Giving birth can be a complicated process. Although the majority of births proceed smoothly and safely, there will always be a significant minority of cases in which doctors, nurses and midwives may need to conduct an assisted delivery in order to safeguard the health of both the mother and the child.

The use of forceps is one of the key tools available to medical practitioners to address routine issues that may arise during the birthing process. If it is decided that an assisted vaginal delivery will result in a better outcome, your obstetrician or midwife will discuss the process with you before obtaining your consent to go ahead.

As such, it is vital that anyone who may require an assisted delivery makes sure they understand the potential risks associated with forceps delivery. In some rare instances of medical negligence, a forceps delivery that is not performed properly can lead to an increased risk of injury to both mother and child, potentially even causing brain damage to the baby in extreme cases.

Here, we will explain the decisions that go into forceps deliveries and outline the potential risk of forceps delivery to help ensure that you understand your rights in case anything goes wrong.

Why are forceps used?

Forceps are smooth metal instruments that are commonly used in modern obstetric practice as a means of helping to move babies through the birth canal. They resemble large spoons or tongs, and work by a similar principle, allowing the practitioner to gently grasp the baby's head and pull. In tandem with the mother's natural pushing and contractions, this makes it easier to deliver the baby.

Forceps delivery is one of the two most common forms of assisted vaginal delivery, sometimes also known as operative vaginal delivery. The other involves the use of a ventouse, or vacuum cup, which is attached to the baby's head by suction to help pull the infant out through the birth canal.

Assisted delivery methods are used in around one in eight births, and will only be suggested if there is a strong medical reason for doing so. The most common justifications for using forceps or vacuum delivery methods include:

• The mother has a history of heart disease, or an underlying heart condition like high blood pressure that would make it unsafe for them to push the baby out naturally.
• The baby is in an awkward or unusual position in the womb or birth canal, and the use of forceps is needed to reposition them.
• The baby has an unusual heart rate or is experiencing fatigue or distress, and needs to be removed with extra assistance.
• The baby is premature, and requires an assisted delivery to offer extra protection to the baby's head.

In order to perform a forceps delivery, your medical team will likely use a local anaesthetic to numb the vagina and perineum (the skin between the vagina and anus). A surgical cut, or episiotomy, will also be needed to make the vaginal opening bigger; this will be repaired after the delivery is complete.

What are the risks associated with forceps delivery?

Before you agree to an assisted delivery, your doctor or midwife will discuss the potential risks of forceps delivery. These are rare for the most part, but can affect the long-term health of the mother and child, and must therefore be taken seriously.

Potential forceps delivery injuries to the mother include:

• Vaginal or perineum tearing
• An elevated risk of blood clots in the mother's pelvis and legs
• Urinary or anal incontinence
• Weakening of the muscles and ligaments in the pelvic organs

Meanwhile, babies born via forceps deliveries may experience the following common risks:

• Marks, cuts or bruises on the baby's head or face, which should heal or disappear within a few days
• Yellowing of the baby's skin or eyes - this jaundice should also pass after a few days

All of these are accepted as routine risks associated with forceps delivery, and none represent a serious injury. Most of these effects can be treated simply, or will heal and resolve themselves within a few weeks.

Can forceps delivery cause brain damage?

However, in some rare cases, the use of forceps has the potential to put the child at a greater risk of a serious birth injury. These more severe outcomes will not happen often, and will usually only arise as the result of a traumatic birth, unusual medical complications or clinical negligence.

Brain damage is one of the most serious examples of this. This occurs when the person responsible for operating the forceps places excessive pressure on the infant's soft skull, resulting in severe injuries that can lead to permanent damage and lifelong health issues.

There are also a number of other potentially serious birth injuries that a child might sustain if the use of forceps is not performed correctly:

• The child cannot exit the birth canal due to shoulder dystocia, a condition that results in the baby's shoulders being stuck in the mother's pelvic region. If the use of forceps is not done delicately enough, it can lead to broken bones, facial injuries, and damage to the nerves of the baby’s shoulders and neck
• Forceps delivery complications result in a skull fracture or twisting of the neck, potentially damaging the baby's spinal cord
• Damage to the baby's brain is accompanied by brain bleeds or swelling on the brain, which can inflict severe trauma
• The baby sustains nerve damage that causes a loss of movement in the face. In many cases, this will heal on its own within a few weeks, but in some instances will lead to more serious and permanent damage

When should forceps delivery be avoided?

The risk of birth injury, especially those associated with cerebral palsy, will be weighed up by doctors and midwives before performing the procedure. In some cases, a forceps delivery may be necessary because a spontaneous vaginal birth is no longer possible, but in all cases, steps must be taken to make sure the baby can be delivered safely.

Doctors, midwives, nurses and obstetricians may avoid forceps delivery in the following circumstances:

• The baby is extremely premature (less than 34 weeks), meaning the risk of forceps delivery injuries would be too high
• The child's head is too large for the birth canal, or the size of the mother’s pelvis meaning the baby cannot safely be removed using forceps
• The baby has not descended far enough into the mother's birth canal for forceps to reach
• The baby has been diagnosed with a serious health condition - for example, something that would affect the strength of their bones - that would put them at a heightened risk of forceps injuries

In these cases, a caesarean section will usually be performed to deliver the baby safely, rather than attempting a vaginal birth.

Does forceps delivery cause cerebral palsy?

Cerebral palsy is one of the conditions that can potentially arise from severe forceps delivery complications. Cerebral palsy is among the most serious consequences of brain injuries sustained before, during or shortly after birth, and can have lasting consequences for the health of the newborn baby.

If an infant sustains serious brain damage or bleeding in the brain as a result of a forceps delivery, they may start showing signs of cerebral palsy over the first two or three years of their lives. These include extreme muscle stiffness and flexibility issues, making it difficult for them to move naturally; it can also delay their physical development and cause them to experience learning disabilities.

Severe cerebral palsy is a life-changing condition that requires ongoing care and support to help the child overcome their permanent disabilities. If a child develops cerebral palsy as a result of birth injuries sustained from improper use of forceps, this will be a case of medical negligence, and you may be able to claim compensation.

You can find out more about how to spot the signs of cerebral palsy in babies here.

What are the other potential long-term effects of forceps delivery?

In addition to cerebral palsy, birth injuries related to forceps delivery can have a number of potential long-term health consequences for children over the course of their lives. These include:

• Skull fractures that leave visible scars
• Facial injuries, lacerations and disfigurement
• Partial paralysis due to nerve damage
• Damage to the eye
• Brachial plexus palsy, a form of nerve injury that causes a loss of control or feeling in the arms and shoulders. The most common form of this condition is called Erb's palsy

How do I know if my forceps delivery was negligent?

Although birth injuries arising from forceps delivery are very rare, it is important for families to be able to recognise when their child's birth injury has been caused as a result of medical negligence. This will help them to understand when they may have a case to claim for compensation, and to hold the responsible parties accountable for the mistakes that caused the birth injury.

For example, the following circumstances could all be considered to be cases of medical negligence:

• The doctor or midwife did not seek your consent before going ahead with a forceps delivery. 
• You were not made sufficiently aware of the potential risk of forceps delivery complications.
• The use of forceps was inappropriate or incorrect, based on the details of your specific case.
• The birth injuries sustained by your child were the result of human error or poor practice during the delivery.

Any of these mistakes can lead to long-lasting consequences for your child and your family, including irreparable brain damage. If you feel you have been affected by medical negligence in your forceps delivery, you are advised to contact an experienced birth injury lawyer to see if you are eligible to make a claim for compensation.

By making a successful claim, you will be better equipped to move on with your life and cover the cost of any medical expenses your child requires as a result of their birth injury.

To find out more, get in touch with the specialist birth injury solicitors at JMW on 0345 872 6666, or complete our online enquiry form to request a call back.