Forceps Delivery Injuries

What is a forceps delivery?

A forceps delivery is a type of assisted vaginal birth in which the doctor places two curved, spoon-shaped blades around the baby’s head and applies traction, timed with the mother’s contractions, to help complete the delivery. Doctors call this an operative vaginal delivery, the same category as vacuum extraction, which uses a suction cup instead of blades.

Operative vaginal deliveries make up roughly 3 percent of births in the United States, and forceps are now the less common of the two instruments; most obstetricians reach for the vacuum first, and many younger physicians have limited forceps training. That last fact matters: forceps are a skill-dependent instrument, and the American College of Obstetricians and Gynecologists (ACOG) is explicit that they should only be used by an experienced, credentialed operator.

When forceps are an appropriate choice

Forceps are not inherently dangerous, and in the right hands they can end a stalled or deteriorating labor faster than an emergency cesarean could. It is fair to say that a well-executed forceps delivery has saved babies from oxygen deprivation. The recognized reasons to consider forceps include:

• A prolonged second stage of labor: the pushing phase has gone on for hours without progress.
• Concern for the baby’s condition: the fetal heart tracing suggests the baby is not tolerating labor and delivery needs to happen quickly. (See our guide to fetal monitoring errors.)
• A maternal reason to shorten pushing: certain heart or neurological conditions, or complete exhaustion.

Just as important are the prerequisites, the safety conditions that must all be true before forceps are applied. The cervix must be fully dilated, the membranes ruptured, and the baby’s head engaged low in the pelvis with its exact position known. The bladder should be emptied, adequate anesthesia in place, and — critically — the physician must have a plan to abandon the attempt and move to a cesarean if the baby does not descend easily.

Injuries forceps can cause

Because forceps blades grip the sides of the baby’s head and can transmit substantial force, the injuries associated with them cluster around the head, face, and brain:

How often does the worst happen? A landmark study of more than 580,000 California births published in the New England Journal of Medicine found intracranial hemorrhage in roughly 1 in 660 forceps deliveries, compared with about 1 in 1,900 spontaneous vaginal births, and the rate climbed sharply, to about 1 in 280, when both vacuum and forceps were used on the same baby. That is why modern guidance discourages switching from one instrument to the other after a failed attempt.

Mothers are also at risk: forceps carry the highest rate of severe vaginal tears (third- and fourth-degree lacerations) of any delivery method, along with pelvic floor injury.

What ACOG’s guidance actually requires

ACOG’s Practice Bulletin on operative vaginal birth (No. 219, 2020) sets the professional standard, and several of its rules matter in injury cases:

• Low or outlet applications only, as a practical matter. The baby’s head must be well descended in the pelvis. The high forceps deliveries of past generations are obsolete, and mid-pelvis attempts are reserved for rare, carefully selected circumstances.
• Know the position first. Applying blades to a head whose orientation is uncertain is how faces and skulls get injured. Ultrasound in the delivery room can confirm position.
• Be willing to stop. If the head does not descend with appropriate traction, the attempt should be abandoned in favor of a cesarean — not repeated with more force.
• Do not stack instruments. Sequential use of vacuum then forceps (or the reverse) multiplies the risk of brain bleeds and should generally be avoided.
• An experienced operator and a real consent conversation. Families should hear the options (forceps, vacuum, cesarean, or continued pushing) when circumstances allow.

When forceps use becomes negligence

Not every forceps injury is malpractice. Superficial marks and bruising are common even in textbook deliveries, and a properly indicated, properly performed forceps delivery that still results in injury is generally not a legal case. The question is whether the decision and the technique met the standard of care. Red flags that experts look for include:

• Forceps applied when the prerequisites were not met: cervix not fully dilated, head too high, or position unknown.
• Excessive traction or twisting force, often evidenced by skull fracture, significant bleeding, or deep facial injury.
• Repeated pulls with no descent, instead of moving to a cesarean.
• Vacuum and forceps used sequentially on the same baby.
• An operator without adequate forceps training or credentialing.
• Forceps chosen to avoid a cesarean when the fetal monitor had been showing distress for a prolonged period, meaning the real error began earlier, with the monitoring response, and the instrument was a last-minute rescue attempt.

Was it preventable?

Preventability turns on the medical records: the labor curve, the fetal heart tracings, the operative note describing station and position, the number of pulls documented, and the newborn’s imaging. When a depressed skull fracture or brain hemorrhage follows a mid-pelvis attempt on a poorly positioned head, the connection between technique and injury can be direct. When a baby also suffered oxygen deprivation and later developed hypoxic-ischemic encephalopathy (HIE), the analysis widens to everything that happened in the hours before the forceps came out.

Legal options for families

A forceps injury claim is a medical negligence claim: it asks whether the decision to use forceps, and the way they were used, fell below the accepted standard of care and caused your child’s injury. Compensation can cover surgery and rehabilitation, therapy, future medical needs, and, in brain injury cases, lifetime care.

Every state sets a deadline for filing, explained in our statute of limitations guide. Where your case would be handled depends on where the delivery happened: Banville Law attorneys are licensed in New York and Washington, D.C.; The Weitz Firm attorneys are licensed in Pennsylvania and New Jersey; elsewhere, the alliance connects families with its vetted network of local birth injury attorneys.

Frequently asked questions

Are forceps deliveries still done?

Yes, though they have become uncommon: well under 1 percent of U.S. births. Vacuum extraction is now used far more often. Because forceps are so operator-dependent, experience and technique matter enormously to their safety.

Are forceps marks on my baby’s face normal?

Mild red pressure marks or bruising where the blades sat are common and typically fade within days. What is not routine: facial drooping (one side of the face not moving when your baby cries), an indentation in the skull, unusual sleepiness, poor feeding, or seizures. Those warrant immediate medical evaluation.

Can forceps cause permanent brain damage?

Rarely, yes. Excessive or misapplied force can cause skull fractures and intracranial hemorrhage, and a delivery delayed by failed instrument attempts can add oxygen deprivation. Large studies put the risk of intracranial hemorrhage at roughly 1 in 660 forceps deliveries: uncommon, but real.

The doctor tried the vacuum first, then forceps. Is that allowed?

Using both instruments sequentially sharply increases the risk of intracranial hemorrhage, and ACOG’s guidance says it should generally be avoided. If your baby was injured after a vacuum-then-forceps delivery, that sequence deserves scrutiny by an independent expert.

What does a case review cost?

Nothing. The review is free and confidential, and birth injury cases are handled on contingency; attorney fees come only from a recovery.

Sources

This page is for general education and is not medical advice. Medical facts above are drawn from the cited primary sources; legal statements reflect the reviewing attorneys’ professional experience. Always consult your child’s physician about medical concerns.