New research from Canada has cast doubt on the safety of a recent increase in assisted, or operative, deliveries. In a study published in the Canadian Medical Journal, public health scientists have linked midpelvic delivery, a form of assisted birth using forceps or vacuum extraction, to increased risks of both maternal and child injury.
To Drive Down C-Sections, Doctors Urge Assisted Delivery
In recent years, obstetricians across the developed world have attempted to cut down on the number of cesarean deliveries, which have sky-rocketed to extraordinarily levels but, in many cases, appear to present no appreciable benefits. One suggestion, floated by such luminaries as the American College of Obstetricians and Gynecologists, is to encourage the use of forceps or vacuum delivery as an alternative for difficult labors.
A new study, however, has raised serious safety concerns about at least one common method used to extract infants from the birth canal.
What Is Midpelvic Delivery?
The technique, known as midpelvic delivery, involves applying the forceps or vacuum extractor when a child’s head has emerged midway through the mother’s pelvis.
Researchers have questioned the intervention’s safety for years, but published studies remain inconclusive. An international team of obstetricians and public health experts now believe they have come one step closer to understanding the effects of midpelvic delivery on infants and mothers.
Study: Midpelvic Extraction More Risky Than C-Section
Analyzing nearly a decade of birth outcomes in Canada, the scientists found that midpelvic vaginal delivery was associated with higher rates of infant trauma, respiratory failure, neurological damage and death than cesarean delivery.
More than 187,000 deliveries were eventually included in the study’s data set. The researchers did not analyze outcomes for twins, triplets or other multiple births, confining their investigation to singleton deliveries.
Risks To Infants
Compared to c-section deliveries, children who were delivered with a midpelvic intervention were around 81% more likely to experience “severe birth trauma.”
Surprisingly, this increased risk remained stable over both of the instruments commonly used to perform the procedure: forceps and vacuum extraction. At least in this Canadian sample, an obstetrician’s choice of instrument made little difference on the ultimate frequency of infant birth injuries. Even so, most practitioners now consider vacuum extraction superior to forceps.
Risks To Mothers
Midpelvic delivery also took a considerable toll on mothers. While the rate of severe maternal injuries wasn’t much higher than with cesarean deliveries, women who underwent midpelvic deliveries were significantly more likely to experience obstetric trauma. This was especially true when forceps were used. Forceps were linked to a 4.5-fold increase in maternal trauma, the leading cause of pregnancy-related death among mothers in the United States.
Midpelvic Delivery Meets Disfavor
Midpelvic delivery is relatively rare. In Canada, only around 3% of singleton deliveries are completed using the controversial method, according to EurekAlert!, a publication of the American Association for the Advancement of Science. While 3% sounds like a small proportion, that still accounts for around 10,000 annual deliveries, 20% of all births that involve forceps or vacuum extraction.
Assisted Deliveries In Sharp Decline
The technique’s popularity may be waning further in the United States, where research from the past decade has shown many obstetricians phasing midpelvic vaginal deliveries out entirely. A 1996 survey conducted with fellows of the American Congress of Obstetricians and Gynecologists found that only 41% of respondents, a total sample of 558 specialists, were still performing midpelvic deliveries.
A parallel reduction in the use of forceps, which is linked to higher rates of birth trauma, has also been observed. In 2016, only 1 in 5 operative deliveries were performed using forceps, according to “Variation in the rates of operative delivery in the United States,” a paper published in the American Journal of Obstetrics and Gynecology. Some recent medical school graduates are being trained exclusively in vacuum extraction techniques, without any course work on the use of forceps.