Birth injury and the use of forceps for delivery

The birth of a baby is a wonderful time but there are many potential issues that can create a nightmare of what should be a magical affair.

The perilous journey for the neonate is one which can bring continued pain and suffering many years later.

This small but dangerous route into the outside world is rarely taken without the aid and experience of healthcare experts.

Midwives and Gynaecological consultants have a difficult time during a normal delivery but their problems are multiplied several fold during a difficult delivery.

Perhaps the baby is bigger than anticipated or mum is not as strechable, the reasons for a difficult birth are numerous.

The two most common types of assisted delivery are:

Forceps delivery

Ventouse delivery.

Forceps are paddle shaped instruments that are positioned either side of baby's head. Applying pressure and pulling assists the baby in transit. 

A Ventouse extraction pump is a cup shaped instrument which is placed over baby's head and suction is used to pull baby out.

These instruments are often used if baby becomes distressed and a speedy delivery becomes necessary. The use of birth instruments by an experienced midwife is commonplace, however there are times for whatever reason that injuries occur.

Types of Injury to the mother,

The main types of maternal injury are:

• Perineal Tears
• Tears and incisions to the Perineum can create a number of medical conditions and is therefore important that damage and treatment is found and treated correctly. It should be accepted mothers who have given birth with forcep delivery should be thouroughly examined for tears.

Episiotomy

An Episiotomy is a surgical procedure which is designed to assist during the delivery. A small incision into the Perineum, thus allowing baby's head to pass through with the intention of reducing tissue damage to the mother. This may be because the baby is larger than normal and the mother may tear during delivery. Tears are far more difficult to repair than a surgical cut. This proceedure reduces the chance of complications following the birth. Unfortunately there are occasions when the cut may be done negligently and this may lead to complication with ongoing pain and suffering.

Dyspareunia

Dyspareunia is pain during or after sexual intercourse. It may affect men, but is more common in women. Women with dyspareunia may have pain in the vagina, clitoris or labia. There are numerous causes of dyspareunia. Many woman suffer Dyspareunia following assisted delivery, particularly forceps. Pain may be due to negligence during childbirth such as tears and surgical proceedures to the perineum.

Faecal Incontinence is the involuntary loss of solid or liquid stool and can also include the involuntary loss of flatus. This is a common maternal injury following tears and incisions to the perineum suffered following a vaginal birth in the case of tears or cut following an episiotomy. Following childbirth a tear or cut may result in nerve damage to the perineal and or pudendal nerves and the consequential lack of control of the anal sphincter may cause faecal incontinence.

Injury to baby - Foetal Injury

Foetal injury occurs in 2% of vaginal deliveries and has increased incidence with instrumental vaginal deliveries.

Injury to baby as a result of assisted birth include:

• Intracranial Haemorrhage - bleeding in the skull.
• Facial Bruising and Lacerations - can cause permanent disfiguement
• Skull Fracture - Injury to the skull bone
• Cephalhaematoma - a haemorrhage of blood between the skull and the periosteum notably from Ventouse delivery.
• Facial Nerve Palsy - Damage to the facial nerve (either upper or lower motor neurone) produces weak muscles of facial expressions notably from Forceps delivery.
• Brachial Nerve Plexus Injury - Nerve damage causes two types of condition Erbs Palsy and Klumpke's palsy.