Operative vaginal delivery: a cause of birth injury or is it?
Operative vaginal delivery has been maligned since the days of W.J. Little with the word "forceps" becoming nearly synonymous with "Birth Injury" and "Cerebral Palsy." However in his presentation to the Obstetrical Society of London in 1861, Little's emphasis was on difficult labors being the culprit in subsequent disabilities in the offspring. Instrumented deliveries in that era were the end result of a long, obstructed labor performed for maternal benefit and to avoid a destructive procedure to the fetus thus allowing a chance at life. If there had been a normal progress in labor, operative assistance for delivery would not have been needed. Thus, was it the instrument or the obstructed labor that led to fetal injury? In this article, we will review what injuries to the fetus and the mother can be directly attributable to the instrument. We will explore the processes of labor, conduct of labor management, and concurrent fetal factors that can modulate the occurrence of birth trauma. Evidence regarding inexperience and improper use as contributing to injury will also be explored.
Towner
Dena R
DR
Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California 95817, USA. drtowner@ucdavis.edu
Ciotti
Mary C
MC
D001003:Anal Canal / Q000293:injuries; D001291:Attitude of Health Personnel; D001720:Birth Injuries / Q000209:etiology*; D020516:Brachial Plexus Neuropathies / Q000209:etiology; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000209:etiology; D007744:Obstetric Labor Complications; D009772:Obstetrical Forceps / Q000009:adverse effects*; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D017695:Soft Tissue Injuries / Q000209:etiology; D020196:Trauma, Nervous System / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology