Forceps Delivery - History and Types

Oct 11 2008

The forceps has been used in delivering babies for about 400 years. The instrument consists of two separate thin steel blades with inner surfaces curved to fit the sides of the infant’s head. The blades are inserted separately into the vagina, opposite each other. When their handles are brought together, the child’s head is securely grasped between the blades. With moderate traction on the handles, exerted in the axis of the vagina, the head is delivered.

The word forceps in Latin means “a pair of tongs.” It is said to have been derived from the earlier Latin words fornus = oven and capere = to take. The obstetric forceps, in variations of its modern form, have been used since the early seventeenth century to deliver a living child without injury to it or to the mother. Prior to this, single-bladed and even doublebladed instruments, called hooks, were in use, but probably only for the extraction of a dead child. The old double-bladed instruments had a permanent articulation so that the blades could not be inserted separately. They looked like ice tongs.

History of the Forceps

The history of the forceps is a story worth telling, calling attention to great changes in the practice of medicine and medical ethics over the past 4 to 5 centuries. The inventors of the modern obstetrical forceps were a singular medical family-the Chamberlens. In 1569 the first of the English line, William, emigrated from France to England to escape persecution, Most of the Chamberlens were royal surgeons or royal physicians, and they attended the labors and births of several queens. This obstetrical dynasty of Chamberlen extended uninterrupted from Peter the Elder’s admission to the Guild of Barber-Surgeons in about 1596 to the death of Hugh, Junior; in 1728.

The forceps was probably invented in about 1600 by Peter the Elder and kept as a hereditary family secret to be buried with Hugh, Junior; more than 100 years later. The retention of an important medical secret transmitted from generation to generation for a century and a quarter is unique in history. The Chamberlens were crafty(and by modern medical standards, unethical) enough to exclude all others from the room when they used the forceps and they used the instrument unassisted.

How was the secret finally revealed? The existence of the forceps was hinted at as early as 1616 at a meeting of the Royal College when a reference was made to the boast of Peter Chamberlen the Younger “that he and his brother, and none others, excelled in the management of difficult labors.”

Hugh Senior emigrated to Holland in 1699 under suspicion of debt. While in Holland, he sold the secret of the forceps to Hendrik van Roonhuyze, the leader of Dutch obstetrics. William Giffard of London used the forceps openly in April 1726, calling it “extractors.” He is generally considered “the altruistic and honorable physician who should receive full credit for introducing the forceps into general use in England.” By 1733, when Edmund Chapman published the first account of the forceps, there were already several models, and their use “was well known to all the principal men of the profession, both in town and country.”

Classifications of Forceps Deliveries

Forceps deliveries are categorized into four types:

High forceps refers to a delivery in which the fetal head is above 0 station or unengaged. This procedure is no longer used as it is too dangerous for mother and fetus.
Midforceps are forceps deliveries when the head is higher than +2 station, but is engaged or at least 0 station .

Low forceps describe a forceps delivery when the baby’s head is at least at +2 station.
Outlet forceps are used when the baby’s head is visible in the entrance to the vagina but has failed to deliver, either because of resistance by the perineum, inadequate contractions, or the mother’s difficulty bearing down.

With low or midforceps deliveries, the fetal head may not have rotated into the occiput anterior(OA) but may be in one of the transverse or oblique positions.

Outlet or low forceps can be done easily under pudendal block or even with local infiltration of the perineum. Midforceps call for more potent anesthesia, not only to relieve the pain of the procedure for the mother, but also to relax her muscles and facilitate the birth. A significant variable in the outcome from midforceps deliveries is the experience and skill of the operator, both in deciding when to deliver and how to do it.