To Pull or Not To Pull: The Question of Forceps

India Thomas, Year 12, Monk’s Walk School, Hertfordshire

Many frequently used obstetrical inventions, like the epidural, were developed during the 20th century. But some of the most widespread and effective technologies evolved during the dark ages of medicine and somehow have survived all way into the 21st century. One such invention is the forceps.

In 2013, 23,000 babies in the US were delivered using forceps. Statistically, this figure is low and in many developing countries, forceps are the main device used in assisted delivery. In the UK and US, the ventouse, a vacuum suction cup, is the more popular tool but can only be used in certain circumstances. For example, for babies born before 34 weeks gestation, the ventouse cannot be used as the baby’s head is too soft to use vacuum technology. Forceps, on the other hand, can be used for almost all vaginal deliveries.

The forceps are made up of a handle with a lock, a shank and two blades. The blades can be inserted separately into the vagina to pull (using traction) or to twist a baby with an obstructed delivery. The blades of the forceps scoop around the baby’s head to gently deliver the baby.

However, the journey to forceps being used routinely in childbirth has not come easily. Before the development of forceps by the Chamberlen family in the 1500s, barbaric attempts to preserve the mother’s life resulted in the sacrificing of the foetus. Instruments such as the Tire-Tete, which had spiked ends, were stabbed into the foetal head to extract the foetus in pieces; a disturbing strategy for saving a life. Without forceps, it was likely that both the mother and baby would die; potentially from sepsis, haemorrhage or exhaustion.

Even after the Chamberlens developed the forceps, death rates remained high as the tool was kept a secret. When the mother gave birth, she was blindfolded, and the forceps were brought into the delivery room in an ornate box, so they couldn’t be seen and hence copied. Fortunately, in the 18th century, forceps became more widespread and many new designs were seen. William Smellie developed the pelvic curve and English lock and since then a plethora of different style forceps have been developed. For mothers in the delivery room today, their obstetrician has access to a wide range of specially adapted forceps, such as the Simpson forceps. Simpson forceps are used for traction and they have both a cephalic curve and a pelvic curve. The cephalic curve is elongated which allows the doctor to clasp the foetal head to deliver the baby safely and the pelvic curve is used to manoeuvre the baby past the obstruction.

The introduction of a seemingly simple piece of technology has led to millions of babies being born relatively safely. In many cases, forceps are used for women who don’t want a caesarean section or for whom the caesarean would take too long and therefore put the baby at further risk. Forceps provide a relatively quick way of removing the baby and have high success rates in preventing the need for a caesarean section.

But medical technologies can’t last forever. As the care of patients is routinely changed and improved, it is predicted that forceps will cease to be seen in the delivery room within the next few decades. But even if the use of forceps is finite, their influence is timeless. The basic principle of removing the baby from the uterus in the most efficient way will always be a priority. Forceps have led to the development of the ventouse, which is now used more frequently than the forceps. The use of forceps may be decreasing in labour, but they’ve survived since the 1500s and will likely influence further technologies in assisted birth; they continue to be a truly incredible piece of technology.

Runner-up for the Schools Science Writing Competition, Trinity Term, 2020