How and Why a Baby Is Delivered by Forceps

In the mid-1500s William Chamberlen invented the obstetrics forceps, an instrument that changed the practice of obstetrics, or midwifery. Forceps were considered so amazing and so valuable that the Chamberlens guarded the design as a family secret for more than 100 years. During that time, the family became socially prominent and financially successful. In fact, when a descendent of the Chamberlen family was finally persuaded to sell the forceps for a tidy profit, he sold only half of the instrument, thus rendering it useless. Ultimately, however, the secret of the design was revealed and the lives of many women and babies were saved.

Obstetrical forceps were designed to solve the problem of the baby getting stuck in the birth canal, due to its size or position, during pushing. Using forceps enables the physician to pull the baby out. Until this century, when Caesarean sections, or C-sections, became possible, the use of forceps was the only technique available for treating this condition.

Forceps can be used only after the cervix is fully dilated and the head has begun to descend through the pelvis. If the fetal head stops descending despite good maternal pushing efforts, the use of forceps may be indicated. They are also helpful in situations in which the head has been descending slowly, but an immediate delivery is indicated because of fetal distress, or when the mother has become too exhausted to push anymore.

Modern forceps come in many types and are used in several circumstances. They look like large tongs. The two individual pieces (known as blades) are inserted separately into the vagina and guided into the appropriate position around the baby's head. Then the handles are locked together. When the next contraction comes, the obstetrician pulls on the forceps. These pulling forces, added to the pushing forces of the uterus, will cause the head to descend further. Often, several contractions are required before the head begins to crown. A generous episiotomy must be made to accommodate the baby's head with the forceps around it. The rest of the delivery is accomplished in the usual way.

The use of forceps is not without risk. Forceps can cause temporary or permanent injury to the baby or the mother, especially if they are used to turn the baby from an unfavorable position to a favorable one. As Caesarean sections have become safer, they are often recommended instead of forceps delivery because the risk of injuring the baby during a C-section is very small. This is one reason the rate of Caesarean deliveries has risen over the last few decades.

How would you know if a forceps delivery would be right for you? As stated above, forceps can be used only when the cervix is fully dilated and the baby's head has begun to descend through the pelvis. Perhaps you have been pushing well, but delivery is still an hour off and the fetal monitor shows signs of fetal distress. Perhaps you have pushed the baby's head down to +3 station, but it will go no further despite additional pushing. These are typical situations in which forceps may be recommended.

Unless the baby's head is very low (+4), there may be some discussion of a C-section versus a forceps delivery. That's because forceps cannot deliver a baby that is too big to fit. This is a common reason for the head to stop descending despite the fact that you may be doing a good job of pushing. If the baby is too big to fit, attempts to pull it through can cause serious injury. That's why the decision whether to use forceps must be made only by an obstetrician highly trained in their use.

If, after discussion, forceps seem to be your best choice, you will be given a spinal or an epidural anesthetic, if you have not already received one. (Forceps are large metal instruments, and placing them in the vagina would cause too much pain if anesthesia were not used.) Then, your bladder will be emptied with a catheter, both to provide additional room and to avoid injury to the bladder. If your bladder is full, it may be injured by pressure from the forceps.

It is possible that the delivery may not be accomplished even with the use of the forceps. If the baby is too large, or the position too unfavorable, the head might not descend even after forceps are applied. In that case, Caesarean section is the treatment of choice.

Babies born by forceps delivery often have temporary marks on their faces and heads from the instrument. These marks heal quickly and are no cause for concern.

It is important to remember that a forceps delivery is a medical procedure, with the possible risks that that implies. Forceps should be used only for a medical reason and not because you don't want to push. It is far better to push the baby out on your own than to have it pulled out.