Dust off the Obstetrical Forceps?

When I think of obstetrical forceps I can’t help but also think of the saying by Werner Karl Heisenberg: ‘Every tool caries with it the spirit by which it has been created.” And The clan of brilliant and skilled obstetricians, the Chamberlains, who invented forceps and  hid them from the world to preserve their secret. The recent experts in obstetrics hid forceps from the patients because of perceived harm. Is it time to re-evaluate forceps? There was a collaborative study just published in the Green Journal: Obstetrics and Gynecology by a group of Eastern seaboard physicians: Johns Hopkins, Yale, Brown, that has showed that the use of forceps, not the vacuum can reduce the risk of adverse neonatal neurologic outcomes. The physicians noted that in 1990 about 1/20 babies was delivered by forceps, and by the year 2007 less than 1% were. If an operative vaginal delivery is selected, and so often a C-section is selected instead, they note that physicians will select a cesarean. This group looked at the three choices: c-section, vacuum delivery or forceps. The c-section group of babies had lower Apgar scores and higher rates of seizures. Rates of other serious complications tended to be worse as well Vacuum deliveries tended to have more scalp cuts, fractures and bruising. Forceps babies had more nerve injuries: face and arm. But when the total numbers of cases of neurologic complications was looked at: forceps were the safest. The data can be confusing because a forceps delivery has to be performed when mom is almost ready to deliver. In many cases with stress on their fetal heart rate tracing mom is not that far along in labor and only a c-section can intervene, and perhaps these babies are indeed sicker. This is also a study from the baby perspective, not mom’s and mom may sustain a tear to get the baby delivered vaginally. The article doesn’t go into the subtleties of the types of forceps, and they were once evolving into a very wide range of designs for each situation the obstetrician encountered: like the Karl Marx saying in 1867: (machines) are ‘knowledge objectified,’ and the obstetricians of antiquity made tools that would fit different pelvic shapes as well as different baby sizes. But we also have to remember, forceps are a tool that has to be taught, and they have been mostly in the closet, so the young physicians have not used them as much. No matter what your choices are, you have to discuss individually with your gyno. 


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