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Forceps…Is it that Scary?? By Dr Bianca Bryce

We have had requests to talk about instrumental births – that is, forceps or ventouse (‘the vacuum cup’).  There are similarities between the two but given my inability to be succinct I will divide them into two separate posts.  First, forceps.

Many women and families have heard negative stories of forceps births, and may be scared of these instruments.  When they are used correctly, though, they can be life saving, and even calm and elegant.  I can see where the fear comes from though, they look (and sound) scary.  Imagine a pair of metal salad servers and you will have a rough idea of what they look like.  But I’m getting ahead of myself…

The forceps or the ventouse are only able to be used in the second stage of labour – when your cervix is fully dilated (10cm).  They may be needed either for slow progress in second stage (when you have been pushing for what can sometimes be hours without the birth being imminent), or for suspected ‘fetal distress’ – when your baby is showing signs of being tired and perhaps becoming low on oxygen.  They are also sometimes used for what we call ‘maternal exhaustion’ – many women find that at some stage during the pushing phase they feel like they don’t have the energy to continue pushing (especially with a first labour), and while most women will find that last shred of energy to push out their baby naturally, occasionally this doesn’t happen.

So what actually happens once that decision is made?  The obstetrician will need to confirm which position your baby is in (with a check of your tummy and a vaginal examination, and sometimes a quick ultrasound).  They will usually ask the neonatal team (the baby doctors) to be in the room for the birth, as sometimes babies born by forceps (or ventouse) are a little stunned or slow to breathe at birth.  They should make sure that you have some sort of pain relief available (this may be an epidural, especially if you already have one or the baby is well and there is time to give one; there is also the option to give some local anaesthetic, either directly into your perineum, or internally (called a pudendal block)).  They need to make sure that your bladder is empty and this is usually done by putting a small tube in to your bladder to empty any urine out.  Then the forceps are gently applied one at a time so that they cup the baby’s head – they are designed to sit in a particular position around the baby’s head and not to squeeze too tightly, so as long as your baby is in the correct position they should not damage the baby’s skull or brain at all.  Then the obstetrician can help you out to guide the baby around that last corner of the birth canal – usually they will pull while you push with a contraction, but the forceps can be used without a contraction if time is really of the essence, and this is one of the reasons why the forceps may be chosen rather than the ventouse.Once a decision has been made that an instrumental birth is recommended, the decision to use forceps vs ventouse is a complex one, based on many factors (which I’ll talk about a bit later).  This decision is really one that your obstetrician needs to make, and although they should take your wishes into account when weighing up the decision, ultimately this is one situation where you need to trust your obstetrician to do what they feel is best for you and your baby.

The forceps do usually leave small marks on the baby’s face, and these will fade quickly but may turn into bruises which will disappear naturally with time.  The other ‘catch’ with forceps is that they can increase your chance of perineal tearing, and for this reason it is common for your obstetrician to cut an episiotomy, to decrease the chance of bigger tears (into the bottom). This should not hurt as you (hopefully) will already have that pain relief we talked about, and will be fixed with dissolvable stitches after the birth.

Back to that decision on ventouse vs forceps.  As I said, it is very much up to the obstetrician.  Some doctors feel more comfortable and have a lot more experience with one or the other, and so that is what they will (usually) choose.  For the forceps to be safe, your baby needs to be in either the direct occipito-anterior (looking down towards your bottom), or direct occipito-posterior (looking up at your pubic bone) position (or up to 45 degrees either side of these positions).  If the baby is in a different position, your obstetrician may choose to use the ventouse instead, or may be able to encourage your baby to turn using their fingers and your pushing with a vaginal examination over a few contractions.  This is a safe way to ensure that the forceps are used correctly and in the safest way for your baby.  The forceps can also be especially useful if your baby is not very low in your pelvis, or if it is difficult for you to push effectively, but again, this will depend on your obstetrician.  The forceps are often felt to be a little gentler on the baby than the ventouse, and for this reason they can be used on premature babies (less than 34 weeks) when the ventouse would not be recommended.

Hopefully this post may have helped correct some of the misconceptions and myths that come with the dreaded word ‘forceps’.  I wish all of you a beautiful normal vaginal birth, but if this is not to be and you do end up needing a forceps birth, rejoice in the fact that you have birthed your baby vaginally.  And you can rest assured that this has no bearing on your next pregnancy and birth, and you are very likely to breeze through a normal vaginal birth next time.

 

By Dr Bianca

 

(This article contains general information only and is not intended to replace advice from a qualified health professional. All information is written from the experience and knowledge of the person writing the post).