Can forceps cause birth injuries?

Forceps, an instrument that looks a bit like a pair of tongs and is used to facilitate vaginal delivery, can cause birth injuries when incorrectly used. Physicians must be very careful to properly apply forceps and to not excessively press or pull on the baby’s head. As each contraction occurs, the obstetrician is supposed to gently guide the baby’s head downward and out of the birth canal. When used according to standards of care, forceps can generally help deliver babies quickly and unharmed. If used improperly, however, damage can be extensive and permanent, causing birth injuries such as brain bleeds, cerebral palsy, and developmental delays.

Under What Circumstances Should Forceps Be Used?

Reasons for the use of forceps include:

• • • The mother has a sudden and major bleed (hemorrhage)
    • The mother is exhausted
    • There is a prolonged second stage of labor
    • The mother has a condition, such as heart disease, high blood pressure, or aneurysm, that makes pushing difficult or dangerous
  • • Drugs and analgesics that inhibit mother’s effort to push are being used

• • The baby’s heart rate and/or pattern is abnormal. This is a sign that the baby may be in danger and should be delivered quickly.

• Breech delivery. A breech delivery is when the baby’s buttocks or legs are the first parts of the baby to appear during birth. Forceps may be used to help deliver the head in a breech delivery.

In addition, there are certain conditions that must be in place before a physician may use forceps:

• The baby’s head must be engaged.
• The cervix must be fully dilated.
• The membranes must be ruptured.
• The fetal presentation, position, lie, and any asynclitism (tilted head) must be known. If any of these are uncertain, an ultrasound should be performed.
• The fetal size must have been estimated with clinical pelvimetry, showing acceptable dimensions.
• The mother’s bladder must be empty.
• The risks of the procedure must have been fully explained to the mother.
• There must be a willingness to abandon attempts if the forceps are not working/labor is prolonged. If this happens, a C-section may be necessary, and physicians should be prepared for this possibility.
• The physician must have experience and be skilled in forceps use.

Contraindications for Use of Forceps

If any of the above prerequisites are not in place, a forceps delivery should not occur.  Contraindications to forceps use include:

• The baby is less than 34 weeks gestation. This is because there is an increased risk of fetal intraventricular hemorrhage.
• There is cephalopelvic disproportion (CPD). This means that the baby’s head is too large to pass through the mother’s pelvis.
• There are signs of fetal demineralization disease, connective tissue disorders, or fetal bleeding diathesis.
• Operator inexperience.

According to the American College of Obstetricians and Gynecologists (ACOG), a physician should not use more than one delivery instrument during a birth. Thus, if forceps have been used, a vacuum extractor may not subsequently be used to deliver the baby. If a baby cannot be delivered by forceps, the physician must move on to a C-section.

Proper Use of Forceps is Crucial

Even if all the above criteria for forceps use are met, the matter of using them correctly remains. The physician must be very careful in how he or she places the tongs. If forceps are applied unevenly to the baby’s head or used with excessive force, the strain on the baby’s head could cause skull fractures, compression of the head, tearing of the vessels in the brain, swelling in the brain, and intracranial hemorrhages (brain bleeds).  All of these conditions can cause brain damage with resultant seizure disorders, strokes, hypoxic-ischemic encephalopathy (HIE), cerebral palsy, and developmental delays.

Informed consent is very important during labor and delivery. This means that the physician must explain all procedures utilized during delivery, including the risks and benefits to the baby, as well as alternatives to the various procedures. Experts agree that forceps should only be used by a physician that is skilled in their use. If a physician has never used forceps, or is otherwise unskilled in their use, this should be conveyed to the mother since this information is crucial to making an informed decision. When explaining the risks of forceps delivery, the physician must also discuss the alternatives, one of which is a C-section delivery.

Forceps Misuse and Infant Brain Damage

When physicians improperly use forceps or don’t quickly move on to a C-section when required, the baby can become permanently injured. Physicians sometimes use forceps to rotate the baby’s head when it is not in line with the mother’s pelvis. If the first attempt at rotation is not successful and the procedure is stopped, the standard of care requires that forceps use be stopped and that the physician proceed immediately to C-section delivery.

In a recent legal case, the first attempt to rotate the baby with forceps was unsuccessful and the physician temporarily stopped. However, instead of quickly moving on to a C-section delivery, the physician tried to use forceps again. The baby was delivered; at first, the use of forceps appeared to have been successful. She was born with a seemingly normal Apgar score, heart rate, and umbilical cord blood gas levels. However, she had a skull fracture, which was revealed through head imaging. The neurologist indicated that it was evidence of excessive force with forceps. As a result of this excessive force, the baby not only had a fracture, but also fluid build up (edema) and brain tissue death (necrosis). The baby began to show signs of brain damage, including seizures. She was diagnosed with permanent cognitive and motor deficits, also called intellectual and developmental disabilities.

Forceps Injuries and Medical Malpractice

It is crucial for a baby to be very closely monitored during labor and delivery. Forceps may only be used when obstetrical indications are present.  Due to the potential for severe injury, it is critical for the physician to be very skilled in forceps delivery technique and follow all standards of care. Failure to follow guidelines and standards of care is negligence. If this negligence leads to injury in the baby, it is medical malpractice.

If your child experienced forceps delivery and sustained permanent damage, the award-winning birth injury attorneys at Reiter & Walsh ABC Law Centers can help. Our lawyers have decades of experience handling complex forceps cases, and have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future. We give personal attention to each child and family we represent.

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  • Treatments for Birth Injuries

• • Birth Injury Glossary

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