In recent years, the number of deliveries involving the use of forceps has decreased. Today, many of the deliveries that would have been performed utilizing forceps are completed by cesarean sections because there is a documented high risk of fetal morbidity and mortality with forceps deliveries. However, the choice usually depends upon the training, experience, and preference of the physician.
Forceps procedures are involved in one out of three malpractice litigations associated with fetal damage. Taking into account that midforceps procedures have been almost largely eliminated in most institutions, the frequency of the use of forceps in the background of malpractice litigation is striking. In cases resulting in malpractice claims involving the use of forceps, forceps were used despite the presence of contraindications to their use in almost one-half of all instances.
There are two major types of medical malpractice cases dealing with forceps deliveries. In the first type, the plaintiffs, generally the parents, claim that the obstetrician was negligent in failing to use forceps. A claim that a physician failed to use forceps is usually secondary to a claim that the physician failed to perform a cesarean section.
Most malpractice claims involve a negligent use of forceps as opposed to a failure to use them. When evaluating a forceps delivery for possible negligence, medical experts look for the presence of the following factors. If a delivery was attempted with forceps and one of the factors was not present, there is probably a deviation from the standard of care.
- The head of the fetus must be engaged, preferably deeply engaged to permit a low forceps delivery. A high forceps delivery is very difficult and often results in fetal death and injury to the mother. This procedure is condemned as an absolute deviation from the standard of care.
- Forceps deliveries should not be attempted if the fetus is in a transverse lie or in a breech position.
- The physician must be precisely aware of the position of the fetal head.
- The mother’s cervix should be completely dilated to prevent lacerations by the use of forceps.
- The membranes should be ruptured to permit a firm grasp of the fetal head. It is generally agreed among physicians that the blades of forceps do not slip off the fetal head in the absence of negligence.
- The fetal head should not be too large to permit passage through the mother’s pelvis. If it is disproportionately large, a forceps delivery should not be attempted, and a cesarean section should be performed.