightly inclined, with your legs spread apart. You might be asked to grip handles on each side of the delivery table to brace yourself while pushing.

Between contractions, your health care provider will place two or more fingers inside your vagina and beside your baby's head. He or she will then gently slide one portion of the forceps between his or her hand and the baby's head, followed by placement of the other portion of the forceps on the other side of your baby's head. The forceps will be locked together to cradle your baby's head.

During the next few contractions, you'll push and your health care provider will use the forceps to gently guide your baby through the birth canal.

If your baby's head is facing up, your health care provider might use the forceps to rotate your baby's head between contractions.

If delivery of the baby is certain, your health care provider will unlock and remove the forceps before the widest part of your baby's head passes through the birth canal. Alternatively, your health care provider might keep the forceps in place to control the advance of your baby's head.

Forceps deliveries aren't always successful. If delivery with assistance of forceps is not successful, your health care provider might recommend a C-section for delivery. He or she might also recommend using a cup attached to a vacuum pump to deliver your baby (vacuum extraction) as an alternative. Your health care provider will assess your delivery situation and make a decision about which option — forceps or vacuum extraction — is the right choice for you.

If your health care provider applies the forceps but isn't able to move your baby, a C-section is likely the best option.

After the procedure

After delivery, your health care provider will examine you for any tears that might have been caused by the forceps. Any tears will be repaired. Your baby will also be monitored for any signs of complications.

When you go home

If you had an episiotomy or a vaginal tear during delivery, the wound might hurt for a few weeks. Extensive tears might take longer to heal.

While you're healing, expect the discomfort to progressively improve. Contact your health care provider if the pain gets worse, you develop a fever or you notice signs of an infection.

If you're unable to control your bowel movements (fecal incontinence), consult your health care provider.

Sept. 15, 2018
References
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  2. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 154. Operative vaginal delivery. Obstetrics and Gynecology. 2015;126:1. Reaffirmed 2018.
  3. Wegner EK, et al. Operative vaginal delivery. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
  4. Frequently asked questions. Gynecologic problems FAQ192. Assisted vaginal delivery. American College of Obstetricians and Gynecologists. https://www.acog.org/~/media/For%20Patients/faq026.ashx?dmc=1&ts=20111213T1052571310. Accessed July 9, 2018.
  5. Handa VL. Effect of pregnancy and childbirth on urinary incontinence and pelvic organ prolapse. https://www.uptodate.com/contents/search. Accessed July 17, 2018.
  6. Toglia MR. Repair of perineal and other lacerations associated with childbirth. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
  7. Berkowitz LR. Postpartum perineal care and management of complications. https://www.uptodate.com/contents/search. Accessed July 9, 2018.
  8. Gabbe SG, et al. Postpartum care and long-term health considerations. In: Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2017. https://www.clinicalkey.com. Accessed July 9, 2018.
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Forceps delivery