10 April 2015
The Future of Forceps and Assisted Delivery in Childbirth
The recent case of baby Thomas Beaty has re-ignited the controversial debate into whether forceps are safe to use and whether more rigorous training should be provided before a specialist is able to carry out the procedure.
Thomas was born at the Royal Oldham Hospital on 12th April 2014. When his delivery became problematic, the decision was taken to introduce the use of forceps to assist with his birth.
Five attempts were made to deliver Thomas using this procedure. When the procedure failed doctors had to push Thomas back up into the womb in order to commence delivery by emergency caesarean section.
Two hours after his birth, Thomas’ parents noticed that he was bleeding from his nose and mouth and shortly after Thomas sadly died.
Investigations revealed that Thomas had suffered from a fractured skull and a major bleed under his scalp which was caused during his forceps delivery. At the inquest, the Coroner recorded a narrative conclusion, stating that the there was a ‘causal link’ between Thomas’ head injury and the use of forceps during his delivery. It is believed that the fractures to Thomas’ skull occurred when he was forced back up the birth canal after the attempt to deliver him using forceps failed.
Slater and Gordon Clinical Negligence Solicitor Zak Golombeck represented Thomas’s parents at the inquest. Following the inquest, Zak said, “The Coroner has concluded that the decision to proceed beyond three forceps tractions was not in line with the general body of obstetric opinion. This was unequivocal from the evidence heard. As well as this helpful conclusion, the Coroner has also confirmed that she will be recommending changes to guidelines both at local and national level.”
Around 10-13% of babies in the United Kingdom are delivered using forceps, instruments that are quite often described as resembling large spoons or tongs. Their purpose is to assist with the delivery of a baby when the mother is experiencing difficulty. Their shape enables them to fit around a baby’s head and, with each contraction, they are gently pulled to assist with the baby’s delivery.
The guidelines provided by the Royal College of Obstetricians and Gynaecologists state that if delivery is not successful following three pulls with the forceps, the procedure should be abandoned except for in exceptional circumstances where an experienced clinician is of the view that delivery will be imminent following a further pull.
The use of this procedure in assisting with the delivery of a baby carries many risks for both the baby and the mother. The main warnings that are given prior to undertaking a forceps delivery are that the forceps may cause marks to the baby’s head or face which will settle within 24-48 hours. Death of the baby remains a recognised complication and there have been many cases which have led experts to question whether or not there has been adequate training provided to enable clinicians to carry out this procedure and whether or not the procedure should be abandoned in its entirety.
A spokesperson for the Royal College of Obstetricians and Gynaecologists has said, “now that a caesarean section is a much safer operation, we no longer need to attempt difficult vaginal deliveries”.
It is clear from the guidelines and the advice provided by specialists that in Thomas’ case an excessive amount of pulls with the forceps were used. It therefore begs the question of whether Thomas’s death would have been avoided with correct use of the instrument.
The doctors involved in Thomas’ delivery have now received additional training following a review by Pennine Acute Hospitals Trust.
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