Types of forceps for delivery

If you challenged an obstetrician to name at least half the "types" of forceps used in the obstetric world, the chances are he or she will fail. There are so many. However, there are only two main groups of forceps.

One is the type used for traction only (this is the most common) and the other group is the type used for rotation and traction. The latter are not used that often; mainly because situations requiring their use are uncommon and secondly because they are not very popular with obstetricians and probably only a small proportion of obstetricians are adequately trained in their use.

Potential complications of using forceps for delivery

Most of the potential complications are soft tissue injuries to the mother.

There may be bruising or even lacerations to the perineum and vagina.

Sometimes, injury to the vaginal wall escapes detection and presents a few hours later as a painful and progressive hematoma (blood-clot) under the vaginal skin.

Injuries may be sustained to the bladder and/or urethra. This may present in the form of urine retention.

The Ventouse for delivery

With the ventouse, a metal or silastic (soft) cup is applied to the baby’s scalp. Controlled vacuum is created in the cup, exerting a grip on the scalp skin. If it is a metal cup, the scalp skin is sucked into the cup, while with the soft rubber (silastic) type; the cup moulds itself on the fetal head to fit like a cap. Controlled traction is then applied but this has to be synchronized with uterine contractions and maternal effort. This is an important safety feature of the ventouse.

Differences between a metal cup and a silastic ventouse cup

There are no significant differences between these two ventouse ‘cups’. They are both equally efficient and just as safe as each other. The metal cup has been around for much longer and the silastic cup only since the early 1970s. However, many obstetricians probably prefer the soft silastic cup, because it is more user-friendly and, in theory at least, has less potential to cause harm to the mother or baby.

As for fetal complications, scalp hematoma (blood clot) is probably more common with ventouse than with forceps.

A complication that is unique to the ventouse but which is exceptionally rare is loss of hair in infancy for the baby.

The most common feature, which parents notice immediately, is the swelling on the baby's head where the ventouse cup has been applied. Metal cups produce a bigger swelling. It takes up to 72 hours for this swelling to disappear. It does not appear to trouble the newborn unduly, because the feeding and sleeping pattern is never disturbed. It is called a chignon.

Choice of the instrument to be used in assisted delivery

Should a mother express a preference if an instrument is to be used to assist delivery? This is a good question. Ideally, there should be no problem with this, as long as she is well informed and both types of instruments are available and ideal for the circumstances. Of course, the operator must have the expertise in employing either.

Safety of forceps and ventouse instruments

These instruments are quite safe for mother and baby. If and when used appropriately by a well-trained operator, these instruments are, not only safe, but extremely useful too. Every case where one of these is used for delivery is a potential caesarean section and the laboring woman on whom these have been used should consider herself "rescued" from a possible major surgery.

Shoulder dystocia: Next page