Use forceps to cut Caesarian rate, say experts

Rising rates of Caesarean births could be reversed if midwives and doctors made greater use of forceps and other instruments in the delivery room, experts believe.

The number of women having surgical births has increased around the world in recent decades, while instrumental deliveries have declined.

Guidance published today in The Obstetrician and Gynaecologist journal says the use of forceps and suction cups should be promoted more to help cut Caesarean rates. In Scotland, emergency Caesarean rates in women with a single baby have increased from 3.9 per cent of births in 1976 to 14.8 per cent last year.

Planned operations increased from 4.7 per cent to 10.1 per cent. This means a total increase in Caesarean births from 8.6 per cent to 24.9 per cent.

In contrast the percentage of forceps deliveries has fallen from 13.5 per cent in 1980 to 9.8 per cent last year, though rates have been rising in recent years.

The experts, led by consultant obstetrician and gynaecologist Prabha Sinha, said the reasons for the decline in instrumental births included a reduction in training hours to teach the techniques, a lack of senior supervision and fear of litigation if something went wrong during the birth.

But they said that the appropriate use of instrumental delivery could reduce the risks associated with Caesareans, such as a longer time spent in hospital, possible complications caused by the surgery and the higher costs involved.

Using the instruments also makes it more likely that women can go on to have natural births in future.

The experts said that those involved in deliveries needed to have practical training using forceps and ventouse - a vacuum device which attaches to the baby's head to help pull them out - using simulators and mannequins.

They said: "This practical training is not routinely available meaning many junior doctors are less prepared than a competent operator when performing forceps delivery.

"Simulator training enables the practitioner to learn how to achieve the appropriate force with the help of computer-assisted visual feedback."Dr Sinha, from Conquest Hospital in St Leonard's On Sea, Sussex, said: "Emergency Caesarean sections carry the risk of severe obstetric morbidity, however if conducted properly instrumental deliveries can be safe and make it easier to give birth again vaginally."

She added: "Enhanced practical training is required for all junior doctors using simulators to maximise expertise prior to clinical application.

"It is essential that trainees perform these procedures under the direct supervision of a trained and experienced obstetrician."

Jason Waugh, editor of The Obstetrician and Gynaecologist, said: "This paper outlines factors to take into account when conducting an instrumental delivery, such as documenting events, knowing the precise position of the baby and being an experienced operator.

"It also highlights the need for further training for junior doctors in this area.

"Caesarean section rates are increasing and it is important to note instrumental delivery is another effective option which may improve outcomes of future deliveries."