Forceps – Risks and Benefits Of A Forceps Assisted Birth

Most pregnant women dream of having a positive and safe birth experience.

But sometimes, things don’t go according to plan.

Although forceps assisted births are not as common today as they were 60 years ago, you may be faced with the possibility of an assisted birth.

Birth is a normal physiological process which often unfolds quite well in the right environment and with supportive care providers. Occasionally, however, things don’t always unfold as expected.

It’s useful to know when and how forceps are used during birth before your labour begins. Being aware of the common reasons for use, risks and benefits can help you make the right choice for your baby’s safe birth should you need to make a choice regarding assisted birth.

What are Forceps?

There are many myths and claims surrounding the origin of the forceps but we know that this tool was invented in the 1600s and kept nearly secret for over a century. In a time when obstructed labour most often ended in the death of both mother and baby, the use of forceps had the potential to save lives.

Over time, forceps have developed and been redesigned many times. During the 1920s when most women gave birth under Twilight Sleep (sedation) forceps were commonly used. Today, the use of forceps is less common than other methods of assisted birth such as ventouse (used for vacuum assisted birth).

Forceps are often described as looking like large salad spoons. They have two parts and curved ends that are shaped to fit a baby’s head. There are different types of forceps used for certain situations.

Why Would I Need Forceps?

Once your cervix has completely dilated, your uterus begins to contract down to push your baby out. In most cases, this stage of labour (called the pushing stage) takes an hour or so before the birth of your baby.

In some situations, the baby needs help to be born. Your midwife or doctor may recommend forceps if:

• Your baby becomes distressed and is not coping with the contractions
• You have been pushing for several hours and are exhausted
• Your baby is not making any progress through your pelvis
• You are unable to push for too long due to a medical condition (high blood pressure, heart disease)
• Your baby is in an awkward position for birth or is breech (bottom down)
• During c-section if baby is stuck

If an assisted birth is necessary, your care provider will check that your baby is in the right position and low enough in your pelvis to perform the procedure safely.

What Happens During A Forceps Birth?

If your doctor thinks a forceps birth is possible but potentially difficult you may need to be moved to an operating theatre in case a c-section is required. You will need to lie down with your legs up in stirrups or supports. A catheter is inserted to make sure your bladder remains empty.

Pain relief will be given either via a local anaesthetic injection into the vagina or an epidural (spinal anaesthetic). The doctor may make a cut called an episiotomy which enlarges the vaginal opening, allowing the forceps to be inserted into your vagina and applied to each side of your baby’s head.

The doctor may need to rotate your baby’s head into position for birth, then will pull as you push with contractions. If you are unable to feel contractions the midwife will tell you when to push. After the baby’s head is delivered you will be able to push the body out. If the baby’s head is not born after three pulls or contractions then the attempt should be abandoned and a c-section performed.

Risks of A Forceps Assisted Birth

Forceps assisted births should only be performed by an obstetrician who is trained in the various types and techniques, and has experience in forceps births.

There are some risks involved with the use of forceps.

Serious injury to babies following forceps delivery are rare but include:

• Bruising, bumps or marks on the sides of your baby’s face
• Cone shaped or swollen head
• Nerve damage to the face caused by pressure
• Cuts to the skin can occur
• Bleeding on the brain
• Minor external eye injury
• Skull fracture

Risks for the mother include:

• Significant damage to the perineum (the area between your vagina and anus)
• Increased recovery time after birth
• Tears, bruising and injury occurring to the labia and vagina
• Risks associated with episiotomy, a severe tear or both
• Incontinence problems such as being unable to control your bladder or bowel movements
• Painful sex following birth

Can I Avoid A Forceps Birth?

Most women don’t need any help when giving birth. There are a number of things you can do to avoid needing assistance during pushing, such as:

• Stay healthy and active during pregnancy
• Use upright positions during labour, to assist your baby’s descent
• Have continuous support from a doula or midwife
• Avoid an epidural or continuous fetal monitoring, which limits your movement and involves lying down
• If you do have an epidural, wait an hour after full dilation or until you have a pushing urge before trying to push.

The benefit of forceps assisted birth can be that first time mothers are able to achieve a vaginal birth as opposed to a c-section, which would limit future birth options. However, it’s important to note that in some situations a c-section birth may be a better option than a forceps birth.

This may include situations such as baby’s head being high or being in a very awkward position, or if there are no experienced and trained doctors available. Forceps should not be used simply to avoid a c-section if it’s the less risky option available.