Most Forceps Deliveries Carry Acceptable Risks.

SAN JUAN, P.R. -- Operative vaginal deliveries involving forceps don't necessarily deserve their bad rap, but those involving rotations over 45 degrees should probably be avoided, according to one expert.

The risks of morbidity that are associated with low-forceps and outlet forceps deliveries using less than 45-degree rotations are acceptable. However, adequate training in the riskier midforceps deliveries and low-forceps deliveries involving greater than 45-degree rotations is lacking, Dr. Gary D.V. Hankins said during a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

While there remains a place for mid-forceps deliveries, the problem is that these types of deliveries are seen as too risky, he said. Also, the public has a misperception that all forceps deliveries are unsafe, and many women are absolutely opposed to them.

Many physicians and patients believe that vacuum extraction is a safer approach than any type of forceps delivery but hemorrhages and other injuries occur significantly more often with vacuum deliveries.

Regardless of these statistics, a recent study revealed that 10% of surveyed fellowship program directors and 25% of residency directors said they believe that midforceps deliveries are obsolete, according to Dr. Hankins, who is chief of maternal-fetal medicine at the University of Texas, Galveston.

It has also been shown that there are insufficient numbers of cases requiring these types of deliveries to provide adequate physician training and that there are few willing or capable trainers, he noted.

Between 1980 and 1987, the number of operative vaginal deliveries involving forceps dropped 43%, while the cesarean-section rate rose 48%.