Operative vaginal delivery remains a crucial skill in obstetric care across Nigeria. A forceps delivery is an assisted vaginal birth where metal instruments are applied to the fetal head to guide it through the birth canal. Midwives must understand when this procedure becomes necessary to support the obstetrician and prepare the delivery room.
Before any forceps can touch the mother, strict clinical conditions must be met to prevent severe trauma. Midwives often act as the final check before the procedure begins. The acronym FIELL or similar mental checklists help confirm safety.
Preparation reduces panic and prevents complications in the labor ward. The bladder must be empty, often requiring a catheter, to maximize pelvic space and prevent bladder injury. Equipment must be checked, including different types of forceps like Simpson or Wrigley patterns.
An experienced neonatal team should be present because assisted deliveries carry risks of birth asphyxia or trauma. Consent must be obtained and documented clearly in the case notes, explaining the risks and benefits to the family in simple language.
The actual application follows a strict anatomical rule: the left blade is introduced first, held in the left hand, and guided by the right hand. Then the right blade follows.
Once both blades are in place, they must lock effortlessly without using force. If they do not lock, the position is incorrect, and the midwife or doctor must remove and re-evaluate them. Traction is applied gently in the direction of the pelvic axis during maternal pushing efforts, mimicking the natural curve of Carus.
While forceps save lives, they carry notable risks that demand vigilant post-procedure observation by the midwifery team.
| Complication Type | Specific Examples |
|---|---|
| Maternal | Vaginal wall lacerations, cervical tears, postpartum hemorrhage, and urinary retention |
| Neonatal | Facial bruising, cephalhematoma, transient facial nerve palsy, and skull fractures |
Proper training and adherence to prerequisites drastically lower the incidence of these adverse outcomes in clinical practice.
After a forceps delivery, comprehensive care shifts to monitoring recovery and documenting the event accurately. Midwives must inspect the birth canal meticulously for any unrecognised lacerations or hematomas. Vital signs are recorded closely to catch early signs of postpartum hemorrhage or infection.
Documentation must include the indication for the procedure, the type of forceps used, the ease of application, anesthesia administered, and the condition of the baby at birth. Clear records protect both the patient and the healthcare personnel legally.