Forceps is widely used and not only  for academic interest. In  some cases it is recommended to  shorten  the second stage of labour e.g heart disease,  eclampsia   

Obstetric forceps is used for certain maternal and fetal  indications to cut short second stage of labour  and even in C- section when head is high . Also to impart knowledge and skills to our  juniors  doctors and reduce the high incidence of caesarean section and its associated morbidity.

Hi Marcelo

Our team headed by Professor Hans Peter Dietz has demonstrated  that forceps is well established as a strong risk factor for both anal sphincter and especially levator ani avulsion with a decreased long term quality of life for women. See attached articles. If you want more we can send them.

 Warm regards

Liz

Dear  Elizabeth Mary Skinner

Thank  you very much  for the links

Yes but the forceps is indicated in  some cases. Mind you these injuries  can  our even  without forceps 

Forceps delivery is indicated in certain maternal and fetal conditions like eclamptia or fetal distress with maternal exhustion with full cervical dilatation. In well selected cases where all pre requisite for forceps have been fulfilled complicatipns are avoided. Some complications arose from inexperiance. Granted forceps and every other medical procedure has to have academic intent because you must teach every skill or procedure to the younger ones for it to be used to save lifes. However, in the context of your question it is not just academics but to shorten and expidite second stage of labour in some selected cases. Academics is a continous process in any procedure skills must be imparted on the younger ones. Finally, the art of forceps is gradually dying in some quartes because of litigations.

Thank  you very much  Abubakar Abubakar Panti

I agree with  you but there is  an important point to  remember is that  in  some rural areas the forceps is always ready and needs simple sterilization without  any others 

Forceps are essential in labour ward. It will never dye. However, few articles could be essential to make few guidelines, could have major role in court and could be strong enough to make it less popular. When second stage is being delayed, head is seen, forceps application in good hands is nothing but a shower in a desert, avoiding complications of CS. Juniors should be trained by demonstration in applying and selecting cases.

    Apart from the usual indications and precaution, one point I must mention for obstetricians working in rural set up, not to use it in delayed referred cases.  

I agree with  you Prabhat Chandra Mondal

I think forceps delivery should be used to shorten the expulsion period of labor which can benefit mother or baby, and should not be used  just with academic function.

I think forceps delivery should be used to shorten the expulsion period of labor which can benefit mother or baby, and should not be used  just with academic function.

I think forceps delivery should be used to shorten the expulsion period of labor which can benefit mother or baby, and should not be used  just with academic function.

Using forceps in each and every case during delivery is totally unethical. It should not be practiced, would never get recommendation in future. Forceps are for the obstetricians who love the subject. Each and every case should be individualized. If pelvis is adequate, expulsion force is sufficient, and head is well flexed,  Forceps are needed very rarely. If you are in panic, you can do .... Delivery is an art which very rarely requires intervention. In my center, Forceps delivery  rate is only 2 %,  total number of delivery is 22,000. 

The forceps, like all other obstetric procedures and operations, should only be used when indicated for safety of both mother and fetus. I don't think it shoud be used merely for academic purposes.

I agree with you Baafuor Opoku

But  a trained hand is needed 

I agree with your submission prabhat chandra mondai.

 Absolutely true baafor opoku but the art should be taught to younger ones in the process.

Indications for the use of the obstetric forceps are well known and taught to every medical student and resident doctors training in Obstetrics. So it will be inappropriate to use the instrument outside those guidelines and just for academic purposes as there is a risk associated with its use, however minor, even in  competent hands. However, acquiring skills in the use of this important obstetric instrument is waning worldwide as many obstetricians are frightened by it. So every opportunity should be used by experts who apply it to show and teach its correct use to medical students and resident doctors. It is here that the academic function of its use comes in because if this is not done, the instrument will become obsolete with time. In fact it is because many younger obstetricians are not familiar with the correct use of this instrument that they resort to caesarean sections as the treatment of many second stage problems that could have been easily addressed with the simple use of a lift out or even rotational forceps extraction. This is one reason for the global increase in the rate of  C sections which is creating fresh problems in subsequent pregnancies and deliveries. The correct use of instruments to effect safe vaginal deliveries - forceps, ventouse for live births and craniotomy for the dead ones is one important skill that should differentiate a properly trained obstetrician from a general surgeon, many of whom can also safely deliver a baby abominably. It is part of the "art" that is involved in obstetric practice, which is regarded as an Art and a Science. We all must do all we can to maintain both the art and the science otherwise, some others will take over our profession in due course. Finally, it must be remembered that the forceps was like a wonder machine in the hands of those who could use it before anaesthesia brought great improvement in the use of C sections. It has been used to save the lives of many mothers and babies and had brought great fame, respect  and rewards to those who mastered its correct use.

Dear  Nimi Briggs

I impressed by  your comprehensive report

Thank you very much

 Nimi Briggs.

Thank you prof for the comprehensive summation. I am not suprised at all because you are one of the reknown teachers of instrumental deliveries. We your students are proud and appretiate the skills you imparted on us. 

Thank you my dear colleagues for your kind words. Vaginal Instrumental Deliveries is an important subject with which all practising obstetricians should be familiar. I will be prepared to do a workshop to teach how the instruments could be used including the use of manikins.

Dear  Nimi

I think  private practice is slightly  different  where Cesarean predominates  

No, it should not be. Even in private practice, the right thing should be done.

Dear Nimi Briggs 

Yes I agree with  you that  it should be same practice in  the governmental  and private one

Professor Nimi Briggs,

  This is common what you told to those who use this instrument regularly and skillfully. Its popularity would remain to those countries which require it. Yes, Delivery is an art, Forceps delivery is the correlating art to science.

The forceps is an intervention when the normal process of labor if continues as is will compromise the fetus or mother. It should not be a routine for shortening labor.

I totally agree with Dr. Briggs. If we stop using forceps there will no more Obstetricians. We would be then just Maternaty surgeons. In many places we would not be relevant. Midwife can take care of normal labour & if it failed call the general surgeon to do a Ceassarean.

I agree with  you Gihad Shabib 

Forceps is an obstetrics art  and should   continue

Pushing hard in squatting position ELIMINATES the need for forceps and vacuum births.    Before a person is anesthetized with an epidural,  she should be informed that the epidural will make it harder for her to push and increase the risk of a need for the use of  forceps or vacuum in some situations.   Forceps and Vacuum births increase the risk of third and fourth degree lacerations to about 5%.  Third and fourth degree lacerations cause 1% of women to be permanently incontinent.  

Women who  are correctly informed before birth, are informed that there is NEVER a need for forceps or vacuum, if the labor is managed without epidural or other anesthesia that prevents them from pushing, and without induction or augmentation and with a person who encourages them to push until the baby comes out.    The majority of doctors likely are resistant to accepting that forceps are never needed in the absence of rickets,        Doctors who are trained by experienced midwives like myself or those who seek alternative ways to assist women,  know this is true.   

Dear  Judy Slome Cohain

I think  we need forceps to  deliver cases other than  women  with epidural or other anesthesia e.g preeclampsia

   I think it's very easy to be confident in evidence. Necessity of Forceps delivery is inevitable unless you do CS in delayed cases. The reality is not so easy just like the evidence. This art of delivery will remain in those countries where it is required. 'Pushing hard in squatting position ELIMINATES the need for forceps and vacuum births' is effective but not in all cases. The necessity will be revealed when increase number of deliveries would be conducted. Trained midwives can avoid forceps by doing CS or referring to higher centres. 

am sorry but I have found it difficult to follow the arguments being made by my colleagues to the write up I made which I thought was sufficiently clear.  Some of the statements being made are rather too sweeping.