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An operative delivery refers to an obstetric procedure in which active measures are taken to accomplish delivery. Operative delivery can be divided into operative vaginal delivery and caesarean delivery. The last several years have seen a steady decline in the operative delivery with an increase in the caesarean section rate. In addition, vacuum-assisted vaginal delivery has become more common than forceps. Most recent data from births in the United States during 2005 indicate that the vacuum-to-forceps ratio is approximately 4:1. The success and safety of these procedures are based on operator skill, proper timing, and ensuring that proper indications are met while contraindications are avoided. This chapter explains how each procedure is performed, the indications and contraindications to the procedure, the potential complications, and how to minimize complications.
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The obstetric forceps is an instrument designed to assist with delivery of the baby's head. The invention of the precursor to modern forceps is credited to Peter Chamberlin in the 1600s. It is used either to expedite delivery or to assist with certain abnormalities in the cephalopelvic relationship that interfere with advancement of the head during labor. The primary functions of the forceps are to assist with traction of the fetal head and/or to assist with rotation of the fetal head to a more desirable position.
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Although forceps-assisted vaginal deliveries were once extremely popular, the most recent data demonstrate that only one-quarter of all operative vaginal deliveries are performed using forceps. The reverse was true approximately 10 years ago. In fact, many investigators are concerned that the use of forceps is becoming a lost art. The reasons often cited in contributing to the decline in the use of forceps are (1) medicolegal implications and fear of litigation, (2) reliance on caesarean section as a remedy for abnormal labor and suspected fetal jeopardy, (3) perception that the vacuum is easier to use and less risky to fetus and mother, and (4) decreased number of residency programs that actively train residents in the use of forceps. These factors have led to a cycle in which less teaching has led to a decrement in technical skills, an increased fear of litigation, and a resultant further decrease in the use of forceps.
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The obstetric forceps (Fig. 20–1) consists of 2 matched parts that articulate or “lock.” Each part is composed of a blade, shank, lock, and handle. Each blade is designed so that it possesses 2 curves: the cephalic curve, which permits the instrument to be applied accurately to the sides of the baby's head, and the pelvic curve, which conforms to the curved axis of the maternal pelvis. The tip of each blade is called the toe. The front of the forceps is the concave side of the pelvic curve. The blades are referred to the left and right according to the side of the mother's pelvis on which they lie after application. During ...