Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
Tel: (781) 890-9095
Forceps delivery
Forceps are metal instruments used in an operative vaginal delivery by
applying traction to the fetal head. Over the last few decades, the long term
safety to the fetus of forceps operative vaginal deliveries has come into
question and the use of forceps to accomplish a vaginal delivery has become
much less common than before the 1970's. Information supporting a higher
incidence of long-term adverse consequences to the newborn further
contributed to the decrease in forceps use.

At present, forceps assisted operative vaginal deliveries account for less
than 5% of vaginal deliveries. A variety of forceps instruments have particular
designs for a particular purpose. Most widely used are the Simpson, Tucker,
DeLee and Piper for the aftercoming head in a breech delivery. Forceps
deliveries are classified in accordance with the level of descent of the leading
bony point of the fetal head in the mother's pelvis. Types of forceps
deliveries include:

  • High forceps
  • Mid forceps
  • Low forceps
  • Outlet forceps

Indications for operative vaginal delivery are similar for forceps and vacuum
extractors. Taking into account that no indication is an absolute, they include:

  • Prolonged second stage without cephalopelvic disproportion
  • Immediate or potential fetal compromise during the second stage of
  • Interruption of second stage of labor because of acute bleeding,
    cardiac disease, pulmonary disease or maternal exhaustion (see

Operative vaginal delivery with forceps should not be undertaken without a
valid indication. Attempts to shorten labor for maternal and/or physician's
convenience does not support the use of forceps at any time. Maternal
exhaustion, although a valid indication at times, requires the medical provider
to assess the underlying reason for the maternal exhaustion. Prolonged
labors are quite often an indication of the presence of cephalopelvic
disproportion or fetal malposition. Cephalopelvic disproportion exists when
the the dimensions of the fetal head are larger than the dimensions of the
maternal pelvis. Delivery of such an infant can only be accomplished at the
expense of a contraindicated compression of the fetal head. Before forceps
can be used, some prerequisites must be fulfilled. They include:

  • Amniotic membranes must be ruptured
  • Type of pelvis must be known
  • Cervix must be fully dilated
  • Position of the fetal head must be known
  • Fetal head must be engaged in the pelvis
  • No cephalopelvic disproportion is present
  • Adequate anesthesia given
  • Physician must be fully trained in the use of forceps

Operative vaginal delivery increases the risk of neonatal intracranial bleeds
when compared with normal spontaneous vaginal delivery or cesarean
section. Complications associated with forceps operative vaginal deliveries
can be divided into maternal complications and fetal complications. Maternal
complications include:

  • Lacerations of the vagina
  • Lacerations of the cervix
  • Perineal lacerations
  • increase in blood loss
  • Hematomas
  • Injury to the urinary bladder
  • Anal sphincter injuries
  • Fecal incontinence

Fetal complications associated with the use of forceps for an operative
vaginal delivery include:

  • Transient facial bruising or lacerations
  • Cephalohematomas
  • Facial palsy
  • Shoulder dystocia
  • Skull fractures
  • Intracranial hemorrhage
  • Tentorial lacerations
  • Cerebral palsy

The combined use of operative vaginal delivery instruments such as vacuum
extractor followed by forceps delivery (or viceversa) or the multiple attempts
such as more than 3 traction episodes to accomplish delivery is clearly
contraindicated. Regardless of the ultimate success in accomplishing a
vaginal delivery under these circumstances, the risk of neonatal intracranial
hemorrhage is markedly increased.

If your child was delivered by forceps and is now suffering from a birth related
injury, or you are suffering from a maternal complication,
Dr. Borten and the  
Boston area medical malpractice attorneys at Gorovitz & Borten can help you
assert your rights and get the compensation you deserve.
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