Sometimes your baby needs help during the pushing stage of labour and your obstetrician may use forceps to deliver him.
What is a forceps birth?
A forceps birth is an assisted birth where a pair of forceps are used to help deliver your baby. Forceps are smooth metal instruments that look a bit like large salad tongs. They come apart separately, but can click together. They’re curved to fit around your baby’s head and cradle it, not squash it. During a contraction and while you push, an obstetrician will gently pull with the forceps to help deliver your baby.
When are forceps used during birth?
If during labour your baby’s progress down the birth canal has slowed down, if shoulder dystocia occurs or he’s becoming distressed, your midwife may consult an obstetrician about the possibility of doing an assisted delivery. This means he’ll use either a ventouse or forceps to help your baby be born. You may also have an assisted birth if you've been advised not to, or can't, push during delivery, or you're having a vaginal delivery of a premature baby.
Are forceps births dangerous?
Forceps births are safe and are only used when necessary for you and your baby, however there are some risks which should be discussed with you.
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Vaginal tearing or episiotomy - this is a cut made in the area between your vagina and anus (the perineum). Even without a forceps or ventouse the perineum may split. It is mended with dissolvable stitches.
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Blood clots - assisted births increase the risk of blood clots in the veins in your legs and pelvis. This can be prevented by moving as much as you can after the birth
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3rd or 4th degree tear - this a vaginal tear that involves the muscle or wall of the anus or rectum. It happens to 8 to 12 in every 100 women during a forceps delivery and you'll need stitches after birth.
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Bladder and bowel problems - urinary incontinence is common after giving birth, but more so after an assisted birth. You will be given advice on ways to help ease this. Anal incontinence, again, is common after birth, but more so if you’ve experienced a 3rd or 4th degree tear.
Deciding on an assisted delivery
‘Your baby needs to be in good shape for an assisted delivery – this means that he has a strong, healthy heart rate and is not in distress,’ says Christian Barnick, a consultant obstetrician and gynaecologist at The Portland Hospital. ‘You need to be 10cm dilated and your baby’s head needs to be at the opening of the cervix and fully engaged.’
Before the procedure goes ahead, your obstetrician may first try a ventouse delivery as this causes less internal issues than forceps. If this doesn’t work, your obstetrician will reassess and decide if your baby can take another attempt at an assisted delivery, and move onto forceps.
‘Forceps are often used if the baby needs to be born quickly, as they’re a much faster method of delivery,’ says Christian. ‘However, they can be slightly more painful.’
What happens during a forceps delivery?
You will be given some form of pain relief before the forceps are inserted. ‘We’d usually recommend an epidural if this hasn’t already been given, or a pudendal block. This is when anaesthetic is injected into a nerve in your vaginal wall to numb any pain in that area,’ says Christian.
If the birthing team are in a rush to get your baby out, there may not be time for an anaesthetist to administer an epidural, and a pudendal block will be faster.
‘The obstetrician will then slide in one part of the forceps, then the other, fit them together, and then when you have your next contraction, he’ll ask you to push while he pulls,’ says Christian.
As your baby’s head is crowning, the obstetrician may make a small cut on the skin at the edge of your vagina, called the perineum, which is known as an episiotomy. ‘This isn’t always necessary and may not happen, but does in the majority of cases, as it helps your baby’s head be born,’ says Christian.
After the birth
Throughout the delivery, your obstetrician should be chatting to you explaining what is happening. After the birth, you’ll be stitched up if necessary.
‘Your baby may have red marks on his face from the forceps,’ says Christian. ‘These should disappear after a couple of days.’
Forceps can affect your pelvic floor by damaging the muscles around it, although some of the damage may also be caused by a long labour or large baby (which are often the causes of an assisted delivery in the first place).
However, if your baby needs to be born quickly, they’re often the best option. The delivery method that's best suited to your particular circumstances will be used and this can vary from birth to birth.