During a long and difficult labor and delivery, doctors may use a number of different techniques to assist the baby out of the birth canal. In some cases, where the baby is stuck, doctors may decide to utilize birth-assistive tools such as forceps to help free the baby. In a forceps delivery, an obstetrician uses an instrument that is more or less shaped like a pair or large spoons or salad tongs and holds the baby’s head to help guide him or her out of the birth canal. Forceps are typically applied during a contraction as the mother pushes.
Your doctor might recommend a forceps delivery during the second stage of labor – when you are pushing, but the labor isn’t progressing or if your child’s safety depends on an immediate delivery. A forceps delivery, while sometimes necessary, poses a risk of serious birth injuries. It may also result in injuries to the mother. If a forceps delivery fails, an emergency Cesarean Section (C-section) might become necessary. Recent studies, including one in the Canadian Medical Association Journal show forceps deliveries increase injury risks to the mother and baby.
There are many times when a doctor’s incompetence and negligence while using forceps result in major injuries to the child and lead to other complications such as Erb’s palsy and cerebral palsy. These are conditions that result in lifelong disabilities for children. If your child has suffered a birth injury during a forceps delivery, you may be able to seek compensation by filing a medical malpractice lawsuit. An experienced New York birth injury lawyer will be able to provide you with more information regarding your legal rights and options.
Why is a Forceps Delivery Done?
Your obstetrician may consider using forceps to aid the delivery of your child if your labor meets certain criteria. Your cervix must be fully dilated, your membranes must have ruptured and your baby should have descended into the birth canal headfirst. If these conditions are satisfied and you are unable to push the baby out, your doctor might choose to use forceps. Here are a few scenarios where your doctor may choose to use forceps:
- You are trying to push out the baby, but you are unable to do so. This is what is known as a “stalled labor,” when you’ve pushed for two to three hours, but haven’t made any progress.
- Your child’s heartbeat suggests there is a problem. If your doctor is concerned about changes in your child’s heartbeat and believes an immediate delivery is necessary, he or she might recommend a forceps delivery.
- You have health complications. Certain medical conditions such as aortic valve stenosis (narrowing of the heart’s aortic valve) might limit the amount of time you are able to push. If you’ve pushed for too long without success, your doctor might choose to use forceps to deliver the child.
- Your child is in breech position or feet-first, as opposed to head-first.
- Your child has a condition that affects his or her bones or has a bleeding disorder such as hemophilia.
- Your baby’s shoulders or arms are leading the way through the birth canal.
- Your child is unable to fit through your pelvis due to being larger than average sized or due to the fact that your pelvis is small.
How is the Procedure Done?
During a forceps delivery, the mother lies on her back, slightly inclined and attempts to push the baby out. Between contractions, your obstetrician will slide one tong between his or her hand and the baby’s head and place the other tong on the other side of the baby’s head. The tongs are meant to cradle the child’s head. During the next few contractions, as the mother pushes, the doctor will use the forceps to gently guide the baby through the birth canal. If the baby’s head is facing up, the obstetrician might use the forceps to rotate the child’s head between contractions.
If the child’s delivery appears to be certain, the forceps will be removed before the widest part of the baby’s head passes through the birth canal. Alternatively, your obstetrician might keep the forceps in place to better control the baby’s head as it advances.
It is important to remember that forceps deliveries are fraught with complications. For example, if the doctor is unable to properly grasp the baby with the forceps, he or she might use a cup attached to a vacuum pump to deliver the baby, a procedure also known as a vacuum extraction. In many cases where a forceps delivery is unsuccessful, doctors opt for an emergency C-section. When certain risk factors are present such as larger than average size of the baby or breech births, a C-section might be the best option in order to avoid the complications that occur during a vaginal birth.
When Should Forceps Not Be Used?
As we saw earlier, there are prerequisites that must be in place prior to a forceps assisted delivery. And there are certain situations where forceps should not be used in the delivery of the baby. If the baby is under 34 weeks of gestation, there is an increased risk of fetal brain bleeds. When the baby’s head is to too large to pass through the mother’s pelvis or if there are signs of connective tissue disorders or fetal bleeding, forceps should not be used. Forceps may also become a dangerous device and lead to serious or fatal injuries in the hands of inexperienced physicians.
If the attending physician has little or no experience carrying out a forceps delivery, it should certainly not be attempted. This may pose a risk of serious injury to the mother and child. The American College of Obstetricians and Gynecologists recommends that a doctor should not use more than one birth-assistive tool at the time of delivery. So, if forceps are being used, a vacuum extractor should not be used just because the forceps have failed. If a baby cannot be delivered by forceps, a C-section should be the next option.
Even when all the criteria for forceps use are present, using them correctly is critical. The obstetrician should be extremely careful with regard to the placement of the tongs. If the forceps are not applied evenly to the baby’s head or if excessive force is used, the pressure may cause skull fractures, head compression, tearing of vessels in the brain, bleeding on the brain and swelling. All of these conditions have the potential to cause irreversible brain damage, hypoxic ischemic encephalopathy (HIE), cerebral palsy and other severe disabilities.
During labor and delivery, informed consent is critical. This means that your doctor should thoroughly explain all procedures before they are used. This includes all procedures, their risks and benefits, and alternatives to various procedures. This helps patients choose the best healthcare option and assists them with making an informed decision. When explaining the risks of forceps delivery, your doctor should discuss alternatives such as delivery by C-section.
Forceps Delivery and Birth Injuries
When forceps are applied incorrectly or used by a doctor who has little to no experience with them, a number of serious birth injuries may occur. Here are some common types of birth injuries caused by improper forceps use:
Erb’s Palsy: This is a condition that damages the nerves, which control the muscles in the hand and arm. Erb’s palsy or a brachial plexus injury is caused by the stretching of the nerve fibers of the brachial plexus when the head and/or shoulder of the baby are pulled with great force. Risk factors include larger than average infants, small mothers, low or mid-forceps delivery and second-stage labor exceeding 60 minutes.
Proper prenatal monitoring of the mother and child can help prevent this type of a situation and injury. Babies with Erb’s palsy may suffer permanent disabilities including paralysis of the affected arm. Another birth injury that may occur is Klumpke’s palsy, which is also caused by injury to the nerves of the brachial plexus involving the fingers and wrist.
Facial palsy and injuries: Facial nerve palsy is essentially the loss of voluntary muscle movement in an infant’s face due to birth trauma involving excess pressure being exerted on the facial nerve. An infant’s facial nerve is also called the seventh cranial nerve. It can be damaged just before or at the time of delivery. One of the most common causes of facial paralysis is improper use or forceps, specifically applying excessive force.
Facial paralysis may be partial or complete. In some cases, only the lower half of the face is affected and other times, the entire left side of the face is affected. Each facial nerve originates at the brain and enters the front of the face where it branches out into five separate parts. These branches help the muscles of the face work, and these muscles are used to generate facial expression. The nerves in the face also control the production of tears, saliva and taste, among other things – functions that may be affected when facial nerves are damaged.
Cerebral palsy: When a doctor puts excessive pressure on the infant’s delicate skull, irreversible brain damage may occur. This type of trauma is, in fact, more common when a baby is delivered vaginally using instruments such as forceps than during a C-section. Cerebral palsy is one example of the type of permanent disability that may occur as the result of a poorly performed forceps delivery. Cerebral palsy is a condition marked by impaired muscle coordination and/or other disabilities, typically caused by damage to the brain at birth.
The pressure on the infant’s brain may cause brain damage, which is the underlying cause of cerebral palsy, a condition that has no cure. Since cerebral palsy is a brain injury, other areas of the brain can be affected, which means children may experience problems with sight, speech, hearing and other functions. Children may also have problems with bladder control and problems with muscles. Children with cerebral palsy may need constant monitoring, treatment and therapy.
Forceps Deliveries and Medical Malpractice
If you have a long or complicated delivery, your medical team has the responsibility to help you make the safest and most effective choices to facilitate the process. There are times when forceps use turns out to be the wrong decision causing your child to suffer severe and disabling birth injuries. If your doctor had sufficient information to know that a C-section would have been less risky or if your doctor used forceps improperly or too forcefully, you may have a medical malpractice claim. You may be able to seek compensation for damages including, but not limited to, medical expenses, lost income and wages, loss of future income, permanent injury, disability, past and future pain and suffering, etc.
If your child has suffered facial paralysis or a birth injury as the result of medical negligence, the experienced New York personal injury attorneys at the Law Offices of Kenneth A. Wilhelm can help you better understand your legal rights and options, and also fight hard to recover just compensation for you.
One of our clients secured a $43,940,000 verdict for a child who was diagnosed with cerebral palsy. The hospital failed to diagnose fetal distress, which led to brain damage and cerebral palsy from lack of oxygen supply to the brain. The delay in diagnosing the fetal distress and ordering a C-section delivery caused the child’s condition. Defense attorneys argued that the child’s injuries were caused by premature birth and that the obstetrical care was appropriate. The $43,940,000 verdict was eventually reduced on appeal, because the verdict was so huge.
In another case, our client obtained a $4,500,000 settlement where the doctor negligently used forceps to deliver a baby cutting oxygen supply to the child’s brain. The infant suffered from cerebral palsy as a result. We were able to prove that a C-section should have been performed, which may have prevented the cerebral palsy from occurring.
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