Guiding Hands: The Function of Obstetric Forceps

Within the sometimes volatile and flimsy science of birth, the occasional guiding hand – or guiding tool – is necessary. Obstetric forceps serve as that surgical instrument. With an intriguing and rich history behind them, these devices have served as an inevitable aid to assist in vaginal delivery where complications, or the necessity to expedite the birthing process, are involved.

They look a bit like small, curved salad tongs, obstetric forceps are specially designed to catch hold of the baby's head gently but exert traction and controlled direction through the birth canal. They are set aside for uncommon situations where either the health of the mother or child might be placed in jeopardy, or in those cases in which labor will not proceed as anticipated.

Why Obstetric Forceps Might Be Needed

There are several reasons that obstetric forceps can be applied during delivery:

Prolonged Second Stage of Labour: When the mother has been pushing for more than two hours without the baby having descended very far.

Maternal Fatigue: When the mother fatigues and is unable to push effectively.

Fetal Distress: When the heart rate or well-being of the baby is becoming problematic, with the need to deliver more urgently.

Maternal Medical Conditions: Prolonged pushing may become unsafe in the presence of some maternal medical conditions.

Abnormal Fetal Position: Forceps will, occasionally, help position the baby's head into a more favorable alignment by tucking it in.

The Anatomy of Obstetric Forceps:

The average pair of obstetric forceps has the following important characteristics:

Blades: Two spoon-shaped structures with a curved shape to accommodate the head of the baby. The blades are made up of two curves:

Cephalic Curve: Curved to the fetal head shape, firmly but gently holding.

Pelvic Curve: Gradually tapering to resemble the mother's birth canal to give traction direction during delivery. Others have fenestrations (openings) in an effort to make them lightweight and not crush the baby's head, but resist slippage.

Shanks: Pieces that connect handles to blades. Length and configuration may vary depending on the application type and type of forceps desired (e.g., rotation movements where longer shanks are needed).

Lock (Articulation): Where the two blades meet. The majority of forceps feature a locking system to secure the blades over the head of the baby. A few specialized forceps possess a sliding lock, where there is minimal movement and rotation of the baby's head.

Handles: Handles upon which the obstetrician exerts traction and impels the baby downwards. Ergonomic handles facilitate a good hold and comfort.

There have been decades of development of various obstetric forceps with unique design features based on clinical scenarios. There are some that are used most often as follows:

Simpson Forceps: Have a long cephalic curve and are most often used when the head of the baby is molded or elongated by labor.

Elliot Forceps: More cephalic curve but more rounded, ideal for individuals with a more rounded head shape.

Kielland Forceps: Due to their extremely shallow profiles pelvic curve and sliding lock, they are extremely convenient in rotational deliveries for the purpose of correction of baby position.

Wrigley's Forceps: Shorter bladed and short shanked, used usually when the baby's head is low in the birth canal to prevent the possibility of uterine rupture. It is also employed in Cesarean section to facilitate delivery of the head.

Piper Forceps: Bent shanks sloping downwards to go around the baby in a breech delivery, for the controlled delivery of the aftercoming head.

Barnes Forceps: An older long forceps composed of, once used for higher stations in the pelvis, though their use in high forceps deliveries is now uncommon in modern obstetrics.

Role of Skill and Judgement

Obstetric forceps application is extremely labor-intensive in training, skill, and prudent clinical judgment. The obstetrician needs to know how to evaluate fetal position, maternal pelvis, and application technique and the amount of traction to apply safely on mother and fetus.

In Conclusion:

Obstetric forceps are a very useful surgical instrument in every obstetrician's arsenal, with methods of safe vaginally assisted delivery at hand in case of need. Although their application developed parallel to the evolution of obstetrician practice, the tool itself remains a component of standard selection in the case of complicated delivery and preservation of the mother's and child's health. Steady, authoritative hands at the rear of these tools have an important role in obtaining positive results while performing difficult deliveries.