They resemble some sort of medieval instrument of torture, or if you are more charitable, like oversized salad tongs. In reality, they are obstetrical forceps and although they are rarely used now, at one time they were an invention that made a difficult childbirth a little bit safer.
Forceps births are one form of assisted birth, where the doctor or midwife uses an instrument to help deliver your baby through your birth canal. Another type of assisted birth is vacuum extraction, where a small cup is attached by suction to your baby’s scalp and is used to help pull the baby down through your birth canal.
Why Are Forceps Used in Some Births?
Your obstetrician or midwife might need to use forceps if you are in the second stage of labor, but your labor is not progressing. You are pushing, and your baby’s head has descended into the birth canal, but he or she is not moving any further. The birth is not progressing. This type of assisted birth may be needed if your baby’s heartbeat suggests there might be a problem or if you have become exhausted from pushing.
In a forceps birth, your obstetrician will insert one half of the forceps, then the second half, and cup them around your baby’s head. The halves are then linked together and used to gently pull your baby out of the birth canal. Before the forceps are used, you will receive a local anesthetic if you haven’t already had an epidural. You will probably also need an episiotomy, a cut to the vaginal opening, to allow for the forceps birth. The forceps are removed just before your baby is fully delivered.
What Are the Risks?
The risks of using forceps include a greater risk of damage to your vagina, cervix, bladder or rectum than with an unassisted vaginal birth. The serious risks to your baby are very rare, but can include injuries to the face and head. Most babies that are delivered with forceps may have some marks or bruises on their head and face that fade or go away in a day or so.
The risks to you include the possible need for an episiotomy or of a tear to your vagina occurring. After the delivery, you may have some pain or short-term difficulty with urinating or emptying your bladder. These are complications that may occur with any vaginal birth, but the risk is slightly increased with the use of forceps. If you suffer a tear or have an episiotomy, there is the chance of excess bleeding or infection.
Your doctor will talk with you if a forceps delivery is needed and explain why it is needed and whether there are any other choices. The decision on whether to use forceps or vacuum extraction may depend on which procedure your doctor prefers or is more comfortable with.
How Often Are Forceps Used?
Forceps are used in less than 1% of births in the United States and vacuum extraction is used in under 3% of births, according to the National Center for Health Statistics. In 1990, more than 5% of births in the United States involved forceps and under 4% involved vacuum extraction.
The use of forceps in childbirth has been greatly reduced because cesarean sections have become far more common. But at one time, using forceps was the only choice for delivering a baby when labor had stalled. Until the introduction of anesthesia, sterile surgical technique, and later, blood transfusions, a cesarean was almost always deadly to the mother and was usually attempted only after she had died during the childbirth. Before cesareans, the use of forceps also allowed the delivery of a stillborn baby that was stuck in the birth canal, which had to be done to save the mother’s life.
Although there are some reports of obstetrical forceps being used in India around 1500 BC, the credit for their use in the birth of a living child in Western medicine is usually given to a family named Chamberlen in England in the 1500s. The Chamberlens were surgeons who practiced midwifery. They managed to keep their invention a secret for more than 100 years by ensuring no one saw what they were doing. They would bring the forceps into the birthing room in an oversized box carried by two men, and then take out the forceps (which actually fit easily into a small lightweight case) only after everyone else was sent out of the room and the mother was blindfolded.
Eventually, the secret slipped out and obstetrical forceps became widely used. Hundreds of types and styles of obstetrical forceps have been invented over the years.
You can see a video of a demonstration of forceps delivery (on a mannequin!) here.
You should discuss any possible need for an assisted birth in advance with your obstetrician or midwife. Ask how often they use forceps or vacuum and whether they prefer one method over the other.