Forceps Delivery

What is forceps delivery?

Forceps delivery is a kind of assisted vaginal delivery, a way that your healthcare team can assist you when labor has stalled. It’s only used when vaginal delivery is in its final stages but not progressing, and when you or your baby’s health are at risk from prolonged labor. Forceps are a medical tool that looks like metal salad tongs. A trained healthcare provider can use the forceps to grasp your baby inside the birth canal and help guide them out. While forceps delivery isn’t common, it is a useful solution under certain conditions that can help you get your baby out without requiring a cesarean (c-section).

What causes forceps to be used during delivery?

When labor is stalled in the second stage — the pushing stage — and pushing isn’t working, your healthcare team will carefully monitor you and your baby’s condition. If you have a health condition that makes pushing more stressful or more dangerous, they might want to limit how much pushing you do. If your baby’s heart rate indicates that they’re under stress from labor, your provider might want to limit the stress on the baby. Certain heart rate patterns may indicate that the baby isn’t getting enough oxygen in the birth canal. When this is the case, your team will want to get them out right away.

When conditions determine that you need help to deliver your baby safely, there are a few different procedures that your healthcare team can turn to. Forceps delivery and vacuum extraction are two options that can help you deliver vaginally before resorting to surgery. Certain conditions have to be met for these solutions to work — for example, your baby has to be at least halfway through the birth canal and your team has to be able to tell what position they’re in. If assisted vaginal delivery isn’t an option, or if it fails, your team may recommend a c-section instead.

Why choose forceps vs. vacuum?

Forceps delivery and vacuum extraction are similar in their risks and benefits. Often the choice between them comes down to the training and experience of your healthcare provider. Forceps delivery is the less common option because it requires more skill and many healthcare providers aren’t adequately trained to use them. But there are some instances where forceps can work and vacuum extraction can’t. While vacuum extraction requires your baby to be head-first and not rotated, forceps can deliver a breech baby (feet first). Forceps can be used to help rotate your baby into a better position for delivery. They also have a higher overall success rate than vacuum extraction.

How common is forceps delivery?

In the U.S., forceps delivery accounts for only .5% of vaginal births. Vacuum-assisted delivery accounts for 2.6%. Forceps delivery rates have been falling in favor of vacuum extraction, partly because of a lack of training in forceps, and partly because forceps are associated with a greater need for anesthesia. Overall, assisted vaginal birth rates have been falling in recent years, while c-section rates have risen steadily to nearly 30% of all births. Some healthcare providers are concerned by these numbers and advocate a return to assisted vaginal delivery methods to avoid unnecessary c-sections.

What are the prerequisites for forceps delivery?

Forceps might be indicated if:

• Your healthcare provider is trained and experienced in forceps use.
• You have been laboring unsuccessfully for a prescribed length of time (one to four hours, depending on your health conditions).
• Your baby has descended to the halfway point in the birth canal, where it can be accessed.
• Your baby’s heart rate indicates it is in fetal distress and needs to be delivered soon.

What are the contraindications for forceps delivery?

Forceps are considered unsafe if:

• You aren’t fully dilated.
• Your baby is more than six weeks premature.
• Your baby has a bleeding or bone disorder.
• Your baby is leading with their arms through the birth canal.
• Your baby’s position can’t be determined.
• Your baby looks like they might not fit through the birth canal.

How will I be prepared for forceps delivery?

Forceps delivery requires informed consent. If you haven’t already discussed contingency plans with your healthcare team, they will explain the risks and benefits and ask for your consent before they proceed. Then they will offer you pain medication if you haven’t had it already.

To prepare, they’ll break your water if it hasn’t broken and drain your bladder with a catheter if needed. This helps make more room in the birth canal. In some cases, they may want to perform an episiotomy — a surgical incision of your perineum — to make more room for the forceps.

How are forceps used during delivery?

While they might remind you of a kitchen utensil, delivery forceps are ergonomically designed for both you and your baby. The blades are curved at the ends to cradle the shape of your baby’s head and curved along their length to accommodate the shape of your pelvis. There are also different types of forceps to accommodate different circumstances, including breech and rotated babies. Your delivery assistant will select the right ones for your baby.

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 delivery assistant will use the rest period between contractions to place the forceps, one blade at a time, on either side of your baby’s head (or feet). They'll use your next contraction to apply gentle traction to the forceps to help guide your baby out, using mostly the force of your pushing. If your baby needs to be rotated into a better position for delivery, they will work on this between contractions.

Forceps are only used as long as they’re helping. If rotating your baby is all the help your baby needs, your delivery assistant will release the forceps. If your baby just needs help getting the widest part of their head through, your delivery assistant will release the forceps after that. Most forceps deliveries progress with one or two pulls and are completed in three or four. If the forceps don’t appear to be helping your baby progress, your delivery assistant will abandon them.

What happens after a forceps delivery?

If the forceps are successful, you’ll complete your delivery normally. If they aren’t successful, your healthcare team may recommend a c-section to help deliver your baby.

Once your baby has been delivered, your healthcare team will check you and your baby out for any wounds resulting from delivery. If you have a tear or an incision to repair, they’ll stitch you up.

Over the next several hours, they’ll continue to monitor your baby for any signs of complications from the procedure. If no symptoms present, you’ll be able to take your baby home.

Is forceps delivery safe?

Childbirth always carries some risk. It’s your healthcare team’s job to minimize that risk for you and your baby. If they recommend an intervention like forceps delivery, it’s because they believe the risks of not intervening are greater. Not intervening could mean that you or your baby sustain serious injury during prolonged labor, particularly if your baby’s heart rate indicates they’re lacking adequate oxygen. The side effects of oxygen deprivation are greater than those of forceps delivery. If labor continues not to progress, you could end up needing an emergency c-section, which also carries a greater risk of complications than forceps delivery does.

What are the risks or complications of forceps delivery?

Risks to the birthing parent from forceps delivery are the same risks that come with unassisted vaginal childbirth. They can be more common with forceps delivery. Risks include:

• Vaginal tears. Tears are more common with forceps.
• Tears of the muscle or wall of the rectum. Also called third or fourth degree tears, these occur in about 10% of forceps deliveries, compared with 3% of unassisted deliveries.
• Difficulty urinating or urinary incontinence after delivery. This risk increases with the risk of tears.
• Pelvic organ prolapse. While this is also common after unassisted delivery, this risk increases with the risk of perineal tears.

Risks to the baby from forceps delivery are mostly mild and temporary. Serious complications are very rare. Risks include:

• Surface wounds to the head or face. These heal within a few days.
• Temporary facial nerve palsy. Damage to the nerves in the baby’s face can produce temporary muscle weakness and drooping of the face. It heals within a few weeks.
• 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 sign of internal bleeding after delivery.

How long does it take to recover from forceps delivery?

You may spend a little longer in the hospital after a forceps delivery, but recovery time is about the same as it is for an unassisted birth. It usually takes about six weeks, occasionally longer if you’re healing from severe tears. If you have stiches, they’ll dissolve in about a month. You might have to wear a pad for normal vaginal bleeding. If you have residual pain, you should be able to manage it with over-the-counter medications. If it’s more severe than that, consult your healthcare provider.

A note from Cleveland Clinic

Forceps deliveries are rare, but they can be helpful under certain circumstances. You may not plan on having an assisted birth, but labor doesn’t always go according to plan. If you want to make informed decisions about how to proceed if things get tricky, talk to your delivery team in advance. It’s always easier to think about contingency plans when you aren’t in the middle of labor. Ask your team:

• If they’re trained or experienced in vacuum extraction or forceps delivery.
• If they have a preference between the two.
• How they might try to prevent an assisted birth.
• What are the risks and benefits of forceps delivery?