Medscape is available in 5 Language Editions – Choose your Edition here.


Forceps Delivery Procedures

  • Author: Michael G Ross, MD, MPH; Chief Editor: Christine Isaacs, MD  more...
Updated: Mar 31, 2014


A forceps is an instrument designed to aid in the delivery of the fetus by applying traction to the fetal head. Many different types of forceps have been described and developed. Generally, a forceps consists of 2 mirror-image metal instruments that are articulated. The blades of the forceps are maneuvered to cradle the fetal head, after which traction is applied to effect delivery.

It is important to emphasize that forceps delivery is skill-dependent and training-dependent. The operator must have a clear understanding of his or her own capabilities, as well as the safe limits of the procedure, and must not exceed either of these.



The following indications for forceps-assisted delivery apply when no contraindications exist[1, 2] :

  • Prolonged second stage of labor - This includes nulliparous women with failure to deliver after 2 hours without and 3 hours with conduction anesthesia; it also includes multiparous women with failure to deliver after 1 hour without and 2 hours with conduction anesthesia
  • Suspicion of immediate or potential fetal compromise in the second stage of labor
  • Shortening of the second stage of labor to benefit the mother - Maternal indications include, but are not limited to, exhaustion, bleeding, cardiac or pulmonary disease, and a history of spontaneous pneumothorax
  • In skilled hands, fetal malposition, including the after-coming head in breech vaginal delivery, can be indications for forceps delivery.

Prerequisites for forceps delivery include the following[2] :

  • The head must be engaged
  • The cervix must be fully dilated and retracted
  • The position of the head must be known
  • Clinical assessment of pelvic capacity should be performed; no disproportion should be suspected between the size of the head and the size of the pelvic inlet and midpelvis
  • The membranes must be ruptured
  • The patient must have adequate analgesia
  • Adequate facilities and supportive elements should be available
  • The operator should be competent in the use of the instruments and the recognition and management of potential complications; he or she should also know when to abort a procedure that is not proceeding appropriately


The following are contraindications to forceps-assisted vaginal deliveries:

  • Any contraindication to vaginal delivery (see Normal Labor and Delivery)
  • Inability to obtain adequate verbal consent
  • A cervix that is not fully dilated or retracted
  • Inability to determine the presentation and fetal head position
  • Inadequate pelvic size
  • Confirmed cephalopelvic disproportion
  • Unsuccessful trial of vacuum extraction (relative contraindication)
  • Absence of adequate anesthesia or analgesia (relative contraindication)
  • Inadequate facilities and support staff
  • An insufficiently experienced operator
Contributor Information and Disclosures

Michael G Ross, MD, MPH Professor of Obstetrics and Gynecology, University of California, Los Angeles, David Geffen School of Medicine; Professor, Department of Community Health Sciences, Fielding School of Public Health at University of California at Los Angeles

Michael G Ross, MD, MPH is a member of the following medical societies: American Association for the Advancement of Science, American College of Obstetricians and Gynecologists, Phi Beta Kappa, Society for Reproductive Investigation, Society for Maternal-Fetal Medicine, Society for Neuroscience, American Federation for Clinical Research, Perinatal Research Society, American Gynecological and Obstetrical Society, American Physiological Society, American Public Health Association, Association of Professors of Gynecology and Obstetrics

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Lumara Health; Cervilenz Inc<br/>Received income in an amount equal to or greater than $250 from: Lumara Health; Cervilenz Inc.


Marie Helen Beall, MD Clinical Professor of Obstetrics and Gynecology, University of California, Los Angeles, David Geffen School of Medicine

Marie Helen Beall, MD is a member of the following medical societies: American College of Medical Genetics and Genomics, American College of Obstetricians and Gynecologists, American Society of Human Genetics

Disclosure: Nothing to disclose.

Specialty Editor Board

Jori S Carter, MD, MS Assistant Professor, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Jori S Carter, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology, Association of Women Surgeons, International Society for Magnetic Resonance in Medicine, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Chief Editor

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

  1. Yeomans ER. Operative vaginal delivery. Obstet Gynecol. 2010 Mar. 115(3):645-53. [Medline].

  2. ACOG Committee on Practice Bulletins--Obstetrics. Operative Vaginal Delivery. June 2000.

  3. Feraud O. [Forceps: description, obstetric mecanics, indications and contra-indications]. J Gynecol Obstet Biol Reprod (Paris). 2008 Dec. 37 Suppl 8:S202-9. [Medline].

  4. Nikpoor P, Bain E. Analgesia for forceps delivery. Cochrane Database Syst Rev. 2013 Sep 30. 9:CD008878. [Medline].

  5. Dupuis O, Moreau R, Pham MT, Redarce T. Assessment of forceps blade orientations during their placement using an instrumented childbirth simulator. BJOG. 2009 Jan. 116(2):327-32; discussion 332-3. [Medline].

  6. Dupuis O. [Operative vaginal deliveries training]. J Gynecol Obstet Biol Reprod (Paris). 2008 Dec. 37 Suppl 8:S288-96. [Medline].

  7. Dupuis O, Decullier E, Clerc J, Moreau R, Pham MT, Bin-Dorel S, et al. Does forceps training on a birth simulator allow obstetricians to improve forceps blade placement?. Eur J Obstet Gynecol Reprod Biol. 2011 Dec. 159(2):305-9. [Medline].

  8. Al Tawil K, Saleem N, Kadri H, Rifae MT, Tawakol H. Traumatic facial nerve palsy in newborns: is it always iatrogenic?. Am J Perinatol. 2010 Oct. 27(9):711-3. [Medline].

  9. Beucher G. [Maternal morbidity after operative vaginal delivery]. J Gynecol Obstet Biol Reprod (Paris). 2008 Dec. 37 Suppl 8:S244-59. [Medline].

  10. Tyagi V, Perera M, Guerrero K. Trends in obstetric anal sphincter injuries over 10 years. J Obstet Gynaecol. 2013 Nov. 33(8):844-9. [Medline].

  11. Gurol-Urganci I, Cromwell DA, Edozien LC, et al. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG. 2013 Nov. 120(12):1516-25. [Medline].

  12. Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population-based cohort study. Am J Obstet Gynecol. 2014 Jan. 210(1):59.e1-6. [Medline].

  13. Ampt AJ, Ford JB, Roberts CL, Morris JM. Trends in obstetric anal sphincter injuries and associated risk factors for vaginal singleton term births in New South Wales 2001-2009. Aust N Z J Obstet Gynaecol. 2013 Feb. 53(1):9-16. [Medline].

  14. de Leeuw JW, de Wit C, Kuijken JP, Bruinse HW. Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery. BJOG. 2008 Jan. 115(1):104-8. [Medline].

  15. Räisänen SH, Vehviläinen-Julkunen K, Gissler M, Heinonen S. Lateral episiotomy protects primiparous but not multiparous women from obstetric anal sphincter rupture. Acta Obstet Gynecol Scand. 2009. 88(12):1365-72. [Medline].

  16. Macleod M, Strachan B, Bahl R, Howarth L, Goyder K, Van de Venne M, et al. A prospective cohort study of maternal and neonatal morbidity in relation to use of episiotomy at operative vaginal delivery. BJOG. 2008 Dec. 115(13):1688-94. [Medline].

  17. Sooklim R, Thinkhamrop J, Lumbiganon P, Prasertcharoensuk W, Pattamadilok J, Seekorn K, et al. The outcomes of midline versus medio-lateral episiotomy. Reprod Health. 2007 Oct 29. 4:10. [Medline]. [Full Text].

  18. Yang X, Zhang HX, Yu HY, Gao XL, Yang HX, Dong Y. The prevalence of fecalincontinence and urinary incontinence in primiparous postpartum Chinese women. Eur J Obstet Gynecol Reprod Biol. October/2010. 152:214-7. [Medline].

  19. Pretlove SJ, Thompson PJ, Toozs-Hobson PM, Radley S, Khan KS. Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review. BJOG. 2008 Mar. 115(4):421-34. [Medline].

  20. Baydock SA, Flood C, Schulz JA, MacDonald D, Esau D, Jones S, et al. Prevalence and risk factors for urinary and fecal incontinence four months after vaginal delivery. J Obstet Gynaecol Can. 2009 Jan. 31(1):36-41. [Medline].

  21. Friedman S, Blomquist JL, Nugent JM, McDermott KC, Muñoz A, Handa VL. Pelvic muscle strength after childbirth. Obstet Gynecol. 2012 Nov. 120(5):1021-8. [Medline]. [Full Text].

  22. Macarthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P, et al. Faecal incontinence persisting after childbirth: a 12 year longitudinal study. BJOG. 2013 Jan. 120(2):169-78; discussion 178-9. [Medline].

  23. Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A. Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012 Feb. 119(2 Pt 1):233-9. [Medline]. [Full Text].

  24. Contag SA, Clifton RG, Bloom SL, Spong CY, Varner MW, Rouse DJ, et al. Neonatal outcomes and operative vaginal delivery versus cesarean delivery. Am J Perinatol. 2010 Jun. 27(6):493-9. [Medline].

  25. Walsh CA, Robson M, McAuliffe FM. Mode of delivery at term and adverse neonatal outcomes. Obstet Gynecol. 2013 Jan. 121(1):122-8. [Medline].

  26. Foad SL, Mehlman CT, Ying J. The epidemiology of neonatal brachial plexus palsy in the United States. J Bone Joint Surg Am. 2008 Jun. 90(6):1258-64. [Medline].

  27. Brimacombe M, Iffy L, Apuzzio JJ, Varadi V, Nagy B, Raju V, et al. Shoulder dystocia related fetal neurological injuries: the predisposing roles of forceps and ventouse extractions. Arch Gynecol Obstet. 2008 May. 277(5):415-22. [Medline].

  28. Blauwblomme T, Garnett M, Vergnaud E, et al. The management of birth-related posterior fossa hematomas in neonates. Neurosurgery. 2013 May. 72(5):755-62; discussion 762. [Medline].

  29. Baud O. [Neonatal outcomes after instrumental vaginal delivery]. J Gynecol Obstet Biol Reprod (Paris). 2008 Dec. 37 Suppl 8:S260-8. [Medline].

  30. Hudelist G, Mastoroudes H, Gorti M. The role of episiotomy in instrumental delivery: is it preventative for severe perineal injury?. J Obstet Gynaecol. 2008 Jul. 28(5):469-73. [Medline].

  31. Moreau R, Pham MT, Brun X, Redarce T, Dupuis O. Assessment of forceps use in obstetrics during a simulated childbirth. Int J Med Robot. 2008 Dec. 4(4):373-80. [Medline].

  32. Rodriguez A, Arenas EA, Osorio AL, Mendez O, Zuleta JJ. Selective vs routine midline episiotomy for the prevention of third- or fourth-degree lacerations in nulliparous women. Am J Obstet Gynecol. 2008 Mar. 198(3):285.e1-4. [Medline].

  33. Villarejo F, Belinchón JM, Carceller F, Gómez-Sierra A, Pascual A, Cordobés F, et al. [Cranial lesions due to forceps delivery]. Neurocirugia (Astur). 2009 Jun. 20(3):262-4. [Medline].

Simpson forceps, labeled to show parts of the instrument. This version has a fenestrated blade.
Luikart modification of the Simpson forceps. Note the semi-fenestrated blade.
Kjelland forceps. These are used for rotation of the fetal head and have no pelvic curve. The shanks overlap, causing less distention of the maternal perineum.
An illustration of a forceps delivery technique.
The left handle is held in the left hand (Simpson forceps).
The left blade is introduced into the left side of the pelvis.
The left blade is in place and the right blade is introduced by the right hand.
A median or mediolateral episiotomy may be performed at this point. A left mediolateral episiotomy is shown here.
The forceps have been locked. The inset shows a left occipitoanterior fetal position.
An illustration of horizontal traction with the operator seated.
An illustration of upward traction.
An illustration of disarticulation of the branches of the forceps; beginning modified Ritgen maneuver.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.