Barton's forceps effective for cesarean deliveries

I have long believed that the use of Barton's forceps to facilitate the delivery of the head during a cesarean delivery is a superior technique, and very much appreciated the discussion by Drs. Obican, Brunner, and Larsen in the September 2011 issue of Contemporary OB/GYN.

As they indicated, [this technique] was described in 1992 by Megison, who was in Louisiana. However, I learned the technique as a resident in 1980 at Overlook Hospital in Summit, New Jersey, where it was routinely used to accomplish deliveries through remarkably small skin incisions.

In the years since, I have used it many times to make difficult cesarean deliveries look deceptively easy, and I was distressed many years ago when the Barton's at my community hospital inexplicably disappeared and we were unable to locate or purchase another set. I hope that your article will help to keep these very useful instruments available.

The forceps need to be grasped at the hinge of the anterior blade. I suggest actually slipping the ring finger and/or little finger between the two blades and wrapping the other fingers and thumb around the shanks. You pull with this hand (ie, the right hand if standing on the patient's right). If you are doing it properly it is like having a small handle right on top of the baby's head, and much of the time fundal pressure is hardly necessary. The other hand (the left in this example) is only used to hold the handles together and stabilize them.

Timothy C. A. Brown, MD, MS, FACOGMassapequa, New York

An alternative to Barton's

Instead of the bottom half of Barton's forceps (Contemporary OB/GYN, September 2011), there already exists the Murless head extractor. It can be kept available at time of cesarean delivery. Also, it probably costs less than the Barton's because it is really just the bottom half of the Barton's.

I didn't know anybody would still use Barton's forceps for a vaginal delivery.

Aaron Shinbein, MD, FACOGLivingston, New Jersey