Use of Instruments During First Deliveries Safe

Dec. 1, 1999 (Baltimore) -- First-time mothers don't need to worry that instruments possibly being used during delivery will injure their infants, according to a study published in the Dec. 2 issue of The New England Journal of Medicine. "In spite of reports in the popular media showing injured babies from the use of vacuum extractors or forceps, our study shows that they are safe," says Dena Towner, MD, assistant professor of obstetrics at the University of California, Davis, and lead author of the study, in an interview with WebMD. "Of course experience counts, but in the right hands I think they're very appropriate instruments."

This study analyzed data from the births of over 583,000 infants in California from 1992 to 1994. All the babies were born to first-time mothers and were of average weight. Several possible injuries to the infants were looked for, from scalp injury to the most serious one, called intracranial hemorrhage, or bleeding inside the baby's skull.

"We found that the rate of intracranial hemorrhage among infants where either forceps or vacuum extractors were used was the same as that when a cesarean section was done after the mother had been in labor," says Towner. "What this seems to suggest is that when injury occurs, it may be due to a problem during labor itself, not to the use of instruments. If the problem was the instruments, we would have expected the rate of injury following cesarean section to be much lower."

Another very important finding in the study was that more babies were injured when both forceps and vacuum extractors were used one after another, says Thomas Benedetti, MD, professor of medicine at the University of Washington in Seattle, who wrote an editorial accompanying the study. "This tells us that if one type of instrument has failed, another should not be tried," he says in an interview with WebMD.

Towner concurs, saying, "When one instrument has failed, using another increases the risk to the baby. Perhaps that's because of the possible labor abnormality."

Benedetti says that this study illustrates three levels of risk of injury to the infant associated with birth. "The lowest risk is if you have a spontaneous delivery," he says. "The next level of risk seems to be forceps or vacuum extraction delivery or a cesarean section following labor, and the last is the use of more than one instrument. As a first-time mother, I would be reassured by this paper that instruments used during delivery would not result in a greater likelihood that my infant would be injured."

• The use of instruments, such as forceps or vacuum extractors, is safe for the babies of first-time mothers.
• When one of the instruments is used, but fails, a second type of instrument should not be used, as this will increase the risk of injury to the child.
• Researchers hypothesize that problems with labor itself, and not the use of instruments, are responsible for injuries, such as intracranial hemorrhage.