Forceps Delivery Procedures

Lee Wright Midwifery Lecturer

Plymouth University and The Royal College of Midwives, United Kingdom

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An Guide To Assisted Vaginal Delivery

This tutorial is designed to re-inforce previous training – and should, therefore, not be regared as sufficient guidance by itself

Forceps delivery

ADVANTAGES

Does not require maternal effort.

So is preferable when you may not want the woman to push. I.e. maternal cardiac disease

May be quicker

Possibly less fetal injury if used correctly

DISADVANTAGES

MAY cause significant maternal genital tract trauma if good practice is not displayed

Clinician’s need increased training and need to display greater skill, dexterity and experience

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Anatomy of the forceps

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Handle

Finger guide

Lock

Heel

Shanks overlapping

parallel

Toe

Blade

Cephalic curve

Toe

Pelvic curve Heel

Blade Handle

Lock Shank

Fenestration

Procedure

There are 10 steps to be followed for forceps delivery

In English, these are easily remembered as A-J

– This comes from the ALSO (Advanced Life Support in Obstetrics) organisation

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10 Steps

Forceps delivery – Step 1

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A Ask…

Ask for help Address the woman (explain

the procedure and ask for consent)

Adequate anaesthesia

Forceps delivery – Step 2

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B Bladder…

Bladder empty May need to be catheterised

Forceps delivery – Step 3

Examine the woman

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C Cervix…

Cervix fully dilated

Forceps delivery – Step 4

– the anterior fontanelle is larger and forms a cross

– the posterior fontanelle is smaller and forms a Y

– assess for bending the ear

Remember moulding of the head makes assessment difficult

Think about dystocia (is the fetus going to fit through the pelvis?)

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Determine the position of the fetal head

D Posterior fontanelle

Anterior fontanelle

Forceps delivery – Step 5

Do you have help?

Do you have resuscitation equipment ready?

What is going to happen if this doesn't work?

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Equipment ready E

Forceps delivery – Step 6

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See next slide for an example

In order to check they are in the correct position. Think. Position for safety!

Forceps applied

F Forceps…

Forceps application – Step 6 (continued)

Articulate the forceps and hold them in position (a)

Disarticulate, place left blade in the left-hand (b)

Apply to the left side of the mother’s pelvis

Cephalic curve towards vulva (c)

Shank vertical at start (c)

Apply to the left side of fetal head

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(a)

(b)

(c)

Forceps application – Step 6 (continued)

Right-hand protects maternal tissue, applies force (d)

Repeat for right-sided (e)

Articulate handles and lock (handles should lock together easily) (f)

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(f) (e)

(d)

Position for safety – Step 6 (continued)

Posterior fontanelle midway between shanks, 1 cm above plane of shanks

Fenestrations admit no more than one fingertip.

Sutures posteriorly fontanelle above and equidistant from, upper surface of each blade, sagittal suture is within the midline

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Forceps delivery – Step 7

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Gentle traction in a downward and outward direction using a J shaped curve

This may be performed during or after contractions

Gentle traction

G Gentle…

Forceps delivery – Step 8

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Handles drawn up in a J shaped curve

Handles

H Handles…

Forceps delivery – Step 9

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Incision or episiotomy needs to be considered when the fetal head is being delivered I

Incision…

Incision

Forceps delivery – Step 10

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Forceps are removed in the opposite order they were placed in. When the Jaw is visible J

Jaw

Jaw

Potential injuries

Crush injuries

Lacerations

Swelling

Bruising

Increased jaundice

Anaemia

Intra cranial haemorrhage

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Forceps Delivery ProceduresForceps deliveryAnatomy of the forcepsProcedureForceps delivery – Step 1Forceps delivery – Step 2Forceps delivery – Step 3Forceps delivery – Step 4Forceps delivery – Step 5Forceps delivery – Step 6Forceps application – Step 6 (continued)Forceps application – Step 6 (continued)Position for safety – Step 6 (continued)Forceps delivery – Step 7Forceps delivery – Step 8Forceps delivery – Step 9Forceps delivery – Step 10Potential injuries