Forceps Delivery

This involves the application of metal instruments that look like a pair of large salad tongs around a baby’s head, so that the OB can help to pull the baby out as the mother is pushing. The OB can pull harder with forceps than with a vacuum, and less maternal effort is needed.

It is most commonly recommended when the 2nd stage (pushing) is prolonged, and the woman is exhausted, or when there is a concern over fetal well-being during pushing.

A forceps-assisted delivery is only safe when the head is low enough, but it does not have to be as low as with a vacuum-assisted birth. If the head is very low, and the OB is fairly certain that the forceps will be successful, the procedure might be done in the labour room. If the head is not so low, or if success is not certain, a ‘trial of forceps’ may be done in the Operating Room (OR), where immediate conversion to an emergency C-section can occur. While it requires a fair amount a pulling to get the baby out, the OB will be careful to avoid excess force, and convert to a C-section when necessary.

If the woman has an epidural, it will be topped-up to make it stronger for a painless procedure. Pressure sensations will still be felt. If there is no epidural, a spinal anesthetic will be administered. In dire emergencies, a pudendal block might be given by the OB, but this is uncommon.

While the forceps may look scary, they actually do a good job of cradling and protecting the baby’s head during the birth. It’s not unusual to see red marks on the baby’s cheeks and these go away quickly. Tearing of the skin is rare. Severe injuries to the baby (skull fractures, intracranial bleeding, nerve injuries) are fortunately very rare, and the OB will explain all of the risks in detail before proceeding.

Forceps sit beside the baby’s head, and take up extra room in the pelvis. Unfortunately, this can lead to more severe perineal tears. The OB will remove the forceps as early as possible to reduce the risk of tearing, and an episiotomy may be necessary. Even with optimal technique, the risk of a 3rd degree tear (involving the anal sphincter) is about 20-25%. Our OBs are highly trained in complex repairs, and outcomes are generally good when repairs are done properly. If there is a sphincter injury, proper perineal care will be explained. In addition to good pain relief, avoiding constipation is imperative.

Because of the increased risks associated with forceps deliveries, women will often be presented with the alternative choice of a C-section, and the pros and cons of both options will be reviewed.