Forceps Delivery

Subject: Midwifery II (Theory)

Overview

When it is inadvisable or impossible for the mother to complete the birth by herself, forceps delivery is used to extract the fetus with obstetric forceps. Forceps can be used to help deliver the breech baby's head and, on occasion, to pull the head up and out of the pelvis during a cesarean section. The indications for forceps and vacuum extractors for surgical vaginal deliveries are the same. There is no definitive indication for surgical vaginal delivery. Contraindications include a lack of sufficient indication, a lack of full cervical dilation, cephalo-pelvic disproportion, uterine contractions ceasing, and so on.

When it is inadvisable or impossible for the mother to complete the birth by herself, forceps delivery is used to extract the fetus with obstetric forceps. Forceps can be used to help deliver the breech baby's head and, on occasion, to pull the head up and out of the pelvis during a cesarean section.

Indication

Indications for operative vaginal deliveries are identical for forceps and vacuum extractors. No indication for operative vaginal delivery is absolute.

When no contraindications exist, the following indications apply:

  • Prolonged second stage: This includes a nulliparous mother who fails to birth after 2 hours without conduction anesthesia and 3 hours with conduction anesthesia. It also includes a multiparous mother who fails to birth after 1 hour without conduction anesthesia and 2 hours with conduction anesthesia.
  • Suspicion of fetal compromise in the second stage of labor, either immediate or impending.
  • Reduction of the second level of maternity benefits: Exhaustion, hemorrhage, cardiac or pulmonary illness, and a history of spontaneous pneumothorax are all examples of maternal indications.
  • Fetal malpositions, particularly the after-coming head in breech vaginal delivery, can be reasons for forceps delivery in expert hands.

Prerequisites for Forceps Delivery 

  • The mind must be focused.
  • The cervix must be dilated and retracted completely.
  • The head's position must be known.
  • A clinical evaluation of pelvic capacity should be carried out. There should be no disparity between the size of the head and the size of the pelvic inlet and mid pelvis.
  • The membranes must be broken.
  • Analgesia must be administered to the patient.
  • There should be adequate facilities and supportive factors available.
  • The operator must be skilled in the use of the tools as well as the identification and management of potential issues. The operator should also know when to stop in order to avoid forcing the issue.

Contraindication

  • Inadequate identification
  • Cervical dilatation, not complete Cephalo-pelvic disproportion
  • Fetal head high station
  • Contractions in the uterus stop.

Procedure and Management

  • Inform the mother of the aim and procedure, and obtain her informed consent.
  • Prepare sterilized delivery, episiotomy, forceps, catheter, emergency medicine, resuscitation, suction oxygen, and other supplies.
  • Inform the pediatrician and prepare the necessary equipment and articles.
  • Mother is in the lithotomy position.
  • The operators wear sterile masks, gowns, and gloves.
  • Draping is used after washing the vulva with an antibacterial solution. To remove the urine, a sterile catheter is passed. Prepare everything in accordance with standard delivery procedures.
  • When necessary, infiltrate the perineum and perform an episiotomy.
  • The left blade is selected initially. The left-hand holds it vertically like a pen, with the cephalic curvature pointing towards the vulva. The two middle and index fingers of the semi-supinated right hand are entered into the posterolateral portions of the vagina besides the head, while the thumb and another finger remain outside.
  • When the convex border of the fenestrated blade is gently tapped by intermitted gentle upward push of the vaginal hand's thumb, the left blade is gently negotiated between the head and the internal fingers.
  • The right blade is introduced in the same spot.
  • The blades have been locked. If there is any problem locking, the handles are depressed on the perineum. If there is still difficulty, the blade is withdrawn, and a thorough vaginal examination is performed to discover any head malposition.
  • The forceps' handles are held with the right hand, and traction is applied during a uterine contraction. The low forceps operation is carried out with a single continuous pull till the head is delivered. The traction is downward, downward forward, and eventually upward.
  • As a result, the head is delivered by extension. After the delivery to the head, the blade is removed.
  • If the forceps delivery fails, a cesarean section should be performed.
  • The third stage is actively handled once the head is delivered.
  • If necessary, resuscitate the newborn and keep the newborn warm by making skin-to-skin contact.

References
Things to remember
  • When it is inadvisable or impossible for the mother to complete the birth by herself, forceps delivery is used to extract the fetus with obstetric forceps.
  • Forceps can be used to help deliver the breech baby's head and, on occasion, to pull the head up and out of the pelvis during a cesarean section.
  • The indications for forceps and vacuum extractors for surgical vaginal deliveries are the same. There is no definitive indication for surgical vaginal delivery.
  • Contraindications include a lack of sufficient indication, a lack of full cervical dilation, cephalo-pelvic disproportion, uterine contractions ceasing, and so on.
Questions and Answers

When it is unsafe or difficult for the mother to deliver the baby naturally, a forceps delivery is a method of removing the fetus with the use of obstetric forceps. Forceps can be used to help deliver the breech baby's head after it has turned around and occasionally to pull the baby's head up and out of the pelvis during a caesarean section.

Forceps and vacuum extractors both have the same indications for operative vaginal deliveries. There is no unqualified justification for surgical vaginal delivery.

The following indications apply when no contraindications exist:

  • Prolonged second stage: This comprises a nulliparous lady who has not given birth after two hours without anesthesia and three hours with anesthetic for conduction. It also covers a multiparous lady who failed to deliver after two hours of conduction anesthetic and one hour without.
  • Suspicion that the second stage of labor may result in an immediate or probable fetal compromise.
  • The second stage for maternity benefits is condensed: Exhaustion, bleeding, cardiac or pulmonary disease, and a history of spontaneous pneumothorax are just a few examples of maternal indications.
  • Fetal malpositions, such as the after-coming head in breech vaginal delivery, can be a sign that forceps delivery is necessary in the hands of a skilled practitioner.

Procedure and Management

  • To obtain the mother's informed permission, explain the operation and its goal to her.
  • Prepare sterilized delivery equipment, resuscitation equipment, forceps, catheters, emergency medications, and suction oxygen, among other items.
  • Inform the pediatrician and get all the tools and materials ready.
  • Mom is positioned in the lithotomy position.
  • The operators are outfitted in sterile gloves, a gown, and a mask.
  • Place drape after cleaning the vulva with an antibacterial solution. Urine removal involves passing a sterile catheter. Create everything in accordance with standard delivery.
  • When necessary, infiltrate the perineum and perform an episiotomy.
  • First, the left blade is selected. The left hand holds it vertically like a pen, with the cephalic curve pointing in the direction of the vulva. The thumb and another finger are left outside while the middle and index fingers of the right hand are inserted into the postero-lateral portions of the vagina next to the head.
  • When the convex border of the fenestrated blade is gently tapped by an intermittent, gentle upward push of the thumb of the vaginal hand, the left blade is delicately negotiated between the head and the internal fingers.
  • The right blade is introduced in the exact same position.
  • The blades have been locked in place. The handles are pushed on the perineum if there is any trouble locking, and if there is still difficulty, the blade is withdrawn before a thorough vaginal inspection is done to look for any head malposition.
  • The right hand grasps the forceps' handles while traction is applied throughout a uterine contraction. One continuous pull is used throughout the low forceps procedure until the head is delivered. The traction moves in three different directions: downward, downward forward, and then upward.
  • As a result, extension is used to deliver the head. After the delivery to the skull, the blade is taken out.
  • Caesarean sections should be performed if the forceps delivery fails.
  • After the head is delivered, the third stage is actively maintained.
  • Resuscitate the newborn if needed and keep the newborn warm with the skin to skin contact.

© 2021 Saralmind. All Rights Reserved.