Forceps Delivery

Forceps delivery is a kind of assisted vaginal delivery. These are techniques providers use to help deliver babies. It helps them deliver your baby before a long labor puts them or you at risk for complications.

Forceps are tools that look like metal salad tongs and help guide your baby out of the birth canal. While forceps delivery isn’t common, it’s useful in some situations. In the U.S., it happens in about .5% of all vaginal births.

When are forceps used?

Forceps are used during a vaginal birth in the second stage of labor — the pushing stage. Your healthcare provider may recommend using them when:

• Labor has stalled: You can sometimes be pushing for hours with little to no progress. Pushing too long can put stress on your heart and cause changes to your baby’s heart rate.
• Your baby is stuck: Sometimes, your baby is in a position that makes it hard for them to move through the birth canal. Forceps can help rotate them.
• You want to avoid a C-section: A C-section is sometimes unavoidable. But if you want to try to avoid it, your provider may offer a forceps delivery.

Forceps should only be used when:

• Your provider is trained and experienced.
• Your baby’s head is low enough to reach.
• Your baby’s position is known and stable.
• Delivery needs to happen quickly for medical reasons.

When should they be avoided?

Forceps are considered unsafe if:

• You aren’t fully dilated.
• Your baby’s position is unknown.
• Your baby is preterm.
• Your baby has a bleeding or bone disorder.
• Your baby looks as if they might not fit through the birth canal.

How will I be prepared for forceps delivery?

Forceps delivery requires consent. Your provider can explain the risks and benefits. Then, they’ll offer you pain medication if you haven’t had it already.

To prepare, they’ll break your water if it hasn’t already broken. In some cases, they may want to perform an episiotomy to make more room for the forceps.

How are forceps used during delivery?

While they might remind you of a kitchen utensil, forceps are designed for both you and your baby. The blades are curved at the ends to cradle your baby’s head. They’re curved along their length to fit the shape of your pelvis.

For the procedure, you’ll lie on your back with your legs spread apart. You’ll continue pushing with your contractions and resting in between. Your provider will use the rest period between contractions to place the forceps, one blade at a time, on either side of your baby’s head. They’ll use your next contraction to apply pressure to the forceps to help guide your baby out. If your baby needs to be rotated into a better position for delivery, they’ll work on this between contractions.

Forceps are only used as long as they’re helping. Most forceps deliveries happen within three or four gentle pulls. If the forceps don’t appear to be helping, your provider will stop using them.

What happens after?

If the forceps are successful, you’ll complete your delivery. Your provider will give you stitches if you have any vaginal tearing. Your care team will check on your baby to make sure there aren’t any wounds from delivery. Over the next few hours, they’ll continue to monitor your baby for any signs of complications from forceps delivery.

If the forceps aren’t successful, your healthcare team may recommend a C-section.

What are the risks or complications?

Childbirth carries risks, and your healthcare team’s goal is to reduce them. If they recommend using forceps, it’s because the benefit of delivering your baby with them is greater than the risk of waiting.

The risks with a forceps delivery are like those of all vaginal births. But they may happen more often with forceps. Risks include:

• Vaginal or perineal tears: Tearing is more common with forceps. Tearing in your rectum is also more common with forceps delivery (also called third- or fourth-degree tears).
• Urinary incontinence: This usually happens from damage to your pelvic floor or sphincter from tearing.
• Pelvic organ prolapse: Your risk for prolapse is also greater when you have a weak pelvic floor from tearing during childbirth.

Risks to your baby from forceps are usually mild. The most common risk is surface wounds or bruises to their head or face.

Rarer but serious risks are:

• Temporary facial paralysis: Damage to the nerves in your baby’s face can weaken their facial muscles. This can cause droopiness on one or both sides of their face.
• Skull fracture: Newborn skulls are soft and easier to injure. Most fractures are small, heal on their own and cause no long-term damage.
• Bleeding within the skull: Brain bleeds are rare, but they can be serious. Your healthcare team will monitor your baby for any signs of internal bleeding after delivery.

What should I ask my healthcare provider?

Things happen quickly during labor. You may not have time to think or ask your provider questions. It might be easier to talk to your healthcare provider during pregnancy about assisted births. Ask your team:

• If they’re trained or experienced in forceps delivery
• How they might try to prevent an assisted birth
• What the risks and benefits of forceps delivery are

How long does it take to recover from forceps delivery?

You may spend a little longer in the hospital after a forceps delivery. But overall, the recovery time is about the same as it is for a vaginal birth. It usually takes about six weeks to heal. It can take longer if you’re healing from severe tears. If you have stitches, they’ll dissolve in about a month. If you have pain from childbirth, you should be able to manage it with over-the-counter medications. If it’s more severe than that, contact your healthcare provider.