Why do physicians use forceps and vacuum extractors?

Forceps and vacuum extractors are used when vaginal delivery is not progressing as it should, there is a maternal health concern, or there is fetal distress (1). When physicians follow medical standards and use forceps and vacuum extractors correctly, these devices can help to safely deliver a baby.  However, many physicians lack experience or are not careful in the use of these devices, with devastating effects on the newborn baby. Forceps and vacuum extractors can cause trauma to the baby’s head, resulting in skull fractures and brain bleeds that can cause death or permanent injury in the baby, such as cerebral palsy (CP) and hypoxic-ischemic encephalopathy (HIE). In addition, physicians may attempt to use forceps and vacuum extractors instead of opting for an emergency C-section. When a baby must be quickly delivered because they are in distress, a C-section often is the best and safest method. When physicians are not skilled in the use of delivery devices or are not careful, they may misuse the instruments, prolonging labor, and worse, injuring the baby.

When can forceps or vacuum extractors be used?

The use of forceps or vacuum extractors alike requires certain key elements to be present during delivery. These criteria include (2):

  • Rupture of membranes
  • Administered anesthesia
  • Empty bladder in the mother
  • Maternal complication that makes pushing not feasible
  • Maternal informed consent obtained
  • Fully dilated cervix
  • Vertex presentation
  • Known fetal position
  • Estimated fetal weight
  • Adequate pelvis for vaginal delivery
  • A back-up plan if operative delivery fails

When should forceps or vacuum extractors not be used?

Contraindications to forceps or vacuum extractor delivery include (2):

  • Cervix not fully dilated
  • Unknown fetal position
  • Membranes intact
  • Fetal head not engaged
  • Prematurity
  • The baby is too large (macrosomia)
  • Cephalopelvic Disproportion (CPD) (when a baby’s head is too large for the mother’s pelvis).
  • Fetal demineralization disease, connective tissue disorders, fetal bleeding diatheses.

Safe delivery when vacuum extractors or forceps are properly used

Before or during delivery, the mother must be given the opportunity to provide informed consent. This means that the physician must explain the risks of and alternatives to any procedure that is about to be performed. Any physician performing a delivery must be skilled in fetal heart rate monitoring and interpretation so that they are aware of when a baby is in distress or when distress is impending. In addition, a physician performing a delivery must be skilled in performing emergency C-sections, and must have the equipment and capacity to perform this in the room where the mother is attempting to deliver a baby.

Vacuum extractors, forceps, and medical malpractice

Due to the risks involved with forceps and vacuum extractors, it is imperative that physicians be very skilled in their use, and understand which device is the most appropriate for each situation. Physicians must be ready to move on to a C-section delivery when forceps or vacuum extractor delivery is not proceeding as it should. Standards of care must be followed at all times. Failure to act skillfully and in a timely manner during delivery is negligence. If negligence leads to injury of the mother or baby, it is medical malpractice.

The importance of c-section delivery

In any labor and delivery situation, the physician must be prepared to quickly move on to a C-section delivery when an operative vaginal delivery is not progressing as it should. If one device is not affecting prompt delivery of the baby, the physician must not attempt to use a different operative delivery device. Some conditions that require the baby to be delivered immediately include fetal distress, uterine rupture, and cord prolapse.

Sometimes physicians fail to perform an emergency C-section when one is indicated, or they wait too long to perform one. Other times, the C-section may be ordered, but the physician lacks skill in the procedure, or the hospital is ill-equipped for it. Delay in performing a C-section can lead to permanent injuries in the baby, such as cerebral palsy and hypoxic-ischemic encephalopathy. Indeed, in many cases, a C-section is the safest way to deliver the baby. Thus, it is critical that physicians be skilled and prepared for the procedure.

Legal help for forceps and vacuum extractor injuries

If you believe your child or loved one was injured as the result of negligent actions by a physician or medical professional, you may be entitled to compensation through a medical malpractice lawsuit. We encourage you to contact us today for a free legal consultation.

ABC Law Centers (Reiter & Walsh, P.C.) is one of the only law firms in the United States exclusively handling birth injury cases. We focus solely on helping families like yours obtain the resources they need, and our niche focus allows us to win even the most medically and legally complex cases.

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Related Resources


  1. Vacuum Extraction. 15 Sept. 2018, www.mayoclinic.org/tests-procedures/vacuum-extraction/about/pac-20395232.
  2. Bonilla EP, Riggs J. Forceps Delivery. [Updated 2020 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538220/