Forceps delivery for non-rotational and rotational operative vaginal delivery

Forceps are a commonly used instrument for assisting vaginal birth. Accepted indications include prolonged labour, suspected foetal distress and maternal medical conditions that benefit from a shortened second stage of labour. Maternal and offspring outcomes of forceps-assisted birth have been extensively reported in observational studies, but randomised trial evidence is limited. Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma. Second-stage caesarean section is associated with less foetal-neonatal trauma than forceps-assisted delivery but markedly reduces the chance of a subsequent vaginal birth. This review outlines the existing evidence on prevention, indications and contraindications for forceps-assisted birth (non-rotational and rotational), short- and long-term complications for mother and baby, alternatives to use of forceps and how to manage an abandoned forceps-assisted birth. The essential components of informed consent are also discussed. •Indications and contraindications for forceps-assisted delivery are outlined including controversial aspects of clinical care.•Procedural aspects of forceps-assisted delivery rely on expert opinion as outlined in evidence-based clinical guidelines.•The evidence base for choosing between forceps, ventouse or caesarean section reflects success rates, morbidity and mortality.•Decision-making about forceps delivery relies on clinical assessment and counselling completed in a time-sensitive manner.•Fetal head impaction after a failed attempt at forceps is an obstetric emergency that requires anticipation and expertise.