Forceps Delivery - Medical Negligence Lawyers
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Forceps Delivery Injury - Medical Negligence
A woman can have a forceps delivery as part of a vaginal delivery. Forceps deliveries are uncommon in obstetrics and yet they can be of necessity in emergency vaginal deliveries. In the procedure, the provider applies an instrument that looks like two open spoons to the baby’s head and clamps them together. The forceps is then given gentle traction to guide the baby’s head out of the vagina. It is usually done in the second stage of labour, when the mother is pushing but is having difficulty getting the baby to advance through the pelvis. The forceps may recommend the last ditch effort before a caesarean section needs to be done.
In order to do a forceps delivery, the labour must meet a certain number of criteria. For example, the cervix must be fully dilated and the membranes need to be ruptured. The baby’s head must have descended partially through the birth canal but the mother must have difficulty pushing the baby completely out. A forceps delivery must be performed only at a birthing centre or hospital where a caesarean section is possible.
Signs you might need a forceps delivery include:
- You are pushing but getting nowhere in terms of descent of the baby’s head. This means about three hours of pushing without progression.
- The baby’s heartbeat is dropping or is having decelerations suggestive of foetal distress in the second stage of labor.
- You have a health problem such as a heart problem that makes a long labour dangerous.
- The baby is face up instead of facing down. This is called “sunny side up”.
Remember that while a forceps deliver is an option, a caesarean section is also an option at the same time.
Forceps deliveries may be contraindicated in the following situations:
- The baby has a problem with the strength of his bones which would be crushed in a forceps delivery.
- The baby’s head has not yet passed the middle of the birth canal.
- The doctor can tell the positioning of the infant’s head.
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 haemophilia
- 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.
- The presenting part is the arm or shoulder and not the head.
- There will likely be an injury to the bladder or urethra.
Risks for having a forceps delivery involve possible injury to the mom and the baby. These risks include:
- Tears in the lower genitourinary tract.
- Perineal pain or tearing.
- Problems voiding after delivery.
- Urinary or faecal incontinence, potentially for long term.
- Anaemia from blood loss in delivery.
- Rupture of the uterus.
- Pelvic organ prolapse in which the muscles of the pelvis are weak.
- Bladder or urethral injury.
- Risk of postpartum infection through the episiotomy.
The risks to the baby are uncommon but include the following:
- Temporary facial palsy with infant muscle weakness.
- Facial injuries from the forceps.
- Skull fracture.
- External eye trauma.
- Bleeding within the skull.
- Seizures from brain injury.
As part of the delivery, the mother is on her back with legs spread apart. She may be asked to grip handles for better ability to push. The provider will insert two fingers inside the vagina next to the baby’s head. This is all done between contractions. One half of the forceps is inserted into the vaginal canal beside the baby’s head. The second tong is then applied opposite the first one. They are clamped together. During the next several contractions, traction is applied to the baby’s head while the mother pushes. Usually, this results in a normal vaginal delivery. The tongs are disengaged when delivery is imminent.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here