A recent case outlined in The Mail on Sunday has resparked debate over the use of forceps during difficult deliveries. Emma Portogallo gave birth to her son, Xavier, on 21 December 2009 at Scunthorpe General Hospital. During the delivery, the obstetrician pulled so hard on Xavier's head with the forceps that Emma Portogallo was dragged down the operating table. Baby Xavier was born with horrific injuries as a result; injuries which included permanent brain damage and injury to his eyeball socket. Xavier has undergone three operations on his left eye and faces the prospect of more surgery in the future. The Mail on Sunday reported that Emma Portogallo did not consent to the use of forceps and there was seemingly no consideration given to a caesarean section.
Xavier's story has sent shockwaves through the field of obstetrics. One senior obstetrician could not believe such a routine delivery had gone so badly wrong in today's society. Pat O'Brien, spokesman for the Royal College of Obstetricians and Gynaecologists (RCOG), stated that 'now that a caesarean section is a much safer operation, we no longer need to attempt difficult vaginal deliveries'. Similarly, a consultant obstetrician in a 2004 paper published in The British Medical Journal described forceps as 'a lethal instrument in unskilled hands'. He advocated their decline in modern practice and acknowledged they had a terrifying reputation due to a long-established risk of traumatic delivery. One senior midwife argued that she reassures mothers that if an assisted birth does not work, she quickly moves on to a caesarean.
Forceps are now used in only some 5% of deliveries, whereas two decades ago the statistic was closer to 15%. Given the risks involved and the concerns raised within the profession, there is a school of thought that forceps are still being overused. The US has banned the use of forceps in most hospitals, with obstetric staff performing ventouse deliveries or caesarean sections. In Europe, forceps are still used but only in the hands of the highly skilled.
The Mail on Sunday reports that increasing numbers of babies are being born injured as a result of misuse or poor application of forceps and blames the Working Time Directive for cutting junior obstetricians' training hours. Britain is also to be the only European country where a consultant obstetrician is not required to supervise trainees on a night shift. This has led to babies being born between 5pm and 9am having a 45% increased risk of neonatal death, highlighting the trainees' apparent lack of competence in this area.
Arguably, the changes in the training provided to junior obstetricians could be making forceps deliveries more dangerous than ever and so, as Mr O'Brien has pointed out, women should always remember they have a right to choose their method of delivery.