Ensuring a future for forceps deliveries
Perhaps the greatest potential threat to forceps deliveries is the dwindling provider base. This has resulted in a subsequent trickle-down effect with fewer providers able to teach the skills, less comfort in offering the method to patients, and then fewer opportunities to demonstrate or involve trainees in these deliveries.
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The decline in utilization of obstetrical forceps is, however, a reversible trend. Training programs today have more resources at their disposal for simulation than ever before, and high-fidelity forceps simulations (as demonstrated in the video, “Forceps delivery technique”) offer realistic approximations of the procedure. In addition, attendings should be encouraged to allow trainees to attempt placement because – unlike the cut-clamp that occurs when transecting a uterine artery at hysterectomy – a misguided forceps blade is an easily remedied misstep. Similarly, traction can be performed hand-over-hand so that direct manual supervision for optimal safety is readily achievable.
Finally, a junior attending who has completed training with a handful of forceps deliveries under her belt should be encouraged to continue to identify patients for whom a forceps delivery is appropriate and perfect her craft. One study comparing 118 attending physicians at varying levels of training in fact showed no difference in lacerations or adverse neonatal outcomes between experience levels.17
The author reports no potential conflicts of interest with regard to this article.
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