From the Guidelines
The use of forceps during delivery can have significant long-term effects on both the neonate and the mother, emphasizing the need for careful monitoring and management after a forceps-assisted vaginal delivery [ 1 ].
Long-term Effects on the Mother
For the mother, potential long-term effects may include:
- Perineal trauma, such as third- or fourth-degree tears, which can lead to chronic pain, incontinence, or sexual dysfunction [ 1 ]
- Increased risk of anal incontinence or rectal prolapse due to damage to the anal sphincter [ 1 ]
- Potential for chronic pelvic pain or pain during intercourse, which can be exacerbated by factors such as levator ani muscle injury [ 1 ]
- Pelvic organ prolapse or incontinence resulting from tissue laxity over the longer term [ 1 ]
Long-term Effects on the Neonate
While the provided evidence primarily focuses on maternal outcomes, it is essential to consider the potential long-term effects on the neonate, including:
- Facial nerve injury, which may resolve on its own within a few months
- Skull fractures or other head injuries, which can increase the risk of developmental delays or cognitive impairments
- Increased risk of seizures or epilepsy, although this is rare
Management and Follow-up
In terms of management, mothers who have undergone a forceps-assisted delivery may require:
- Pain management with medications such as acetaminophen or ibuprofen for up to 6 weeks post-delivery
- Pelvic floor physical therapy to strengthen the muscles and improve bladder and bowel function
- Follow-up appointments with their healthcare provider to monitor for any potential complications or long-term effects [ 1 ]
Babies who have experienced a forceps-assisted delivery may require:
- Close monitoring for any signs of developmental delays or cognitive impairments
- Regular check-ups with their pediatrician to assess their overall health and development
- Potential referral to a neurologist or other specialist if any concerns arise regarding their neurological development.
From the Research
Long-term Effects on the Neonate
- The study 2 found that long-term adverse neurological outcomes were seen in 6.4% of cases, including mild disorders such as delayed milestone, speech delay, and motor clumsiness.
- Another study 3 found that infants delivered by forceps were not at risk of physical and cognitive impairment at 17 years of age, after adjusting for confounding factors.
- The same study 3 found that the forceps-delivery group had functional impairment of feet, vision, and retina compared with the spontaneous-delivery group, but the differences were small.
Long-term Effects on the Mother
- A study 4 found that outlet forceps delivery was associated with an increased incidence of maternal perineal trauma, including deep perineal lacerations, in nulliparous women.
- The study 5 found that form-based management of forceps delivery could reduce the incidence of maternal adverse outcomes, such as postpartum hemorrhage and perineal laceration.
- Another study 6 found that forceps-assisted delivery was associated with a higher incidence of maternal pelvic floor trauma compared with vacuum-assisted delivery.
Comparison with Other Delivery Methods
- A study 6 found that second-stage caesarean section was associated with less fetal-neonatal trauma than forceps-assisted delivery, but markedly reduced the chance of a subsequent vaginal birth.
- The study 4 found that there were no significant differences in neonatal outcomes, including Apgar scores and umbilical arterial pH values, between outlet forceps delivery and spontaneous vaginal delivery.
- Another study 2 found that the use of forceps delivery was not associated with an increased risk of long-term adverse neurological outcomes in children at 7 years of age.