Forceps delivery: science wears its art on its sleeve

Abstract

[Extract] Few of us think about it, but the obstetric forceps have been calculated to 'have saved more lives than any other instrument'. That's quite a rap for two pieces of interlocking surgical steel made to a design that hasn't really changed in our lifetimes. Yet with more than 130 million births around the world each year and with the perinatal death rate for unassisted vaginal birth as high as one in ten in some developing countries, such a revelation should not surprise us at all.

In countries where accurate records are kept, the rate of instrumental delivery is about ten per cent. For Australian women, the proportion of all births that were instrumental vaginal births fell only slightly from 11.3 per cent in 1995 to 10.7 per cent a decade later. However, over that time period, the proportion of instrumental births conducted with forceps more than halved, from 7.8 per cent to 3.5 per cent. Over that same decade, the rate of caesarean birth doubled. Why the sudden drop in forceps deliveries?