When dangerous complications occur during the birthing process, forceps can be used for immediate delivery of the baby. They have been used to aid childbirth for centuries, dating back to the 1840s. However, prevention of forceps injuries requires extreme caution. Excessive pressure, improper placement, and other mistakes during delivery can have devastating effects on a mother or newborn’s health. Forceps injuries range from minor bruising to severe brain damage or death.
Use of Forceps
Forceps are a tong-shaped metal device designed to gently grasp the head of the fetus inside the womb. They feature two curved branches that position around the head to provide a firm grip. Once positioned, they can be used to rotate an improperly positioned fetus or guide it through the birth canal.
Numerous delivery complications can lead to the use of forceps, involving:
- Maternal exhaustion that prevents the mother’s ability to push the fetus from her womb
- Maternal illnesses such as hypertension, heart disease, and other conditions that make pushing unsafe
- Maternal inhibition to push caused by analgesic drugs, such as spinal or epidural anesthesia
- Breech presentation, or “bottom-down,” in which the fetus’ buttocks or feet proceed its head
- Prolonged labor during which the fetus does not make timely progress through the birth canal
- Changes in the fetal heart rate that indicate fetal distress and the need for immediate delivery
Types of Forceps Injuries
Due to the invasive nature of this type of assisted childbirth, several forceps injuries can occur to both a mother and her child. Standard forceps injuries, such as bruising or marks, occur in roughly 17% of newborns delivered using the aid of forceps. Temporary or permanent facial nerve damagecan result from forceps injuries.
Forceps injuries to newborns include:
- Facial marks, lacerations, or bruising
- Facial nerve damage
- Skull or clavicle facture
- Brachial plexus injuries
- Shoulder dystocia
- Misaligned vertebrae
- Intracranial hemorrhage
- Cerebral palsy or Erb’s palsy
- Developmental delays
Forceps injuries to delivering mothers include:
- Increased pain and postnatal recovery time
- Postnatal incontinence issues
- Vaginal or rectal laceration
- Vaginal or rectal hemorrhage
- Damage to the pelvic floor
- Perineal or cervical injury
- Anal sphincter disruption
Preventing Forceps Injuries
Specific guidelines are in place to ensure that practitioners use forceps appropriately, in an effort to prevent forceps injuries. The American College of Obstetricians and Gynecologists (ACOG) classifies forceps delivery based on the level and position of the fetus’ head inside the womb.
Standard guidelines for prevention of forceps injuries require that:
- The cervix is fully retracted and dilated
- The membranes are ruptured
- The pelvis type is known
- The mother receives adequate anesthesia
- The fetal head is engaged and its position is known
- Adequate facilities and support elements are available
Furthermore, the practitioner must be experienced and know how to identify and manage complicationsto prevent forceps injuries. Forceps are inappropriate in cases of cephalopelvic disproportion, or when the fetal head is too large to travel through the mother’s birth canal. Other delivery options, such as emergency C-section, may be considered.