Forceps Delivery
This delivery methds is infrequently used because of the position of the baby or weak labor or other reasons, spontaneous delivery of the baby may not be possible or would be unnecessarily protracted, Forceps may be necessary. These are instruments with cuplike blades which are used with some form of anesthesia.
The use of forceps has greatly advanced the art of obstetrics. These extracting instruments were introduced by the Chamberlen family in the seventeenth century and kept a family secret for over one hundred years. Not until 1726 were forceps generally introduced into obstetrical practice in England.
There are many types of forceps, depending on their uses. For instance, there are forceps for turning the baby’s head if it is pointed in a wrong direction. The head may be rotated and delivered in the normal position. If the baby is in imminent danger, with poor heart action or extruding a great deal of stool (meconium), or if there is massive bleeding, labor can be promptly terminated by the use of forceps. There are circumstances in which forceps are not advisable – if the baby’s head is too big for the mother, if the baby is very high, or immediate delivery is necessary. In such circumstances, cesarean section is a safer means of delivery.
Breech Delivery
In three or four of a hundred deliveries, the baby’s buttocks instead of the head will be present at the birth canal. When this condition is noted by the obstetrician, x-ray pelvimetry is done to determine if the mother’s pelvis is of adequate size. If not, cesarean section is done before labor begins.
Labor in breech is usually longer than “headfirst” delivery. Usually the membranes are kept intact as long as possible to act as a wedge to dilate the cervix. There is a longer stage of pushing by the mother to bring the buttock down. Generally a large episiotomy is performed as soon as the buttock shows at the entrance to the vagina. As soon as the buttocks and extremities are delivered the patient is anesthetized and the trunk, upper extremities, and head are delivered.
The head may be born by pressure by the obstetrician on the inside of the baby’s mouth, pressure by the nurse from above on the abdomen, pushing the head down and through the vagina, or special forceps applied to the head. If labor is slow and progress unsatisfactory in a breech presentation, or if the umbilical cord should protrude, or if the pelvis is too small, cesarean section is done.
Induction of labor (artificial stimulation of labor before it starts naturally) is sometimes necessary for medical reasons such as Rh sensitivity or diabetes.
Induction may also be done for convenience when the time and circumstances are right.
Labor is induced by rupturing the membranes, particularly in a woman who has had several children and whose cervix is dilated and completely effaced, or by the use of oxytocic (contraction-stimulating) drugs.
Induction will not work unless the cervix is “ripe” – thin and dilated. For medical indications, induction may require several days with use of oxytocin. An obstetrician knows when labor may be induced for the convenience of the patient. Induction for convenience can only be performed on a ripe cervix with an infant of sufficient size.