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Ask A Childbirth Educator
Questions and Answer

Q. Are forceps or other apparatuses used to help pull the baby out? If so, how dangerous is this?

A. Forceps and vacuum extractors are only used in births that are having difficulty, not in normal vaginal births.

Forceps are twin steel blades that are placed in the vagina and secured on either side of the baby's head. The blades are locked and the doctor pulls and rotates the baby until the head is delivered. Vacuum extractor (or ventouse) is a soft flexible cup attached to a suction device. The vacuum extractor is placed on the top of the baby's head and the suction is activated. The doctor again then pulls and rotates the baby until the head is born.

With both of these instruments, mothers may very well need an episiotomy to facilitate insertion of the instrument. Risks of forceps to the baby include: facial nerve damage, skull fracture, intracranial hemorrhage, facial paralysis, bruising leading to jaundice after the birth. There is also a possibility of pulling the neck vertebrae out of alignment. These risks have much to do with the placement of the blades and the amount of traction the doctor uses. Minimal traction should be used with forceps to reduce these risks. Risks to the mother include: lacerations of the pelvic floor and birth canal, urinary tract infection and bladder or rectum injury. Risks of the vacuum extractor to the baby are less than forceps and include: scalp abscess, and fractured skull. Complications occur much less often with the vacuum extractor than with forceps.

While there are rare occasions when forceps or vacuum extraction may be medically necessary, many times an instrument delivery is done because a woman has been given epidural anesthesia or is laboring on her back. The anesthesia can interfere with her ability to push, as can the poor position of being on one's back, causing the second stage of labor to take much longer and even cause fetal distress. Instruments are then employed.

Alternatives to this include maintaining upright positions for pushing. Mothers who are upright have the benefit of gravity to help open up their pelvis and maximize the work of the uterus. Changing position while pushing can also help the baby descend without the intervention of forceps or the vacuum. When women are active participants in their birth process, the need for instruments is reduced. Squatting, sitting on the toilet or birth ball, walking, and rocking all help bring the baby down and out without using forceps. Women who do not have epidurals or other anesthesia are better able to change position as needed during labor, facilitating the birth of the child.

Karen Klimsak-Ungar, CCE has been a certified childbirth educator for Birth Works® since 1996. She is currently Managing Editor for the Birth Works newsletter, sits on the Birth Works Board of Directors, and serves on their National Trainee Review Committee. A happily married mother of two, she also continues to teach Birth Works classes as well as private classes.

Karen will answer your questions on fertility, pregnancy, birth, breastfeeding and babies. Her advice does not take the place of your practitioner. Personal answers will not always be possible.