When a baby is delivered with the assistance of forceps, families may have questions about what happened during birth, why the instruments were used, and whether any injuries could occur as a result. Understanding forceps delivery complications can help parents recognize symptoms, seek appropriate medical care, and know what to expect during recovery.

This page explains what forceps delivery is, when it is used, what complications can arise for both infants and mothers, and how families can access support and medical care if an injury occurs.

What Is Forceps Delivery?

Forceps are specialized medical instruments shaped like large spoons or tongs that are carefully placed around a baby’s head to help guide the baby through the birth canal during delivery. This type of assisted vaginal birth is typically used when labor is not progressing, when the mother is too exhausted to continue pushing effectively, or when there are signs of fetal distress that require a quicker delivery.

Forceps delivery is considered an operative vaginal birth, meaning it involves the use of instruments to assist the natural birth process. The use of forceps has declined significantly in recent decades as cesarean sections and vacuum extraction have become more common. However, in certain situations, forceps remain a valuable tool when used by an experienced obstetrician under the right conditions.

When Forceps Are Used?

Obstetricians may decide to use forceps for several medical reasons, including:

Prolonged second stage of labor
When pushing has gone on for an extended period without progress, forceps can help move the baby through the birth canal.

Fetal distress
If the baby shows signs of distress, such as an abnormal heart rate, a faster delivery may be necessary.

Maternal exhaustion
After hours of labor, some mothers are physically unable to continue pushing effectively.

Maternal health concerns
Certain medical conditions, such as heart disease or high blood pressure, may make prolonged pushing dangerous for the mother.

The American College of Obstetricians and Gynecologists has established clear guidelines for when forceps should be used. These include specific requirements about the position of the baby’s head, how far down the birth canal the baby has moved, and the experience level of the physician performing the procedure. When these criteria are not met, or if delivery cannot be safely accomplished with forceps, the medical team should move quickly to a cesarean section.

Complications for Infants

Most babies delivered with forceps do not experience serious injuries. However, complications can occur, particularly if the instruments are applied with too much force, placed incorrectly, or used in situations where forceps delivery is not appropriate.

Minor Injuries

Many infants experience temporary marks or bruising after a forceps delivery. These typically include:

Facial bruising or swelling
The pressure from the forceps can cause bruising on the baby’s cheeks, forehead, or around the eyes. This usually fades within a few days to a couple of weeks.

Scalp swelling
Some babies develop a soft swelling on the scalp called caput succedaneum, which resolves on its own.

Small cuts or scrapes
Minor skin injuries from the forceps typically heal quickly without treatment.

These minor injuries are relatively common and generally do not require medical intervention beyond routine newborn care and monitoring.

Nerve Injuries

One of the more concerning complications is injury to the facial nerve, which controls the muscles of the face.

Facial nerve palsy
This occurs when the facial nerve is compressed or damaged during delivery, leading to weakness or paralysis on one side of the baby’s face. Parents may notice that one side of the mouth does not move when the baby cries, or that one eye does not close completely. In many cases, facial nerve palsy improves on its own within a few weeks to months as the nerve heals. However, some cases may result in permanent weakness.

Brachial plexus injury
Though more commonly associated with shoulder dystocia, brachial plexus injuries can also occur during forceps delivery. These injuries affect the network of nerves that control movement and sensation in the arm and hand. Erb’s palsy, which affects the upper arm, is the most common type. Recovery varies depending on the severity of the nerve damage.

Skull and Brain Injuries

More serious complications involve injuries to the skull and brain.

Skull fractures
Excessive pressure or improper placement of the forceps can cause a break in the skull bones. While many skull fractures heal without treatment, some may require close monitoring or intervention.

Intracranial hemorrhage
Bleeding inside the brain is a rare but severe complication that can occur when blood vessels are torn during a difficult forceps delivery. This risk is higher in premature infants, whose blood vessels are more fragile. Intracranial hemorrhage may lead to seizures, developmental delays, or other neurological problems and requires immediate medical attention.

Subdural hematoma
This type of bleeding occurs between the brain and the outer covering of the brain. It may cause symptoms such as poor feeding, irritability, seizures, or changes in consciousness.

Long Term Effects

In most cases, infants recover fully from forceps delivery without lasting effects. However, severe injuries can lead to long-term complications, including:

Persistent neurological impairment
Developmental delays
Cerebral palsy in rare cases
Vision or hearing problems if nerve damage is severe

Early detection and intervention are critical for the best possible outcomes. Parents should work closely with their pediatrician and specialists to monitor development and access therapies as needed.

Complications for Mothers

Forceps delivery carries risks for mothers as well as infants. Research shows that maternal complications occur more frequently with forceps than with vacuum extraction or unassisted vaginal delivery.

Tears and Lacerations

The use of forceps increases the likelihood of tearing in the vaginal and perineal area.

Vaginal lacerations
Studies indicate that up to 40% of women who deliver with forceps experience vaginal tears. These can range from minor first degree tears that affect only the skin to more severe third and fourth degree tears that extend into the muscle and rectum.

Cervical lacerations
Tears in the cervix occur in approximately 16% of forceps deliveries. While many heal without complications, severe cervical tears can cause significant bleeding.

Episiotomy
Some physicians perform an episiotomy, a surgical cut in the perineum, during forceps delivery to make more room and potentially reduce the risk of severe uncontrolled tearing. However, the routine use of episiotomy is debated, as it does not always prevent serious tears and adds its own healing challenges.

Postpartum Hemorrhage

Excessive bleeding after delivery is more common following forceps use. Studies report that postpartum hemorrhage, defined as blood loss exceeding 500 milliliters, occurs in approximately 14% to 33% of forceps deliveries. This can result from tears, uterine atony (when the uterus does not contract properly after birth), or injury to blood vessels.

Women who experience significant blood loss may require blood transfusions, medications to help the uterus contract, or in rare cases, surgical intervention.

Pelvic Floor Injuries

The pelvic floor is a network of muscles, ligaments, and connective tissue that supports the bladder, uterus, and rectum. Forceps delivery can cause trauma to these structures, leading to both immediate and long term problems.

Pelvic organ prolapse
Over time, damage to the pelvic floor can cause one or more pelvic organs to drop or press into the vagina. This may result in a feeling of pressure or bulging, difficulty with urination or bowel movements, and discomfort during intercourse.

Urinary incontinence
Injury to the muscles and nerves that control the bladder can lead to leaking urine, especially when coughing, sneezing, or exercising.

Fecal incontinence
Damage to the anal sphincter muscles, particularly with third or fourth degree tears, can cause difficulty controlling bowel movements.

Physical therapy, pelvic floor exercises, and in some cases surgery can help manage these conditions.

Other Maternal Risks

Additional complications may include:

Injury to the bladder or urethra
Blood clots in the legs or lungs
Infection at the site of tears or episiotomy
Uterine rupture in very rare cases

Most maternal injuries heal with time and proper care, but some may require ongoing treatment or result in lasting effects on quality of life.

Risk Factors for Complications

Certain factors increase the likelihood of complications during forceps delivery.

Large birth weight
Babies weighing more than 4,000 grams, or about 8 pounds 13 ounces, have a significantly higher risk of injury during forceps delivery. Studies show injury rates of 1.6% for larger infants compared to 0.4% for smaller babies.

Prolonged second stage of labor
The longer the pushing stage lasts, the higher the risk of injury for both mother and baby. Current medical guidelines suggest that for first time mothers, the second stage may safely last up to three hours or more before considering operative intervention, but each situation must be evaluated individually.

Operator experience
Forceps delivery is a skill that requires training and practice. Outcomes improve significantly when the procedure is performed by an obstetrician who has experience with forceps and follows established protocols.

Difficult fetal position
Forceps work best when the baby’s head is in a favorable position. Attempts to rotate the baby’s head or deliver a baby whose head is not far enough down the birth canal increase the risk of injury.

Sequential use of instruments
Using vacuum extraction after an unsuccessful forceps attempt, or vice versa, is associated with higher rates of complications and is generally discouraged.

Prevention and Medical Standards

Preventing complications from forceps delivery begins with careful patient selection and skilled technique.

Medical standards emphasize that forceps should only be used when:

The cervix is fully dilated
The membranes have ruptured
The baby’s head is engaged in the pelvis
The exact position of the baby’s head is known
There is no suspicion of cephalopelvic disproportion (baby’s head is too large for the mother’s pelvis)
The bladder is empty
Adequate anesthesia is in place

If forceps cannot accomplish delivery safely and relatively quickly, the medical team should transition to cesarean section without delay. Prolonged attempts increase the risk of serious injury.

The American College of Obstetricians and Gynecologists also recommends that hospitals have protocols in place for monitoring both mothers and newborns after operative vaginal delivery, with clear guidelines for when to escalate care.

Families have the right to be informed about the risks and benefits of forceps delivery and to ask questions about their provider’s experience and the reasons for recommending this approach.

Statistics on Forceps Delivery Complications

Understanding how common these complications are can help families put their own experiences in context.

Serious birth injuries from all causes, including forceps delivery, occur in approximately 3 out of every 1,000 births
Maternal trauma after forceps delivery occurs in about 25% of cases
Infant trauma occurs in approximately 10% of forceps deliveries
Postpartum hemorrhage rates range from 14% to 33% depending on the study and definition used
Vaginal or cervical lacerations occur in 15% to 40% of forceps births
The risk of injury is significantly higher when the baby weighs more than 4,000 grams

Most injuries are minor and resolve without lasting effects, but the statistics underscore the importance of careful decision making and skilled technique.

Medical Care After a Forceps Delivery

Whether or not complications occur, both mothers and babies require careful monitoring after a forceps delivery.

For Infants

Immediate assessment
Newborns should be evaluated immediately after birth for signs of injury, including bruising, swelling, abnormal muscle tone, difficulty breathing, and abnormal reflexes.

Neurological monitoring
Babies who experienced a difficult forceps delivery may need additional monitoring for signs of brain injury, such as seizures, lethargy, poor feeding, or abnormal movements.

Imaging
If there is concern about skull fracture or intracranial bleeding, imaging studies such as ultrasound, CT scan, or MRI may be ordered.

Follow up care
Even if no immediate problems are identified, infants should have regular pediatric follow up visits to monitor development and catch any delayed effects early.

For Mothers

Postpartum monitoring
Healthcare providers will monitor for excessive bleeding, signs of infection, and healing of any tears or episiotomy.

Pain management
Adequate pain relief is important for recovery. Options include over the counter pain relievers, prescription medications, ice packs, and sitz baths.

Pelvic floor assessment
Women who experience significant tears or symptoms such as incontinence should be referred to a specialist for evaluation and treatment.

Mental health support
A traumatic or complicated delivery can affect emotional wellbeing. Mothers should not hesitate to seek support if they are struggling with anxiety, depression, or symptoms of post traumatic stress.

Treatment and Recovery

Treatment for Infant Injuries

Minor injuries
Facial bruising and swelling typically resolve on their own without treatment. Parents can provide comfort and follow normal newborn care routines.

Facial nerve palsy
Most cases improve without intervention as the nerve heals. Physical therapy and massage may be recommended in some cases. If the palsy does not resolve within several months, further evaluation and possible surgical intervention may be considered.

Brachial plexus injuries
Treatment depends on severity and may include physical therapy, occupational therapy, and in some cases, nerve surgery. Early intervention improves outcomes.

Skull fractures
Many skull fractures heal without treatment, but some require surgical repair, especially if there are bone fragments or associated brain injury.

Intracranial hemorrhage
Babies with bleeding in the brain may need intensive care, medications to prevent seizures, and sometimes surgery. Long term follow up with neurologists and developmental specialists is important.

Treatment for Maternal Injuries

Tears and lacerations
Most tears are repaired immediately after delivery with stitches. Healing typically takes several weeks. Proper hygiene, pain management, and avoiding heavy lifting help promote recovery.

Postpartum hemorrhage
Treatment may include medications to help the uterus contract, repair of lacerations, blood transfusion, or in severe cases, surgical procedures.

Pelvic floor injuries
Pelvic floor physical therapy is often very effective for treating incontinence and pelvic organ prolapse. Exercises to strengthen the pelvic muscles, biofeedback, and other techniques can significantly improve symptoms. Surgery may be an option if conservative treatments are not successful.

When to Seek Medical Attention

Families should contact a healthcare provider promptly if they notice any of the following after a forceps delivery:

For infants:

Seizures or unusual movements
Extreme sleepiness or difficulty waking
Poor feeding or refusal to eat
Persistent vomiting
Fever
Increasing swelling or bruising
Weakness or lack of movement in an arm or leg
Asymmetry in facial movements that does not improve

For mothers:

Heavy bleeding (soaking through more than one pad per hour)
Fever or chills
Foul smelling discharge
Severe abdominal or pelvic pain
Difficulty urinating or inability to control urine or bowel movements
Signs of infection at the site of stitches
Chest pain or difficulty breathing
Severe headache or vision changes
Feelings of sadness, anxiety, or hopelessness that interfere with daily life

Support and Resources for Families

Coping with complications from a forceps delivery can be overwhelming. Families do not have to navigate this alone.

Medical specialists
Depending on the type of injury, families may work with neonatologists, pediatric neurologists, orthopedic surgeons, physical therapists, occupational therapists, urogynecologists, and pelvic floor specialists.

Major medical centers in New York
Hospitals such as Mount Sinai, NYU Langone, Columbia Presbyterian, and Albany Medical Center offer specialized perinatal and neonatal care, as well as comprehensive support services for families dealing with birth injuries.

Early intervention programs
For infants with developmental delays or physical challenges, early intervention services provide therapies and support at no cost to families in many states, including New York.

Parent support groups
Connecting with other families who have experienced similar challenges can provide emotional support and practical advice.

Mental health services
Counseling and therapy can help parents process a difficult birth experience and manage stress, anxiety, or depression.

NYBirthInjury.com exists to provide trusted, evidence based information and connect families with qualified medical and support resources. We understand how difficult it is to face unexpected complications, and we are here to help you find the answers and support you need.

Moving Forward

Most families affected by forceps delivery complications find that with appropriate medical care, supportive resources, and time, both mothers and babies recover well. While some injuries may have lasting effects, early intervention and ongoing support can make a significant difference in outcomes and quality of life.

Understanding what happened, what to expect, and where to find help is an important first step. If you have questions or concerns about a forceps delivery, speak openly with your healthcare providers, seek second opinions when needed, and do not hesitate to reach out for the support your family deserves.

If you believe your child’s forceps delivery complication was caused by medical negligence, don’t hesitate to ask for legal assistance. Contact us today for a free consultation. You deserve answers, and compensation, and we’re here to help you get it.

Forceps Delivery Complications