Infants can also “present” abnormally in the birth canal, and some obstetricians will use an assistive device to rotate the child’s head in line with the mother’s pelvis.
Some of these factors are true medical emergencies, which put infants in harm’s way. Pulling a baby out, and using forceps to do so, may seem like the only viable option to an obstetrician.
What Are Forceps?
Forceps have been used in assisted deliveries since at least the 16th century. The device resembles a pair of large spoons, or salad tongs, and can be clamped directly to an infant’s head. Using the forceps to gain traction on a child’s head, obstetricians can ease the baby through the birth canal.
Forceps Delivery Risks & Complications
But for perfectly obvious reasons, using forceps during a difficult delivery poses significant risks. Physicians must use extreme care to avoid causing unnecessary harm to infants, as well as mothers.
Risks For Infants
At the least, most babies who are delivered with forceps will have minor marks or scratches on their faces. These mild birth injuries, due to the pressure exerted by the forceps, should heal on their own within a matter of days or weeks.
In many assisted deliveries, however, infants suffer far more serious injuries. Since forceps must be applied to a child’s head, facial nerve damage is a particular risk. Bell’s palsy, in which a nerve in a baby’s face is bruised or torn, can lead to permanent paralysis.
Severe forceps injuries are rare, but should be taken extremely seriously. Pressure from the device can cause skull fractures, and even internal bleeding inside an infant’s brain. In babies, internal hemorrhage is a significant contributor to brain damage, which itself can result in stroke, seizure disorders and cerebral palsy.
Forceps can also inflict serious injuries on mothers, including severe vaginal tears. Many women also experience bowel and bladder issues after an assisted delivery. Infection, excessive bleeding and nerve injuries are possible as well.
Are Forceps Still Used In Birth?
Yes, although their use is declining. More and more obstetricians are turning to vacuum extractors, or relying solely on cesarean deliveries, to handle difficult phases of childbirth.
As we’ve seen, the risks involved in a forceps-assisted delivery can be quite significant. But there are still circumstances, according to researchers in the British Medical Journal, in which forceps may be the safer option.
When Are Forceps Used?
Babies who present face-first, for example, usually can’t be delivered through vacuum assistance, since you wouldn’t want to put a suction cup right on a newborn child’s face. Likewise, obstetricians normally discourage using a vacuum to deliver a premature infant, because preemies are at an increased risk for intracranial hemorrhage (bleeding in the skull).
Moreover, successful vacuum extraction requires maternal participation; a mother must push as the obstetrician pulls for this method of delivery to work. Mothers who are, or become, unable to push during delivery usually can’t undergo vacuum extraction, so forceps become the only choice.
There also situations in which forceps can help in the completion of a cesarean section.
Vacuum Assisted Delivery
Due to significant risks, forceps have fallen out of favor over recent years, according to Reuters. Since extreme care must be used to avoid harming mothers and children, many younger obstetricians refuse to use the device entirely.
Instead of forceps, obstetricians are opting for vacuum extractors in greater numbers. The rate of cesarean sections has also skyrocketed, from around 21% in 2000 to more than 32% in 2014.
Vacuum extraction, or ventouse as it is sometimes called, is simple in principle. An obstetrician applies a vacuum cup to the baby’s head, and uses the suction to guide the infant out of the birth canal. Early models were made out of metal, but newer vacuums generally use a soft plastic suction cup.
Vacuum Delivery Birth Trauma
Vacuum extraction, however, still isn’t as safe as unassisted vaginal delivery. The use of a vacuum increases the risk of traumatic birth injuries by ten times, according to scientists in BioMed Central Pregnancy and Childbirth.
In fact, the US Food & Drug Administration has even spoken out about the use of vacuum extractors during difficult deliveries. “Concerned that some health care professionals […] may not be aware that the device may produce life-threatening complications,” the FDA released a battery of recommendations on the proper use of vacuums in 1998. The agency noted several reports of death and serious injuries in babies who had been “helped” through delivery with vacuum extractors.
Risks To The Baby
As with forceps, vacuums often cause superficial wounds to an infant’s scalp. Children will often be delivered with cone-shaped heads, caused by swelling. This formation, known as a chignon, usually disappears within a matter of days.
Although facial nerve palsies and bleeding in the eye are possible, the most severe risk of a vacuum-asssisted delivery is bleeding in the brain. Intracranial hemorrhage, a type of bleeding inside the skull, can lead to cerebral palsy, epilepsy disorders and developmental delays.
Can Vacuum Delivery Cause Brain Damage?
Both forceps and ventouse can cause minor bruising on a child’s head, which should clear up within a few days or weeks. But can the risks go deeper?
Brain damage is a rare, but severe, side effect of vacuum extraction. In the course of ventouse, babies can suffer brain damage in several ways, both direct and indirect.
Birth Trauma After Ventouse
Suction applied to the head can accidentally rupture blood vessels in the brain, leading to an internal hemorrhage that could compress brain tissue and rob brain cells of oxygen. In extreme cases, a vacuum extractor can even fracture a child’s skull, creating the obvious potential for brain damage.
Increased Risk Of Jaundice & Kernicterus
In a less-direct way, vacuum extraction increases the risk of jaundice in newborns. Jaundice, in turn, increases the risk for brain damage.
How Ventouse-Related Bruising Can Lead To Brain Damage
Many children who undergo ventouse will be born with a cephalohematoma. Blood vessels burst between the skull and the periosteum, a thin tissue of membranes surrounding the skull, creating a bump of soft, squishy skin on a child’s scalp.
Cephalohematoma is usually nothing to worry about; in most cases, the leaking blood is reabsorbed into the body over a few days or weeks, leaving the baby’s head smooth. But the blood loss also creates an increased risk for jaundice, one of the most common medical conditions diagnosed in newborn babies.
A Brief Introduction To Jaundice
Jaundice is caused by bilirubin, a chemical pigment, yellow in color, produced as a byproduct when our bodies break down old red blood cells. Babies, though, have immature livers, which can’t always filter bilirubin out of the blood efficiently. Instead, the bilirubin builds up, ultimately turning the child’s soft tissues a pale shade of yellow or orange.
Like cephalohematoma, jaundice usually goes away of its own accord, but in some cases, the conditions can work together. In a fundamental sense, cephalohematoma is a form of blood loss; the blood has left the circulatory system, coming to occupy a bubble on the baby’s scalp.
As this blood breaks down over time, it releases bilirubin. That increases the risk for jaundice, along with the most serious complication of jaundice, a form of brain damage known as kernicterus. Kernicterus is almost always preventable. When a child develops kernicterus, it’s usually a sign of medical negligence.
Risks To The Mother
Vacuum extraction has been shown to increase the risk of vaginal and rectal soft tissue injuries in mothers. Blood loss is not uncommon, and can lead to chronic conditions like anemia. Many women develop incontinence and pelvic organ prolapse, even years after delivery.
Unsuccessful Birth Procedures
When the use of either assistive device proves unsuccessful, obstetricians should move on immediately to an emergency c-section. Trying an alternative birth-assistive device is not the right choice. Researchers have found that combining the use of forceps and vacuum extraction increases the risk of an infant’s death to intolerable levels. According to the American College of Obstetricians and Gynecologists, an assisted delivery should only be attempted using one device, either forceps or a vacuum. If the first device isn’t effective, a c-section is the best option.
Assisted Delivery & Birth Injury Lawsuits
Only experienced, and skilled, obstetricians should attempt an assisted delivery. In the hands of an inexperienced doctor, forceps and vacuum extractors can easily become weapons. These devices can cause serious harm, and when they do, some families will be eligible to file a medical malpractice lawsuit.
The medical experts at Medscape say that obstetricians should obtain maternal consent before using forceps. In fact, maternal consent is generally considered a prerequisite before any assisted vaginal delivery, including the use of a vacuum. Assisted deliveries are considered operations – both under the law and in the medical field. Obstetricians have a duty to disclose the risks of any operation to a patient, prior to the operation itself.
Informing mothers about the risks of an operation isn’t enough. Experience and skill are key to the successful use of birth-assistive devices. Doctors should disclose their own experience, or lack of experience, in using these devices before the procedure.
We should note that many of the injuries caused by birth-assistive devices only begin to present symptoms after a child’s delivery. Obstetricians should always notify an infant’s pediatricians that forceps or vacuum extraction were used, so that these other doctors can watch for emerging signs of trauma.
Negligence & Medical Standards
In birth injury lawsuits, especially ones related to assisted deliveries, many mothers say that they were never warned about the risks beforehand. But failing to disclose the significant risks of an assisted delivery is not enough, on its own, to create a viable medical malpractice claim. Nor is a failure to obtain informed consent a precondition of filing suit.
To secure compensation, families will have to prove that their healthcare professional acted negligently during the delivery – and that this failure to follow accepted medical standards caused injury to the child. In the vast majority of cases, this will only be possible with the help of an experienced birth injury attorney.