5 misconceptions about forceps

The forceps is a medical instrument that facilitates the extraction of the baby during delivery. Target of many received ideas, it is sometimes seen as an object of torture by expectant mothers. We unravel the true from the false.

“Forceps” is a Latin word for pincers. It is a metallic instrument made up of two branches in the shape of large hollowed out spoons, articulated together. The branches reproduce the woman's pelvic curvature to adapt as much as possible to her anatomy. Each branch is placed on either side of the baby's head during childbirth to guide it through the genital tract and thus facilitate its exit through the mother's vagina.
The pose and traction depends on the type of forceps. There are the forceps with converging branches and forceps with crossed branches (crossed on an axis). The most used forceps in France are Suzor forceps (with converging branches) and Tarnier forceps (with crossed branches) equipped with a tractor.

Forceps can only be used by an obstetrician-gynecologist. Midwives are not empowered with instrumental extraction (forceps, suction cup, spatulas) to deliver women.
In France, over a quarter of vaginal instrumental deliveries are performed using forceps.

Forceps are used to fetch the baby from the womb

Forceps are used to fetch the baby from the womb
No, the forceps are not designed to pick up the baby “stuck” in the womb.
The use of forceps is considered when the baby is already engaged in the pelvis, that is to say at the end of delivery, during the expulsion phase and in certain specific indications:

  • when the mother can’t push enough during the contractions.
  • when there is fetal distress: the baby may lack oxygen and have abnormal heart rhythms.
  • when the expulsion work lasts more than 30 min and the head of the fetus does not progress into the pelvis.
  • when the mother suffers from a disease for which pushing efforts are contraindicated (heart disease, respiratory disease, pre-eclampsia …).

The obstetrician may use forceps provided that:

  • the cervix is ​​dilated to 10 cm.
  • the water pocket is broken.
  • the baby is engaged in the upper strait of the pelvis (upper part of the pelvis), with a presentation of the head first. He can be in the anterior position (his face down, his back against his mother's belly) or in the posterior position (his face up, his back against his mother's spine).

Forceps hurt

The doctor inserts the branches of the forceps between two contractions and does it in two stages. He introduces a first branch on the left side of the baby's head, then introduces the second branch on the right side of the baby's head. The branches of the forceps are lubricated and do not compress the head of the fetus since they are fixed. A baby's head caught between the forceps, he asks the patient to push each contraction while exerting a traction to guide the baby's head towards the exit. When the head is sufficiently advanced, the forceps are removed and the doctor finishes the delivery naturally.
Forceps are never used without anesthesia. The mother is either under epidural or anesthetized locally (drowsiness of the nerves of the perineum).

As for the baby, the use of forceps does not constitute suffering for him. On the contrary, they help him get out of a situation that could be dangerous for him. A baby stuck in the pelvis for too long can get tired and have abnormal heart rhythms.

Forceps always cause tears

The use of forceps increases the risk of tearing (dilation of the perineum is faster), but it is not systematic. It results in a rupture of the tissues of the perineal region which can go up to the anal region. To avoid this maternal complication, the medical team often decides to perform an episiotomy. This incision makes it possible to limit the extent of the tear and therefore the complications in the long term such as stress urinary incontinence or anal incontinence. The introduction of forceps without episiotomy can indeed cause larger tears that can affect the anal sphincter, but this is rare.
Be careful, this does not mean that the episiotomy is systematic in case of forceps. It is up to the doctor to decide by evaluating several parameters such as the flexibility of the patient's perineum, the size of the baby, the urgency of getting the baby out …
However, if the fetus does not progress in the pelvis despite the forceps, the doctor must abandon this delivery route after 3 unsuccessful pulls.

Forceps distort baby's head

This is one of the main fears of the pregnant woman regarding forceps and yet it is unfounded. Indeed, the forceps clamps are fixed, they cannot compress the baby's skull. The baby may have slight red marks on the cheeks, temples and ears, but they usually disappear 24 to 48 hours after birth. If the head of the newborn baby is deformed, this is due to its passage through the mother's pelvis, but never from the forceps.
Skull fracture with depression of the fractured part is possible when using forceps but it is rare. On the other hand, forceps cannot induce neurocognitive sequelae in children.

Cesarean section is safer for babies than forceps

For those who would prefer to go through the caesarean section rather than the forceps, know that the use of forceps is more judicious. First of all, you should know that the use of instruments during childbirth allows above all the parturient to avoid the cesarean section. As we know, women who deliver vaginally often recover faster than those who have had a cesarean. But that's not all, forceps are less invasive for the baby than cesarean. According to a study published in the journal Obstetrics & Gynecology in 2012, babies born vaginally with forceps had a 55% lower risk of neonatal seizures compared to those born by cesarean or with suction cup. Also, babies born using instruments are less likely to have an Apgar score below 7 (test which assesses the vitality of a newborn. A score below 7 indicates a or failures) than those born by cesarean.

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Also read on aufeminin
7 things I wish I had been told before giving birth
Episiotomy, an essential gesture?
Why should women no longer give birth on their backs?
Childbirth without an epidural: how to prepare for it and manage pain?

Assisted delivery: how does the suction cup work?


Video by Nathalie Barenghi