Forceps Delivery Complications
Forceps are an obstetric delivery tool used during difficult vaginal births to avoid having to perform a C-section. Forceps deliveries can be life-saving for when a baby needs help being born quickly, but they also have risks for the mother and baby.
What Is a Forceps Delivery?
A forceps delivery is a type of operative vaginal birth where an obstetrician uses metal instruments shaped like large salad tongs to guide the baby's head through the birth canal as the mother pushes during contractions.
Forceps are typically used during the second stage of labor when the baby's head is low, the cervix is fully dilated, and birth needs to happen soon.
How Common Are Forceps Delivery Complications?
In the US, operative vaginal births (assisted deliveries using forceps and/or vacuum) have become much less common. In 2024, less than 0.5% of all deliveries involved using forceps.
Although the total number of deliveries using forceps is low and has decreased, a 2023 analysis found that about 1 in 4 mothers sustained significant obstetric trauma after a forceps delivery.
What Are the Risks of a Forceps Delivery?
Risks to the Mother
For mothers, the use of forceps increases the risk of potential injuries, most commonly involving vaginal and rectal tears (third and fourth degree), vaginal wall lacerations, and perineal muscle damage.
Other potential risks include:
- Postpartum hemorrhage: Severe bleeding after birth can cause dangerous effects such as a drop in blood pressure, increased heart rate, decreased red blood cell count, pale or clammy skin, and pain and swelling in the vaginal or perineal area.
- Pelvic floor dysfunction and incontinence: Pelvic organ prolapse, urinary or fecal incontinence, and chronic pelvic pain and sexual dysfunction can occur and may require therapy or surgery to improve.
- Uterine, cervical, or bladder injury: In rare instances, cervical or vaginal wall tears can extend high into the birth canal. Bladder or urethral trauma, and in extreme cases, uterine rupture can occur during obstructed labor.
Risks to the Baby
For babies, damage can involve minor issues like temporary nerve weakness or facial marks or serious complications like skull fractures, brain bleeds, brain damage, or brachial plexus injury, which can lead to Erb's palsy.
Other potential risks include:
- Facial bruising, marks, and skin injury: Forceps press on the baby's cheeks and sides of head and can cause redness, bruising, indentations, small cuts, or abrasions on the face or scalp.
- Facial nerve injury (facial palsy): Pressure from forceps can temporarily compress facial nerves. Babies may have an uneven smile or drooping on one side of the face.
- Cerebral palsy: Depending on the area of the brain damaged, cerebral palsy can lead to symptoms such as abnormal muscle tone, difficulty moving the body, uncontrollable body movements, epilepsy, developmental delays, and other lifelong disabilities.
- Skull fractures and cranial bone injury: In rare cases, if too much pressure is applied, skull fractures can lead to swelling, abnormal head shape, or neurologic symptoms like lethargy and irritability.
- Intracranial hemorrhage (bleeding in or around the brain): Serious hemorrhages can lead to seizures, breathing problems, poor feeding, or long-term neurodevelopmental issues.
- Shoulder dystocia: Damage to the brachial plexus nerve can cause weakness, mobility issues, and even paralysis in the shoulder or arm in more severe cases.
- Eye and vision injuries: Eye swelling, bruises, and corneal abrasions or scratches can occur if forceps were close to the baby's eyes. Most minor eye injuries heal on their own, but any redness, discharge, or baby keeping one eye shut should be evaluated urgently.
- Neonatal respiratory distress: Difficult assisted deliveries are more likely to involve immediate breathing difficulties or the need for NICU admission or respiratory support.
Are Forceps Deliveries Always Unsafe?
No, not all forceps deliveries are unsafe, but the delivery team must take extra care and precaution while using them. According to safe birthing guidelines from the Royal College of Obstetricians and Gynaecologists, operative vaginal births are safe and appropriate when:
- The fetal head is low and properly positioned
- The mother has adequate pelvis size and shape
- The cervix is fully dilated and membranes are ruptured
- A trained clinician applies the tool correctly
- Emergency C-section capability is immediately available
In some cases where the baby is already deep in the pelvis and distressed, a well-performed forceps delivery may be safer than a late, emergency C-section.
When Should Parents Be Concerned After a Forceps Birth?
Most forceps delivery injuries, such as small cuts, bruises, and blemishes, can be treated or heal on their own. However, some injuries from forceps deliveries, like cerebral palsy and Erb's palsy, cannot be cured, and delaying treatment can cause more complications and disabilities if they are not addressed early on.
You should seek urgent care if you notice any of these signs in your baby:
- Poor feeding, unusual sleepiness, or seizures
- Asymmetrical or uneven movement in the arms, face, or eyes
- Persistent swelling, soft spots, or indentations in the head that get worse
- High-pitched crying, extreme fussiness, or inconsolable behavior
For the mother, seek care if you experience:
- Heavy bleeding or large clots
- Loss of bowel or bladder control, or inability to hold gas or stool (incontinence)
- Severe perineal pain, fever, or foul-smelling discharge
- Sexual dysfunction or pain during intercourse
- A feeling of "pressure" or bulging in the vagina weeks or months after birth
For mothers, one of the most common injuries is damage to the pelvic floor. Sometimes doctors will perform an episiotomy, a small incision made between the tissue of the vagina and anus (called the perineum), to give more space for the forceps to be inserted during delivery which sometimes causes tears.
In the event of a perineal or vaginal tear, dissolvable stitches or a temporary catheter may be needed to treat urinary or fecal incontinence. Specialists should also make sure to advise mothers to continue postpartum physical therapy and targeted exercises to strengthen the pelvic floor muscles.
Note: These issues do not necessarily mean that something definitely went wrong, but they should be evaluated as soon as possible in order to ensure that there are no postpartum complications that may affect you or your child's health.
Why Would a Doctor Recommend a Forceps Delivery?
While there are many different ways to deliver a baby, in cases where there is prolonged or difficult labor, forceps may be used to assist the birth when it is safe to do so. Most assisted deliveries involving forceps are typically used during the second stage of labor.
Your child's delivery team is required to be properly trained to understand when it is safe to use forceps and when it may potentially cause harm to the baby and mother.
Forceps may be considered when:
- The baby is low in the pelvis but not progressing despite pushing
- There is a non-reassuring fetal heart rate, and birth needs to be expedited
- The mother is too exhausted to keep pushing or has medical conditions such as heart disease or high blood pressure that make prolonged pushing unsafe
- Multiple births (twins or triplets) are being delivered
- The baby is premature
When used correctly, forceps can:
- Avoid an urgent or repeat C-section
- Shorten the second stage of labor and reduce the amount of time the baby is in distress
- Help achieve a vaginal birth when safe prerequisites are met
When Should Forceps Not Be Used?
Forceps should not be used if:
- The baby has a bleeding or bone disorder
- The baby has not descended low enough in the birth canal
- The position of the head inside the womb is unknown
- The baby is unable to fit through the mother's pelvis
- The baby has an arm- or shoulder-first position in the womb
- Shoulder dystocia (baby's shoulder is stuck behind the pelvis) is suspected
Can Forceps Complications Be Medical Malpractice?
Yes, some complications can be considered medical malpractice. Despite following best practices and acting urgently to protect the mother and baby, concerns of malpractice may arise if:
- Forceps were used without meeting standard prerequisites
- Excessive traction, repeated failed attempts, or going back and forth between using a vacuum and then forceps occurred without clear justification
- Serious injuries were not recognized or quickly treated after birth
If standards of care were not followed, or medical providers made negligent mistakes, families may be able to pursue a birth injury lawsuit. In cases of medical malpractice, parties that may be held accountable for mistakes during delivery include:
- Doctors
- Obstetricians
- Nurses
- Anesthesiologists
- Hospitals
- Other medical staff
Using forceps requires significant skill and precision, which is why guidelines stress that clinicians should only use them when they are properly trained and when an emergency C-section is immediately available if forceps attempts fail.
If you suspect you or your child sustained any injuries during delivery or have any concerns, speak to your obstetric team and your child's pediatric specialists, and consult with a birth injury lawyer as soon as possible to understand your situation and potential legal options.
Forceps Delivery Complications FAQs
Written and Medically Reviewed by:
Cerebral Palsy Hub Team
Cerebral Palsy Hub was founded to help support children and their families with cerebral palsy and to create a safe space for those affected. We strive to provide the most accurate, up-to-date information, and tools to help give your child the life they deserve.
Last Updated: December 21, 2025
