Forceps delivery

Forceps Delivery is an option to deliver the baby if the vaginal delivery is in the final stages but is not moving forward due to various reasons and the baby’s health is at stake. 

Forceps look like giant tongs and are used by the doctor to pull the baby out from the birth canal when a cesarean also known as a C-section is to be avoided. This form of birth is also called assisted birth and is considered a safe method for delivery. However, women who have had a normal vaginal delivery before may not require any assisted birth techniques like forceps or vacuum. If the assisted techniques like forceps and vacuum fail, the c-section is opted.

Forceps have curved edges at the end to hold the baby’s head. They are shaped in a way that they fit in the pelvic region well. The doctor uses different kinds of forceps for the delivery of breech or rotated babies.

When Are Forceps Used During Delivery:

There are certain indications when the doctor may choose to use an assisted birth technique.

• The baby is in the second stage which is the pushing stage but somehow the mother is unable to push and the birthing is stalled.
• The mother has a health condition that makes pushing more stressful for them.
• The baby is halfway in the birthing canal and the team of doctors is aware of the baby’s exact position.
• The baby’s heart rate shows that the baby is under stress caused due to labor and is not getting enough oxygen in the birth canal. Thus making it vital to pull the baby out as soon as possible.

When Is The Forceps Delivery Not Recommended:

There are certain contraindications for using forceps. They include:

• The cervix of the mother is not completely dilated.
• The baby is over six weeks premature.
• The baby had developed bleeding or a bone condition.
• The baby has their legs and arms facing toward the vagina.
• The doctor is unable to find out the position of the baby in the birth canal.
• The baby appears to not fit into the birth canal.

What Does The Forceps Delivery Procedure Involve:

• The doctor and the medical team require consent from the mother or the couple to choose this form of assisted birth. If the doctor has discussed the options of delivery earlier, they will inform the mother that they need to opt for the procedure and let them know about the risks involved. 
• Painkillers are given if the mother has consented to forceps delivery.
• The water is broken artificially if it hasn’t already and the bladder is drained with the help of a catheter. This is done to make more space in the birth canal. Sometimes the doctor may perform a procedure called episiotomy which involves making an incision in the perineum (the area between the anus and vulva in females) to accommodate the forceps.
• The mother is asked to lie on their back with their feet apart. They are encouraged to continue pushing when the contractions appear. The doctor uses the intervals between the contractions to place the forceps and gently pull the baby out along with the pushing force applied by the mother. If the baby’s position needs to be changed during delivery the doctor uses the time between the contractions to adjust the position of the baby with the forceps. 
• The forceps are used only if needed.
• If the position of the baby, needs adjustment then the doctor may remove the forceps after doing that. If the baby needs help pushing only the head through the birth canal, the forceps are used for that and released. In most cases, the forceps need to be engaged only three to four times and if they don’t help in the delivery the doctor removes them.
• If the forceps are successfully used, the delivery is completed in a normal way or else the doctor may recommend a c-section.
• Once the baby is out the doctor checks the baby for any injuries or wounds. If the mother has any tear or injury it is treated immediately with stitches.
• The baby is monitored for any complications for the next few hours.
• The mother may take a little longer to recover after a forceps delivery due to the stitches taken to seal the tearing. Severe tearing takes longer to heal.
• The mother is asked to wear a pad for vaginal bleeding and the pain can be taken care of by painkillers.
• The doctor should be contacted if there is excessive bleeding or the pain is severe and fails to subside with painkillers.

Risks Involved In Using Forceps During Delivery:

• There are chances of vaginal tearing or episiotomy while using forceps which needs to be taken care of with stitches. Sometimes the tear is severe and involves the tearing of the muscle or the wall of the anus or rectum. 
• The using of forceps increases the risk of blood clots in the veins of the legs or the pelvic region. This can be prevented by moving around after childbirth. Wearing anti-clot stockings and certain medications helps the blood to clot less.
• Though urinary incontinence is common after childbirth, forceps increase the condition. Physiotherapy and certain pelvic floor exercises help in managing the problem.
• The forceps can also increase the occurrence of anal incontinence which involves involuntary farting or leaking of stools due to the tears.
• The forceps can leave a mark on the baby’s head or face which usually goes away after 2 days. In some rare cases, the use of forceps may leave a cut on the baby’s scalp or face. However, these injuries also heal within some time. 
• The baby can develop jaundice.
• The forceps can damage the baby’s nerves and cause muscle weakness for a few weeks.
• The babies have very soft skulls which can fracture during a forceps delivery and heal within some time on their own without causing any damage.
• Some babies can have internal bleeding and may require continuous monitoring.

Conclusion:

A forceps delivery may pose multiple risks in some cases but most of the time, it is a safe procedure that helps in the birthing process when the baby or the mother is in some kind of distress and unable to continue with the delivery. Forceps delivery may not always be a planned delivery and the doctor may decide on the procedure after considering various factors to ensure that the mother and the baby are safe.

The mother and their family need to discuss the process and the potential complications in detail with the doctor to make an informed decision to avoid any confusion and miscommunication later.