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Forceps delivery

Extracted from Myles Textbook for Midwives 15th Edition. Diane M. Fraser, Margaret A. Cooper (Eds). London; Churchill Livingstone: 2009. Courtesy Elsevier.

Figures 15, 16, 17, 18

[Legend] Technique for forceps delivery

Forceps delivery is one of the alternatives (the other being ventouse) for assisted or operative (instrumental) vaginal delivery, used when the mother is unable to give birth without medical or surgical assistance. Assisted vaginal birth is a widely practised intervention, accounting for approximately 11 per cent of births in the UK, and 15% in Australia and Canada. Women who use epidural analgesia are at increased risk of having an instrumental assisted birth.

Forceps are most commonly used to expedite the birth of the head, or to protect the fetus or the mother or both from trauma and exhaustion. Forceps are also used to assist the delivery of the after-coming head of the breech.

Obstetric forceps are composed of two separate blades, right and left, that are inserted separately on each side of the head and then locked together. The blades are spoon shaped (cephalic curve) to accommodate the form of the baby's head.

Forceps deliveries fall into two categories, low and mid-cavity. High cavity forceps are now considered unsafe and a caesarean section will be carried out instead.

The main indications for a forceps delivery are delay in the second stage of labour, fetal compromise, and maternal distress.

Prior to forceps delivery, ensure:

  • The woman's bladder is empty to prevent injury;
  • Adequate analgesia is provided (epidural or pudendal block plus perineal infiltration of local anaesthetic
  • Information is given and consent obtained
  • Paediatrician or advanced neonatal practitioner is informed and available if required
  • Neonatal resuscitation equipment is checked and prepared in case it is necessary

Further reading

Royal College of Obstetricians & Gynaecologists (2011) Operative vaginal delivery. Green-top guideline No 26. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg26.pdf

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