MoonDragon's Women's Health Procedures Information
OBSTETRIC FORCEPS USE DURING BIRTH
For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.
Obstetric Forceps Description Types of Obstetric Forceps Indications For use of Obstetric Forceps Conditions & Preparations For Obstetric Forceps Delivery Use of Anesthesia For Obstetric Forceps Delivery Low Forceps Delivery Mid Forceps Delivery Delivery With Keilland's Forceps The Classical Technique Other Applications of Obstetric Forceps Complications of Obstetric Forceps Delivery
OBSTETRIC FORCEPS DESCRIPTION
Forceps should not used in a homebirth setting and by individuals that are not fully trained in the proper use of and dangers of these obstetric tools. Improperly used, they can cause severe birth injury to both the mother and infant.
The obstetric forceps is designed to grasp the fetal head when it is in the vagina and bring about delivery by traction and guidance without causing injury to the mother or baby. The forceps consists of two arms which are movable. They somewhat resemble large connected salad spoons.
The blades have two curves.
The cephalic curve is adapted to provide a good application to the fetal head.
The pelvic curve allows the blades to fit in with the curve of the birth canal.
There are several kinds of locks:
The pelvic axis necessitates traction "round a corner", so some forceps have detachable handles, rods or tapes which allow traction in the pelvic axis. This technique of "axis traction" should be unnecessary in present day practice. Difficult forceps delivery is avoided by cesarean section.
The traction rods can make the forceps a very powerful and therefore dangerous instrument.
Forceps operations are of two kinds:
The fetal head has reached the perineal floor and is visible at the vulva.
Engagement has taken place and the leading part of the head is below the level of the ischial spines.
Application of the forceps when the head is not "engaged" is known as "high forceps". Some suggest that only low forceps should be used and that mid forceps should be replaced by cesarean section.
TYPES OF OBSTETRIC FORCEPS
There are very many different patterns. The forceps shown here are all well known and are identified with the three main operations - the low forceps, the mid forceps, and the rotation-extraction forceps delivery.
Wrigley's Forceps: Wrigley's Forceps is designed for use when the head is on the perineum and local anesthesia is being used. It is a short light instrument with pelvic and cephalic curves and an English lock.
Milne Murray's Axis Traction Forceps: In theory the axis traction rods which were designed to apply traction to a head high in the pelvis are now obsolete; but in practice they are often of considerable help and the action of the rods allows the forceps blades to move more naturally along the pelvic curve without hindrance from the operator's hands. The forceps has an English lock and an additional screw lock to maintain a firm application, and the traction rods are connected in such a way as to give the best mechanical advantage. This instrument is a little awkward for the beginner, and the traction rods if used may damage the perineum unless a large episiotomy is made. This instrument can be very powerful and therefore very dangerous if not used with caution.
Kielland's Forceps: This forceps was originally designed to deliver the fetal head at or above the pelvic brim, lying in the transverse axis of the pelvis and rotating it when it had reached the pelvic cavity. The forceps is used today for rotation and extraction of the head which is arrested in the deep transverse or occipito-posterior position.
The blades have very little pelvic curve and are virtually an axis traction forceps. A large episiotomy is needed. The shallowness of the curve allows safe rotation in the vagina. Downward traction encourages rotation of the head.
The Claw Lock allows the blades to slide on each other and correct or encourage synclitism of the fetal head as required.
The range of movement allowed by the lock makes it possible to apply lethal compression to the fetal head if the instrument is used improperly.
INDICATIONS FOR THE USE OF OBSTETRIC FORCEPS
1. Second stage delay. When progress is absent or slow and the laboring woman is tiring, whatever the position of the baby's occiput. This covers a wide variety of attitudes to the second stage; but in general, in the current medical practice it may be said that the second stage should not last over an hour in a primigravida and half-an-hour in a multigravida.
2. Fetal Distress.
3. Maternal Distress. When the mother is exhausted by a long labor or is emotionally unequal to the demands of a second stage labor; or when some condition such as cardiac failure or hypertension makes the effort of the second stage undesirable.
CONDITIONS & PREPARATIONS FOR OBSTETRIC FORCEPS DELIVERY
1. The cervix must be fully dilated. If the forceps is applied before this stage is reached the operator may produce severe lacerations and hemorrhage.
2. Except when the head is on the perineum, the bladder should be emptied by catheter.
3. The laboring woman should be in the lithotomy position, although some practitioners find delivery easier with the laboring woman in the left lateral position. She must be cleaned and draped and aseptic precautions must be observed. Negligence in this respect will almost certainly lead to genital infection.
4. For low forceps operations local anesthesia may be used provided it is acceptable to the mother. It avoids the risks of general anesthesia and allows the mother to assist in the delivery by bearing down when asked.
5. Epidural anesthesia may be used for pain relief, and this is adequate for low forceps or when little manipulation is required.
6. If general anesthesia is used, it should be given by an experienced anesthesiologist. The stomach must be emptied by gastric suction, the laboring woman should receive pre-medication, and endotracheal intubation is probably the safest technique.
7. Mechanical suction should be available for mother and child, and the head end of the bed or table used for the operation should be capable of being lowered rapidly if vomiting should occur when the mother is under anesthetic.
USE OF ANESTHESIA FOR OBSTETRIC FORCEPS DELIVERY
Local anesthesia for forceps delivery is usually a combination of local infiltration and pudendal nerve block. Lidocaine or xylocaine in 1 percent without adrenaline solution is satisfactory and up to 50 mls may be used with safety.
Local infiltration is usually all that is needed for low forceps operation.
PUDENDAL NERVE BLOCK
The forefinger is placed on the ischial spine (behind which runs the pudendal nerve) and a long needle is passed via the ishiorectal fossa. When needle point, spine and finger are in conjunction, 5 ml of anesthetic is injected. It is advisable to withdraw the plunger before injecting to make sure that the needle is not in a blood vessel. The needle, preferably a guarded one can be passed per vagina if the practitioner finds it easier.
LOW FORCEPS DELIVERY
MID FORCEPS DELIVERY
DELIVERY WITH KEILLAND'S FORCEPS
THE CLASSICAL TECHNIQUE
The "Classical Technique" is to guide the anterior blade round under the pubis into the space between head and shoulder and then rotate the blade gently in this space in the direction of the "dip" of the blade so that it lies with the fetal curve facing the head and shoulder. The blade is then withdrawn slightly to lie on the head in the usual fashion.
OTHER APPLICATIONS OF OBSTETRIC FORCEPS
DELIVERY OF THE HEAD IN THE OCCIPUT-POSTERIOR POSITION
This is the easiest and often the best method of delivering an infant with the head in the direct OP position. If the head is low in the pelvis it is likely to be deliverable with vary little traction and the fetus is spared the risks of manipulation. A large episiotomy is necessary.
The correct cephalic application is with the head in the OA position as shown. Sometimes an oblique grip is obtained by mistake. This is undesirable unless very little traction is needed for delivery. If the head is transverse it is permissible to apply the forceps laterally, obtaining an anterio-posterior application. Manual rotation or by Kielland's forceps is better. In a breech presentation the safest method of delivering head is by applying the forceps once it has entered the pelvis. In a face presentation (mento-anterior) the forceps may be applied direct. (Mento-posterior positions must be rotated.)
COMPLICATIONS OF OBSTETRIC FORCEPS DELIVERY
1. Perineal tears are inevitable unless episiotomy is done at the right time.
2. Vaginal wall may be split especially if compressed between ischial spine and fetal head or forceps inserted carelessly.
3. Cervical and vaginal tears may be caused during a Kielland's rotation. After delivery the vagina and cervix should be carefully palpated and all damage repaired.
Except from lacerations, hemorrhage is no more likely than after spontaneous delivery. If the uterus is "atonic" (i.e., if contractions have ceased for some time before delivery) intravenous oxytocin should be given.
INJURIES TO BABY
If the blades have been properly applied, the fetal head should be protected by the rigid case of the forceps blades. Where excessive traction force has been applied, there may be bruising, facial nerve palsy, or depression fracture of the skull.
This is an old term which means that an attempt to deliver with forceps has been unsuccessful. The causes are:
1. Unsuspected disproportion.
2. Misdiagnosis of the position of the head.
3. Incomplete dilation of the cervix.
4. Outlet contraction (very rare in an otherwise normal pelvis).
1. If the mother is in good condition and the cause is undiagnosed malposition, an attempt at correction may be made by an experienced practitioner. Antibiotic cover should be started and general anesthesia should be used.
2. If the cause is incomplete dilation of the cervix and mother and child are in good condition, the woman should be given sedatives and given intravenous fluids and antibiotic cover. Contractions should be stimulated with oxytocin to see if labor advances.
3. If disproportion is present, or if the woman is exhausted and lacerated, cesarean section should be carried out. In such circumstances there is a good argument for the classical operation which avoids the edematous and easily torn lower segment.
Information obtained from Obstetrics Illustrated by Garrey, Govan, Hodge, & Callander, 3rd edition.
MoonDragon's Procedures: Medical & Obstetrical Information
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
MOONDRAGON'S MERCHANT VENDORS & PRODUCTS
Educational materials and health products are available through Amazon.com.
Use the search box provided below to search for a particular item.
MOONDRAGON'S REALM - WEBSITE DIRECTORY
A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.