Forceps delivery is a means of facilitating the birth of the baby's head
by providing traction and rotation with the aid of obstetric forceps when it is
impossible for the mother to complete the delivery by her own effort.
Forceps deliveries are classified by the level of the head at the time
the forceps were applied i.e. high-cavity, mid-cavity or low-cavity.
Low-cavity or out let forceps applications are done when thefetal head is visible on the perineum.
Mid-cavity or Mid forceps applications are
for those in whichthe head is at the level of ischial spines and engaged.
High-cavity or High forceps applications are
those in whichforceps are applied through the cervix before the head is engaged
in the bony pelvis.
There are certain conditions which must exist before forceps application
including those conditions that require a shortened second stage labour: when
mother or fetus is in jeopardy or when assistance with maternal bearing-down is
The fetal head must be engaged in the maternal pelvis.
The cervix must be fully dilated.
The membrane should be ruptured
The bladder and bowel should not be distended to avoid trauma
Positive identification of presentation and position
Absence of cephalo pelvic disproportion, sacral or pelvic out let
Adequate anesthesia must be used
Fetal distress in the second stage of labour
Delay in the second stage of labour – if the duration of the second
stage exceeds 11/2 hours or more than one hour of pushing, or if the fetal head
is delayed on the perineum for more than 30 minutes.
Malposition: occipeto lateral, occipito posterior position
Maternal exhaustion or distress
For the delivery of the after coming head of a breach presentation.
Preterm delivery: this is still a matter of debate, but some
obstetricians and pediatricians like to protect the fetal head, with its soft
skull bones, if delivery occurs before about the 36th week of gestation.
· Conditions in which pushing is undesirable, such as cardiac conditions or moderate to sever hypertension.
A woman about to be delivered with forceps will often be get fully
explanation about the procedure itself and the need for it is likely to result
in greater retrospective satisfaction and relief. Once the decision has been
made, adequate and appropriate analgesia must be offered.
When such analgesia has been instituted the woman's legs are placed in the lithotomy position. Both legs must bepositioned simultaneously to avoid strain on the woman's lower back and hips. This is uncomfortable position, especially for a tired woman with a weighty gravid uterus who is in advanced labour. The woman's legs should not be placed in the stirrups for longer than is necessary, and the vulval area should remain covered whenever possible. The minimum number of staff should be present, and interruptions should be discouraged she should be tilted towards the left at an angle of 150 to prevent aortovanacaval occlusion. Preparations must also have been made for the baby and resuscitation equipment checked and in working order.
The woman's vulval area is thoroughly cleaned and draped with sterile
towels using aseptic technique; the bladder is emptied. The obstetrician will
perform a vaginal examination in order to confirm the station and exact
position of the fetal head. It is to positively identify the forceps blades by
assembling them briefly before proceeding.
Failure- Undue force should never be
used. If the head does not advance with steady traction the attempt is
abandoned and the baby is delivered by cesarean section.
Bruising: Severe bruising will cause
marked jaundice whichmay be prolonged
Cerebral irritability - A traumatic forceps delivery
may causecerebral edema or hemorrhage.
Cephal haematoma - is a swelling on the neonate's
skull, aneffusion of blood under the periosteum covering it, due to friction
between the skull and pelvis.
Tentorial tear- results from compression of
the fetal head bythe forceps. The compression causes elongation of the head and
consequent tearing of the tentorial membrane.
Facial palsy-occasionally the facial nerve
may be damagedsince it is situated near the mastoid process where it has little
Bruising and trauma to the
may cause dysuriaand occasionally haematuria or a period of urinary retention
Vaginal and Perineal trauma the vaginal wall may be
tornduring forceps delivery and the vagina must be inspected carefully prior to
perineal repair. The episiotomy may extend or be accompanied by a further
perinea tear and these must be repaired with care. As with any damaged perineum
there may be bruising, oedema or occasionally haematoma formation.
Rupture of the uterus with
increased risk of infection
Increased risk of uterine atony
and excessive bleeding
Fracture of the coccyx and
The nurse must be prepared to locate the appropriate types of forceps
when requested. The nurse must support the mother if she is awake, explaining
what is being done. Maternal comfort level should be observed closely; forceps
applications should involve sensations of pressure but adequate anesthesia or analgesia
should be established so that no pain results.
The nurse should monitor the FHR closely during application and
traction. Fetal bradycardia may be observed as a result of head compression and
is transient. The neonate delivered with forceps should be carefully examined
for cerebral trauma or nerve damage.
The nurse must be alert for possible sequele of forceps deliveries. The
mother should be observed carefully for excessive bleeding, severe perineal
bruising and pain, difficulty in voiding, and cervical or vaginal lacerations