Saturday, October 2, 2010

Birth With Forceps

You find birth everywhere, don't you?

I am currently reading "The Late Talker" (Agin, Geng & Nicholl) in an effort to learn more to help our little one, who is likely going to have speech delays. In reading the forward, I ran across this:

"... Dakota, who had severe respiratory and devlopmental problems due to a traumatic forceps delivery. Dakota had suffered torn neck muscles, crushed facial nerves, and internal head bleeding - and he was a late talker. From birth he had been under the observation of a neurologist and receiving therapy."


I wondered then - how often are forceps needed during unmedicated births? I have never heard of an unmedicated mother needing forceps - the only times that I have heard of forceps being used have been with medicated (i.e. epidural) mums.

In looking it up, I found that there is a definite association between epidural use and forceps delivery. Here is one article that was very interesting (though it was quite old - 1985):

Epidural analgesia during labour: Why does this increase the forceps delivery rate?'

Here is a quote from the article:

"It is postulated that this rise in the incidence of forceps delivery is at least in part due to the abolition of the Ferguson reflex due to blocking of the pelvic autonomic nerves, as demonstrated by Goodfellow et al. (1983). Since there is an increased instrumental delivery rate in those patients with epidurals in whom cephalopelvic disproportion has clearly been excluded, the need for instrumental delivery must be due to deficient expulsive forces. Maternal bearing down effort is certainly compromised by the lack of sensation, but in the light of the above studies it is thought that there may also be a deficiency in uterine activity."

From the website Childbirth Solutions, I found this listed under epidural risks:

"Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors. In addition, forceps or vacuum extractor are required more often (20-75%)."


Considering that homebirth midwives safely attend naturally-laboring women with no forceps or vacuum, it seems to be likely that forceps and medicated labors are inextricably intertwined, as are unmedicated labors and the absence of a need for forceps.

The only time that I have heard of homebirth midwives being unable to bring babies out naturally are when baby is good and truly stuck, and a hospital transport is made for a cesarean (as happened to a friend of mine two months ago). But if baby can fit, then forceps just don't seem to be needed with an unmedicated, mobile, and usually-upright mother.

Whatever the cause, forceps are associated with occasional incidents of gruesome injuries, like this story from last year (poor baby!) and others.

Definitely a reason to favor unmedicated birth whenever possible, and a reason to favor vacuum extraction when any sort of extra assistance is needed, rather than forceps. (As a matter of fact, I believe that the vacuum extractor was developed in part to avoid the injuries observed with forceps births.)

Thoughts, anyone? More data to share, or stories? Please share!

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