Obstetric forceps

Forceps in childbirth
Drawing of childbirth with use of forceps by Smellie
ICD-9-CM	72.0-72.4
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Obstetrical Forceps is an instrument that can be used to assist the delivery of a baby as an alternative to the ventouse (vacuum extraction) method.

Forceps births are, like all assisted births, only undertaken to help promote the expected health of the mother and/or baby. In general, although caveats such as operator skill apply, a forceps birth is likely to be safer for both the mother and baby than the alternatives - either a ventouse birth or a Caesarean section.

Advantages to forceps use include avoidance of caesarean section (and the short and long-term complications that accompany this), reduction of delivery time, general applicability with cephalic presentation. Commonly occurring complications include the possibility of bruising the baby and causing more severe tears than would otherwise be the case (although it is important to recognise that almost all women will sustain some form of tear when delivering their first baby). Severe and rare complications (occurring less frequently than 1 in 200) include nerve damage, Descemet's membrane rupture (extraordinarily rare), skull fractures, and cervical cord injury.

Obstetric forceps consist of two branches (blades) that are positioned around the fetal head. These branches are defined as left and right depending on which side of the mother's pelvis they will be applied. The branches usually, but not always, cross at a midpoint which is called the articulation. Most forceps have a locking mechanism at the articulation, but a few have a sliding mechanism instead, allowing the two branches to slide along each other. Forceps with a fixed lock mechanism are used for deliveries where little or no rotation is required, as when the fetal head is in line with the mother's pelvis. Forceps with a sliding lock mechanism is used for deliveries requiring more rotation.

The blade of each forceps branch is the curved portion that is used to grasp the fetal head. The forceps should surround the fetal head firmly, but not tightly. The blade characteristically has two curves, the cephalic and the pelvic curves. The cephalic curve is shaped to conform to the fetal head. The cephalic curve can be rounded or rather elongated depending on the shape of the fetal head. The pelvic curve is shaped to conform to the birth canal and helps direct the force of the traction under the pubic bone. Forceps used for rotation of the fetal head should have almost no pelvic curve.

The handles are connected to the blades by shanks of variable lengths. Forceps with longer shanks are used if rotation is being considered.

All American forceps are derived from French forceps (long forceps) or English forceps (short forceps). Short forceps are applied on the fetal head already descended significantly in the maternal pelvis (i.e., proximal to the vagina). Long forceps are able to reach a fetal head still in the middle or even in the upper part of the maternal pelvis. At present practice, it is uncommon to use forceps to access a fetal head in the upper pelvis. So, short forceps are preferred in UK and USA. Long forceps are still in use elsewhere.