Forceps Delivery Procedures

Updated: Apr 11, 2017
  • Author: Michael G Ross, MD, MPH; Chief Editor: Nicole W Karjane, MD  more...
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Overview

Background

A forceps is an instrument designed to aid in the delivery of the fetus by applying traction to the fetal head. Many different types of forceps have been described and developed. Generally, a forceps consists of 2 mirror-image metal instruments that are articulated. The blades of the forceps are maneuvered to cradle the fetal head, after which traction is applied to effect delivery.

It is important to emphasize that forceps delivery is skill-dependent and training-dependent. The operator must have a clear understanding of his or her own capabilities, as well as the safe limits of the procedure, and must not exceed either of these.

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Indications

The following indications for forceps-assisted delivery apply when no contraindications exist [1, 2] :

  • Prolonged second stage of labor - This includes nulliparous women with failure to deliver after 2 hours without and 3 hours with conduction anesthesia; it also includes multiparous women with failure to deliver after 1 hour without and 2 hours with conduction anesthesia
  • Suspicion of immediate or potential fetal compromise in the second stage of labor
  • Shortening of the second stage of labor to benefit the mother - Maternal indications include, but are not limited to, exhaustion, bleeding, cardiac or pulmonary disease, and a history of spontaneous pneumothorax
  • In skilled hands, fetal malposition, including the after-coming head in breech vaginal delivery, can be indications for forceps delivery.

Prerequisites for forceps delivery include the following [2] :

  • The head must be engaged
  • The cervix must be fully dilated and retracted
  • The position of the head must be known
  • Clinical assessment of pelvic capacity should be performed; no disproportion should be suspected between the size of the head and the size of the pelvic inlet and midpelvis
  • The membranes must be ruptured
  • The patient must have adequate analgesia
  • Adequate facilities and supportive elements should be available
  • The operator should be competent in the use of the instruments and the recognition and management of potential complications; he or she should also know when to abort a procedure that is not proceeding appropriately
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Contraindications

The following are contraindications to forceps-assisted vaginal deliveries:

  • Any contraindication to vaginal delivery (see Normal Labor and Delivery)
  • Inability to obtain adequate verbal consent
  • A cervix that is not fully dilated or retracted
  • Inability to determine the presentation and fetal head position
  • Inadequate pelvic size
  • Confirmed cephalopelvic disproportion
  • Unsuccessful trial of vacuum extraction (relative contraindication)
  • Absence of adequate anesthesia or analgesia (relative contraindication)
  • Inadequate facilities and support staff
  • An insufficiently experienced operator
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