One page summary: Forceps delivery injuries

In two sentences

Forceps are two curved blades placed around the baby's head so the doctor can guide and pull during contractions. They are used when the baby needs to be born quickly in the second stage of labor. ¹

Most forceps births leave marks on the baby's face that fade within days. The injuries that matter are facial nerve palsy, skull fracture, bleeding inside the skull, and, for the mother, more severe tearing than with other modes of birth. ^{1 2}

The numbers, with their sources

• Why forceps are used. To shorten the second stage when the baby needs to be born quickly, when the second stage is prolonged, or when maternal effort is not possible or advisable ¹
• What guidance covers. Guidance on operative vaginal birth addresses indications, prerequisites, classification by station and rotation, number of attempts, and when to abandon the procedure ¹
• The nerve most at risk. The facial nerve, which passes close to the surface just in front of the ear and can be compressed by a blade ³
• Maternal risk. Forceps delivery carries a higher rate of severe perineal tearing than spontaneous vaginal birth, and guidance addresses prevention and repair ²
• Sequential instruments. Using forceps after vacuum, or the reverse, is associated with higher risk to the baby ¹
• The usual finding. Marks or bruises on the cheeks and sides of the head where the blades sat, which fade over days ³

What to do this week

1. Ask whether your baby's face moves symmetrically when crying, and whether the forehead moves on both sides.
2. If the eye does not close, get drops and instructions before discharge.
3. Ask for the operative note, including the indication, the classification, whether rotation was performed, and the number of attempts.
4. Ask whether both vacuum and forceps were used.
5. Ask whether bilirubin is being followed.
6. Ask about your own tearing: what degree, how it was repaired, and what follow-up you need.
7. Request the complete records with the records request builder.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the pediatrician

• Does the whole side of the face move, including the forehead?
• Does the eye close, and how do I protect it?
• Has the skull been examined, and is imaging needed?
• Is bilirubin being followed?
• When should the marks and any weakness be gone?

For the obstetric team

• What was the indication for forceps?
• What was the station and position of the head?
• Was rotation performed?
• How many attempts, and was another instrument used?
• What degree of tearing did I have, and how was it repaired?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Forceps delivery injuries

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.