Forceps Delivery: What Moms Need to Know

What is forceps delivery?

Forceps are a smooth, metal medical device shaped like a large pair of spoons or tongs. They’re used to help guide a baby’s head out of the vagina during delivery. During delivery, the forceps are applied to the head and your obstetrician will gently guide the baby out during a contraction as you push. They’re inserted right before a contraction begins, and they gently guide your baby's head out while you push, rotating the head if necessary and helping a tired mother deliver a stuck baby.

This procedure is performed during what’s referred to as the second phase of labor — when the cervix is fully dilated (open 10 cm), and you’re actively pushing. Operative vaginal delivery (delivery that's aided with medical tools) isn’t intended to help you become dilated or move the baby from the womb through the vagina. In fact, looking at a pair of forceps, you'll notice they aren’t overly long. Your doctor will need the shorter handles to be able to best gauge the passage of your baby through the birth canal.

Generally, if your cervix is fully dilated, the membranes are ruptured, you are pushing, and the baby has descended into the birth canal, but your labor isn’t progressing, so your doctor may choose forceps over performing a cesarean section (C-section) delivery. It’s important to understand the risks of using forceps, when they may be needed, and how your doctor will perform the procedure if your labor stalls. There are certain physical characteristics of a woman’s body, as well as certain health conditions, that may increase the chances that forceps will be used during your delivery, although they are currently used in just around 0.5% of deliveries.

When is forceps delivery needed?

Forceps-assisted delivery is most common when labor has stalled and the mother isn’t able to push the baby out. At this point, the cervix will be fully dilated, the fluid-filled amniotic sac has ruptured (also known as water breaking), and the baby is already headfirst in the birth canal.

Your doctor may choose to deliver with forceps if you aren’t able to push the baby out, especially if your baby’s heartbeat suggests a problem. Prolonged delivery can lead to fetal distress, which can have severe health effects on the baby, including death. In these cases, an immediate delivery is needed. While this sometimes necessitates a C-section, that procedure is a major surgery, and you may have risk factors that can make it dangerous.

For the mother, certain health concerns like high blood pressure, preeclampsia, or heart disease may restrict the amount of time your primary health care provider wants you in advanced labor.

Benefits of forceps delivery

The benefits of forceps delivery mostly center around avoiding a C-section delivery — a major surgery that has such risks as infection and heavy bleeding — and reducing the amount of time spent in active labor. They’re generally meant to protect the mother’s health, although your doctor may choose to use forceps to speed up delivery if the baby begins to show fetal distress.

If you’re trying to have a vaginal birth after a previous C-section (called a VBAC), then using forceps to hasten delivery may be something you and your OB-GYN wish to discuss. Repeated C-section surgeries carry increased risk factors, but a VBAC does as well. For your own peace of mind, it’s important to explore all possibilities when constructing your birth plan.

Risks of forceps delivery for the baby

The use of forceps is low and when performed by a qualified health care professional carries a very low risk of injury to the baby. The most common injury to the baby from forceps is minor facial scrapes and scratches. Some babies may experience injuries of scalp and head, temporary weakness of the facial muscles (facial palsy), and external eye trauma.

More serious risks from forceps — although extremely rare — can include a skull fracture, bleeding within the skull, or seizures. This is why it’s important that a forceps delivery is only performed in a hospital.

This medical technique is generally not performed on babies under 34 weeks of gestational age. The head and skull need to have reached a certain size and density in order for the procedure to be performed safely. 

Risks of forceps delivery for the mother

Using forceps to assist delivery can cause injuries for the mother, typically lacerations in the vagina and perineum (the area between your vagina and anus). Depending on the degree of lacerations, these injuries can lead to long-term incontinence for both urination and defecation or may cause the muscles that control your urethra and bowels to weaken, making it more difficult to clench or contract these openings. However, these difficulties may heal on their own, especially if you practice exercises to strengthen the pelvic floor.

Other risks for the mother include blood loss and, as a consequence, anemia. More severe complications can include pelvic organ prolapse, and these two complications may not show up right away. They may not be discovered until months after delivery.

An episiotomy is sometimes performed before the forceps are used to help increase the size of the vaginal opening and make it easier for the doctor to insert the instrument. An episiotomy is a small incision that widens the opening of the vagina. This is usually treated with a few stitches after delivery, although this, too, can be painful and become infected due to improper hygiene.

How is forceps delivery performed?

To begin, the mother lies back at an angle with legs spread apart, sometimes holding the sides of the bed to assist with pushing or if they’re nervous. In between contractions, the doctor will check the position of the baby’s head using their fingers inside the vagina. They will insert the forceps, guiding first one side and then the other using their hand as a guide between the vaginal wall and baby’s head.

Once both sides of the forceps are in place, the device will be locked together, gently cradling the baby’s head. Beginning with the next contraction, the doctor will gently guide the baby’s head through the vagina during a push, rotating the baby’s head if needed to ensure it’s in the correct position.

The forceps remain locked in place until the obstetrician is certain that the baby is ready to be delivered — usually just before the baby’s head passes through the widest part of the birth canal. At this point, they’ll unlock the two pieces of the forceps and remove them, unless it’s absolutely necessary to guide the baby’s head and control its advance.

Is it possible to prevent forceps delivery?

If you’re having difficulty progressing through the second stage of labor, there are a couple of other options that your health care provider may attempt. You may have your epidural adjusted to encourage more powerful pushing, or you may have a synthetic version of the hormone oxytocin added to your IV to stimulate stronger contractions.

Other alternatives to forceps-assisted vaginal delivery include vacuum-assisted vaginal delivery or a C-section. During the labor process, you may not have the time to weigh all the pros and cons of each medical procedure, which is why, if you prefer to avoid forceps, it’s important that you talk through the other options with your doctor and have a written birth plan in the bag you take to the hospital. You may even be able to attach one to your medical records.

Forceps or vacuum delivery: Which one is better?

A vacuum extraction is a similar type of operative vaginal delivery, using a suction cup attached to the baby’s head and vacuum suction to guide the baby out. This procedure is becoming more common for a few reasons, chiefly that there’s a reduction in lacerations of the perineum. Vacuum-assisted deliveries also don’t need either general or local anesthesia, which forceps deliveries often do.

Many women report less pain in the vagina and perineum after a vacuum delivery.

However, forceps have their own benefits, too. Delivery is typically achieved faster, which is critical for women who have health conditions exacerbated by the delivery process. Successful vaginal delivery — and avoiding a C-section — is also higher with forceps delivery. This is partly because forceps, unlike the vacuum device, don’t detach from the fetal head during use when used correctly. They can also help rotate the head into a better position to travel safely through the birth canal.

While forceps do carry an added threat of lacerations to the skin around the vagina, the incidences of injuries to the baby’s scalp, such as cephalhematoma and subgaleal hematomas, are lower. Ultimately, the use of either of these devices — or neither — is your personal choice. A frank discussion with your obstetrician can help you determine which of these you feel most comfortable with.

Conclusion

A forceps-assisted delivery — or any assisted vaginal delivery procedure — can be a source of anxiety. You can reduce the risks during these procedures by opting to give birth in a hospital with qualified medical professionals. Many women feel that knowledge is power and are more comfortable understanding when and why certain procedures may be performed and their process. Choosing your own birth plan can also help you remain calm during the stress of delivery. Finally, if your doctor does feel that forceps are necessary for safe delivery, be assured that the risks of injury to you or your baby are very low.