A forceps delivery is basically a type of assisted vaginal delivery, which is at times needed to ‘assist’ childbirth. When it comes to a forceps delivery, forceps, which are an instrument shaped like a pair of salad tongs or large spoons, are applied by the healthcare provider to the baby’s head in order to guide the baby out of the birth canal. This procedure is typically performed while the mother is pushing during a contraction.
A forceps delivery may be recommended by your healthcare provider during the second stage of labor while you’re pushing. It is mostly performed if labor doesn’t progress or in case the baby’s safety becomes dependent on an immediate delivery. Here’s a look into all you should know about this form of assisted vaginal delivery:
7 Why is a forceps assisted delivery performed?
A forceps assisted delivery may be taken into consideration when you start meeting a certain criteria. This includes:
- Your membranes have ruptured
- Your cervix is fully dilated
- Your baby has descended into the birth canal but you are being unable to push him out
What you need to bear in mind is the fact that a forceps delivery is best performed in a hospital or birthing center so that a C-section may be performed immediately, if needed.
A forceps delivery might be recommended by your healthcare provider if:
1. Your baby’s heartbeat is suggestive of a problem – In case your doctor becomes concerned about changes in your baby’s heartbeat and believes he should be immediately delivered.
2. You’re pushing, but your labor is not progressing – If this is the first time that you’re giving birth, labor will be considered stalled if you’ve pushed for about two to three hours without any progress. However, if you’ve given birth before, your labor will be considered stalled if you’ve pushed for about an hour or two without any progress and this is when you might be recommended to have a forceps assisted delivery.
3. Your baby is facing the wrong direction – Your healthcare provider may also recommend a forceps assisted delivery if your baby is facing up instead of down.
6 What will happen during such a delivery?
In order to block pain, your doctor may administer certain medicines including a numbing medicine placed in the vagina or an epidural block. Next, the forceps are going to be carefully placed on your baby’s head. Once a contraction comes on, your health care provider will ask you to push again while she gently pulls your baby to help you deliver.
Once your baby’s head is delivered by the doctor, you will have to push the baby the rest of the way out. As long as your baby is doing well, you will be able to hold him on your tummy right after delivery. However, you need to bear in mind the fact that a C-section may be required if the forceps do not assist in moving your baby.
Points to consider
Having a forceps assisted delivery is far more risky for the mother as compared to the baby. This is because there is a greater chance for the mother having tears in her perineum, cervix, vagina and anal sphincter.
5 What are the risks involved?
There are quite a few risks involved in a forceps assisted delivery. Some of these are:
- Tears and wounds in the lower genital tract
- Pain in the perineum after delivery (the tissue found between your vagina and anus)
- Short-term or long-term urinary and/or fecal incontinence
- Difficulty urinating or emptying your bladder
- Uterine rupture – a condition in which the uterine wall becomes torn, thereby making it possible for your baby or placenta to be pushed into your abdominal cavity
Other risks to the mother
Apart from the risks mentioned above, the mother may also be at risk of suffering from anemia that is triggered by severe blood loss during delivery. Also, the mother’s bladder or urethra may get injured and the muscles and ligaments supporting her pelvic organs may weaken as well. This may lead to a pelvic organ prolapse in which the pelvic organs drop lower in the pelvis.
4 What happens before a forceps assisted delivery?
Your doctor will explain the reasons why it is important for you to have a forceps assisted delivery. For this, she will examine you internally and observe your bump to check your baby’s position. This is basically meant to help her make sure that a forceps delivery is the right thing to do. In case a forceps assisted delivery may be difficult, you will be moved to the operating theatre so that a C-section may be performed immediately.
Just so you know, it may not be possible for you to have a successful forceps assisted delivery if:
- Your baby is large
- Your baby’s head is not low down in the birth canal
- Your body mass index or BMI is over 30
- Your baby is lying back-to-back
If a forceps assisted delivery is possible, your legs are going to be placed in stirrups for the procedure to be performed. In order to empty your bladder, a catheter attached to a bag will be placed inside your bladder – a word of caution, this may be a little uncomfortable. You will also receive pain relief in the form of an epidural, spinal block or an injection inside your vagina.
3 Risks to the baby
The risks that your baby may face during and after a forceps assisted delivery are:
- Your baby’s head may swell or appear cone-shaped. However, this is natural in childbirth and it usually goes away in a day or two.
- While this rarely happens, your baby may get cut from the forceps and start bleeding.
- There may be bruises, bumps or marks on your baby’s face or head – these will take a few weeks to heal.
- The pressure from the forceps may injure your baby’s nerves.
In case your baby’s nerves get injured, his face muscles may droop as well. However, once the nerves start healing, these muscles will go back to normal. Also, although extremely rare, but your baby may bleed inside their head.
Other risks that your baby may be exposed to
Your baby can become permanently injured in case the physician improperly uses forceps and doesn’t move on to a C-section quickly enough. Physicians sometimes use forceps to rotate the baby’s head when the head is not in line with the mother’s pelvis. If the first attempt at rotation is not successful and the procedure is stopped, the standard procedure of care requires that the use of forceps be stopped and that the physician proceed immediately to C-section delivery.
A forceps assisted delivery will not be possible if any of these prerequisites are not met. The contractions to forceps are typically inclusive of:
- Cephalopelvic disproportion or CPD, which is a condition in which the baby’s head is too large to pass through the mother’s pelvis
- The baby is less than 34 weeks gestation – in such a case, there is a higher risk of fetal intraventricular hemorrhage
- Fetal demineralization disease, fetal bleeding diatheses or connective tissue disorders
Something to Remember
The American College of Obstetricians and Gynecologists (ACOG) suggests that physicians should only use a single delivery instrument during a birth. What this means is that multiple instruments should not be used for different birthing attempts. Thus, if forceps have been used, a vacuum extractor may not subsequently be used to deliver the baby. If a baby cannot be delivered by forceps, the physician must move on to a C-section.
1 What about recovery?
If you receive more than a tiny tear, you will definitely need stitches that are going to take a few weeks to fully heal. However, there is also the chance that the tissue around an episiotomy will tear, which means that you will have a laceration that goes through or into the anal sphincter, thereby increasing your chances of experiencing gas or fecal incontinence. This type of tear can occur in any type of vaginal birth, though it's more common with an assisted delivery.
After the sort of prolonged delivery that requires the use of forceps, you may find it difficult to go to the bathroom, or you may experience urine leaks because of temporary changes in your pelvic and perineal nerves and muscles.
You may be constipated
That’s right, if you keep resisting your bowel movements due to the pain being felt from your episiotomy or tears, there’s also the chance that you will end up being constipated.