Forceps in Child Birth

Forceps are a surgical instrument that resembles a pair of tongs and can be used in surgery for grabbing, maneuvering, or removing various things within or from the body. They can be used to assist the delivery of a baby as an alternative to the ventouse (vacuum extraction) method.

Kielland forceps (1915, Norwegian) are distinguished by having no angle between the shanks and the blades and a sliding lock. The pelvic curve of the blades is identical to all other forceps. The common misperception that there is no pelvic curve has become so entrenched in the obstetric literature that it may never be able to be overcome, but it can be proved by holding a blade of Kielland's against any other forceps of one's choice. Probably the most common forceps used for rotation. The sliding mechanism at the articulation can be helpful in asyncletic births (when the fetal head is tilted to the side), since the fetal head is no longer in line with the birth canal. Because the handles, shanks and blades are all in the same plane the forceps can be applied in any position to effect rotation. Because the shanks and handles are not angled the forceps cannot be applied to a high station as readily as those with the angle since the shanks impinge on the perineum.

The cervix must be fully dilated and retracted and the membranes ruptured. The urinary bladder should be empty, perhaps with the use of a catheter. High forceps are never indicated in the modern era. Mid forceps can occasionally be indicated but require operator skill and caution. The station of the head must be at least +2 in the lower birth canal. The woman is placed on her back, usually with the aid of stirrups or assistants to support her legs. A mild local or general anesthetic is administered (unless an epidural anesthesia has been given) for adequate pain control. Ascertaining the precise position of the fetal head is paramount, and though historically was accomplished by feeling the fetal skull suture lines and fontanelles, in the modern era, confirmation with ultrasound is essentially mandatory. At this point, the two blades of the forceps are individually inserted, the left blade first for the commonest occipito-anterior position; posterior blade first if a transverse position, then locked. The position on the baby's head is checked. The fetal head is then rotated to the occiput anterior position if it is not already in that position. An episiotomy may be performed if necessary. The baby is then delivered with gentle (maximum 30 lbf or 130 Newton) traction in the axis of the pelvis.