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Forceps deliveryBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/forceps-delivery/MY02085
A forceps delivery is a type of operative 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.
A forceps delivery poses a risk of injury for both mother and baby. 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. If you've never given birth before, labor is considered stalled if you've pushed for a period of two to three hours but haven't made any progress. If you've given birth before, labor might be considered stalled if you've pushed for a period of one to two hours without any progress.
- Your baby's heartbeat suggests a problem. If your health care provider is concerned about changes in your baby's heartbeat and an immediate delivery is necessary, he or she might recommend a forceps delivery.
- You have a health concern. If you have certain medical conditions — such as narrowing of the heart's aortic valve (aortic valve stenosis) — your health care provider might limit the amount of time you push.
- Your baby's head is facing the wrong direction. A forceps delivery might be needed if your baby's head is facing up (occiput posterior position) rather than down (occiput anterior position).
Keep in mind that whenever a forceps delivery is recommended, a C-section is typically also an option.
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
A forceps delivery poses a 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 and wounds
- Difficulty urinating or emptying the bladder
- Short-term or long-term urinary or fecal incontinence
- Anemia — a condition in which you don't have enough healthy red blood cells to carry adequate oxygen to your tissues — due to blood loss during delivery
- Injuries to the bladder or urethra — the tube that connects the bladder to the outside of the body
- Uterine rupture — when the baby breaks through the wall of the uterus into the mother's abdominal cavity
- Weakening of the muscles and ligaments supporting your pelvic organs, causing pelvic organs to slip out of place (pelvic organ prolapse)
While most of these risks are also associated vaginal deliveries in general, they're more likely with a forceps delivery.
If your health care provider does an episiotomy — an incision in the tissue between the vagina and the anus that can help ease the delivery of your baby — you're also at risk of postpartum bleeding and infection.
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
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).
If a forceps delivery seems to be the best option, your health care provider will explain the risks and benefits of the procedure and ask for your consent.
If you haven't already been given a regional anesthetic, your health care provider will likely give you an epidural or a spinal anesthetic. 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 tong between his or her hand and the baby's head, followed by placement of the other tong on the other side of your baby's head. The tongs 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 your health care provider isn't able to properly grasp the baby with the forceps, he or she might use a cup attached to a vacuum pump to deliver your baby (vacuum extraction) or opt for a C-section.
If your health care provider applies the forceps but isn't able to move your baby after three pulls or if delivery doesn't occur within about 20 minutes, a C-section is likely the best option.
After the procedure
After delivery, your health care provider will examine you for any injuries that might have been caused by the forceps. Any tears or incisions will be repaired.
Your baby will also be monitored for signs of complications that can be caused by a forceps delivery.
When you go home
If you had an episiotomy or vaginal tear during delivery, the wound might hurt for a few weeks. Extensive tears might take longer to heal.
In the meantime, you can help promote healing:
- Soothe the wound. Apply an ice pack to the affected area, or place a chilled witch hazel pad between a sanitary napkin and the wound. You can find witch hazel pads in most pharmacies.
- Take the sting out of urination. Use a plastic cup to pour warm water over your vulva as you're urinating, and rinse yourself with a squirt bottle afterward.
- Prevent pain and stretching during bowel movements. Press a clean pad firmly against the wound when you bear down for a bowel movement.
- Sit down carefully. Tighten your buttocks as you lower yourself to a seated position. Sit on a pillow or padded ring rather than a hard surface.
- Consider complementary treatments. Some research suggests that lavender might help relieve pain after a tear or episiotomy. If your health care provider approves, add a few drops of lavender essential oil to your bath water or apply the oil directly to the affected area.
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 a pus-like discharge.
Pregnancy and birth stretch the connective tissue at the base of the bladder and can cause nerve and muscle damage to the bladder or urethra. You might leak urine when you cough, strain or laugh. Fortunately, this problem usually improves within three months. In the meantime, wear sanitary pads and do Kegel exercises to help tone your pelvic floor muscles.
To do Kegels, tighten your pelvic muscles as if you're stopping your stream of urine. Try it for five seconds at a time, four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. Aim for at least three sets of 10 repetitions a day.
If fear of pain leaves you avoiding bowel movements, take steps to keep your stools soft and regular. Eat foods high in fiber — including fruits, vegetables and whole grains — and drink plenty of water. It's also helpful to remain as physically active as possible. Ask your health care provider about a stool softener or fiber laxative, if needed.
If you're unable to control your bowel movements (fecal incontinence), frequent Kegel exercises might help. If you have persistent trouble controlling bowel movements, consult your health care provider.
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