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Is it safe? · Pregnancy Smart

Forceps Delivery Risks for Mother and Baby

Assigned clinical reviewerMichael Yuzefovich· MD, FACOGDraft · pending clinical reviewUpdated

What does the evidence say about forceps-assisted delivery during pregnancy?

  1. ACOG lists a concerning fetal heart rate, prolonged pushing without descent, exhaustion, and a maternal condition that limits pushing among reasons to consider assisted vaginal birth. The cervix should be fully dilated and the fetal head low enough in the pelvis before an attempt. 1
  2. Safe forceps use depends on known fetal head position, an engaged head, an adequate pelvis, suitable anesthesia, an empty bladder, informed consent, trained staff, operating-room access, and a backup plan if vaginal birth is not achieved. 2
  3. A 2025 meta-analysis of seven randomized trials with 2,299 participants found more perineal tears and vaginal injuries with forceps than vacuum, while vacuum was associated with more newborn cephalohematoma. Failure to achieve vaginal birth with the assigned instrument did not differ significantly. 3
  4. MedlinePlus describes maternal risks including deeper vaginal tears and urinary or bowel difficulty. Most newborn effects are temporary bruises, marks, swelling, or facial-nerve weakness; cuts and bleeding inside the head are uncommon, with intracranial bleeding described as very rare. 4
  5. ACOG states that assisted vaginal birth has a low overall newborn-injury rate and no evidence of an effect on child development. It also notes a small increase in vaginal, perineal, and anal tissue injury and that a very small number of patients experience urinary or fecal incontinence from those injuries. 1

Is forceps-assisted delivery safe in each trimester?

  • First trimester. Forceps are used during the second stage of labor, not in early pregnancy. A prior pelvic-floor injury or difficult assisted birth is worth raising early so the obstetric team can discuss recurrence risk and delivery preferences.
  • Second trimester. Ask whether the planned hospital has clinicians currently skilled in forceps and vacuum birth and immediate access to cesarean birth. Operator experience and a backup plan are part of safe case selection.
  • Third trimester. Birth planning can cover the circumstances in which forceps, vacuum, or cesarean birth might be offered. Consent should include maternal tears, temporary newborn marks or nerve effects, uncommon serious injury, and what happens if the attempt does not progress.

Frequently asked questions

Why would forceps be offered during labor?

Forceps may be offered when the fetal heart rate is concerning, pushing has continued without enough descent, the birthing patient is exhausted, or a heart or neurologic condition makes continued pushing unsafe. The fetal head must already be low enough for an assisted vaginal birth to be appropriate.

What must be checked before forceps are used?

Before forceps-assisted delivery, the cervix should be fully dilated, membranes ruptured, fetal head engaged, and head position known. The clinician also assesses fetal size, pelvic adequacy, anesthesia, bladder emptying, staff and operating-room readiness, consent, and a backup plan.

How do forceps risks compare with vacuum risks?

Randomized-trial evidence associates forceps with more maternal perineal tears and vaginal injuries than vacuum. Vacuum is associated with more newborn cephalohematoma. Neither instrument is automatically best; fetal position, urgency, gestational age, and the clinician's current skill determine the safer option.

What are the main forceps risks for the mother?

Forceps-assisted delivery raises the chance of vaginal and perineal injury, including anal sphincter injury. Bruising, pain, and short-term difficulty urinating or moving the bowels can follow. Severe tears can contribute to later pelvic-floor symptoms, so repair and postpartum follow-up matter.

What are the main forceps risks for the baby?

Temporary facial marks, bruising, superficial cuts, swelling, or facial-nerve weakness are the more typical newborn effects. Eye injury, skull fracture, or bleeding inside the skull can occur but are uncommon. MedlinePlus describes bleeding inside the head as very rare.

Can forceps cause developmental problems later in childhood?

ACOG reports no evidence that assisted vaginal birth affects a child's development. This population-level reassurance does not mean every injury is harmless, but lasting problems are uncommon when forceps are correctly selected and used by an experienced clinician.

What happens if a forceps attempt does not work?

A forceps attempt should stop if the head does not descend with controlled traction. Cesarean birth may then be needed. Sequential vacuum after a failed forceps attempt is generally avoided because combining instruments can increase newborn complications.

Can I discuss forceps consent before labor?

Yes. A prenatal discussion can cover the hospital's forceps and vacuum expertise, likely reasons either instrument might be offered, maternal and newborn risks, alternatives, and the backup cesarean plan. The actual decision still depends on fetal position, station, urgency, and conditions during labor.

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References

  1. Assisted Vaginal Delivery

    ACOG · https://www.acog.org/womens-health/faqs/assisted-vaginal-delivery

  2. Forceps Delivery

    NCBI Bookshelf · https://www.ncbi.nlm.nih.gov/books/NBK538220/

  4. Assisted delivery with forceps

    MedlinePlus · https://www.medlineplus.gov/ency/patientinstructions/000509.htm

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.