Why Are Forceps Used in Childbirth?
Forceps are used in childbirth to assist in the delivery of the fetus when the mother's pushing efforts alone are insufficient. Forceps may only be used by obstetricians, not midwives. Local anesthetic and an episiotomy (an enlargement of the vaginal opening usually made with surgical scissors) are typically required.
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Function
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A delivery in which forceps is used is called an operative delivery. Operative deliveries with forceps are less common, having been supplanted by vacuum extractions and/or Cesarean sections when a difficult or prolonged second stage of labor is encountered.
History
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The Chamberlen family first introduced the use of obstetrical forceps in 1650. The use of forceps was popularized in the early 1700s when William Smellie advanced its use greatly, being the first to use forceps to deliver a baby's head in a breech delivery. He recognized that women who had suffered from rickets often had narrow and distorted pelvises, which complicated childbirth.
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Considerations
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Forceps may be used to shorten the second stage of labor--which begins at full dilation and ends in delivery--or if there are indications of fetal or maternal distress. A prolonged second stage can be the result of a number of factors, including fetal size, presentation or position, or maternal fatigue. The application of forceps may cause injury to the fetus, including neurologic abnormalities, and/or to the mother, including perineal trauma.
Time Frame
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Forceps may be applied to the fetal head at any time after full dilation of the cervix. According to the American College of Obstetricians and Gynecologists (ACOG), if the scalp of the fetus has reached the pelvic floor and the scalp is visible at the vaginal outlet, the application is referred to as outlet forceps. If the fetal head is engaged but above +2 station as measured by its position in the pelvis, the application is called mid forceps. If the fetal head is a +2 station or greater, the application is called low forceps. High forceps deliveries, where the fetal head is not engaged, are not recommended; Cesarean sections are preferred in these situations.
Features
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Obstetric forceps consist of two blades, each with a curved end, that lock together along the shank. The blades of the forceps must accommodate the shape of the fetal head along with the curve of the birth canal. Three of the more common types of forceps are Wrigley's Forceps, Milne Murray's Axis Traction Forceps and Kielland's Forceps.
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