Does Forceps Increase Risk for Hemorrhage?

Apr 08, 2025

Sometimes, when a baby needs help being born, doctors use a tool called forceps. It looks a bit like big spoons and gently helps the baby come out. This can happen if the baby is having trouble or if pushing is taking too long.

Some people wonder if using forceps can make the mom bleed more after the baby is born. The truth is, it can happen sometimes, but not always. It depends on things like how long the mom was pushing, how the forceps are used, and how careful the doctor is.

We’ll talk about when bleeding might happen, why it happens, and what helps keep moms safe. No scary stuff just simple, clear answers to help you understand.

Can Forceps Cause Hemorrhage?

Forceps are special tools doctors might use to help deliver a baby when labor is taking too long or not going smoothly. They look like big spoons or tongs and are used to gently guide the baby out during birth. While forceps can be helpful, they also come with some risks. One of the main concerns is heavy bleeding after birth, known as postpartum hemorrhage (PPH).

Can forceps cause this kind of bleeding? Not directly, but they can raise the chances of it happening. It really depends on how long the labor lasts, how the baby is positioned, if the mom has any health conditions, and how experienced the doctor is. It’s not just about the tool it’s about the full situation.

For mothers, the main problems are the uterus not tightening after birth (called uterine atony) or getting tears in the birth canal. One study found that PPH happened in about 9 out of every 100 forceps deliveries, which is more than in regular vaginal births. That doesn’t mean it always happens, but it’s something to keep in mind. In some serious cases, moms needed blood transfusions or extra care.

Babies can also be affected if forceps are not used the right way. Though it’s rare, brain bleeding can happen, especially in tough deliveries or if the baby is born early. More common problems include bruising or swelling on the baby’s head, which usually goes away without any long-term issues.

Forceps aren't used as much as they used to be. Today, they’re used in about 1 out of every 100 vaginal births. That’s partly because of the risks and partly due to concerns about legal issues. But in certain situations like if the baby is facing the wrong way or in distress forceps might be the best and quickest way to help.

To sum it up, forceps don’t always cause bleeding, but they can increase the risk. What really matters is having skilled medical care, using the tools properly, and making sure the doctor understands what’s going on in each birth. That’s why it’s important to talk with your healthcare provider so you understand your options and what’s best for you and your baby.

Why Might Forceps Increase Bleeding Risk?

Using forceps during childbirth can be really helpful in tough situations, but they can also raise the risk of bleeding for both the mother and the baby. Forceps don’t always cause bleeding by themselves, but how they’re used, and the condition of the mother and baby at the time, can make a big difference. Let’s explore why that is.

For moms, the most common reason for bleeding is physical damage. Forceps can cause cuts or tears in the vagina, cervix, or perineum while being used to help deliver the baby. These injuries can cause serious bleeding. Sometimes, doctors make a surgical cut called an episiotomy to make room for the forceps, which also adds to the bleeding risk. Research has shown that when forceps are used, the chances of heavy bleeding, postpartum hemorrhage (PPH), go up compared to regular vaginal deliveries.

Another important factor is uterine atony, which means the uterus doesn’t contract properly after the baby is born. This is more likely after a long labor, which is also when forceps are often used. If the uterus doesn’t tighten up, blood vessels stay open and bleeding continues.

In rare cases, forceps might also be used in dangerous situations like undiagnosed placenta problems (placenta previa or accreta), which can lead to very serious bleeding. If the mother has any health issues like clotting disorders, anemia, or high blood pressure, the risks are even higher.

For babies, bleeding can happen if the forceps apply too much pressure or are placed incorrectly. This can lead to problems like:

Cephalohematoma: a pool of blood under the scalp that can lead to jaundice or anemia.
Intracranial hemorrhage: bleeding inside the skull, which can be dangerous and affect the baby’s brain.
Subgaleal hemorrhage: a rare but life-threatening condition where blood builds up under the scalp and can cause shock if not treated quickly.

Certain babies are at higher risk, like those born early (preterm), those that are larger than average (macrosomia), or babies in a hard-to-deliver position (like face-up). If a baby has a bleeding disorder, forceps delivery is usually avoided because it can make things worse.

The doctor’s experience also matters. Inexperienced doctors might place the forceps wrong, use too much force, or not fully understand the mother’s anatomy. This can lead to more injuries and more bleeding. Also, some types of forceps used to rotate the baby’s head (called rotational forceps) are riskier and more complex.

All of these risks are why forceps are used less often today about 1 out of every 100 vaginal births. Doctors usually choose them only when they’re clearly the best option. In some cases, they can help avoid an emergency C-section.

In the end, forceps can increase the risk of bleeding through physical injury and other medical factors. But with a skilled doctor and the right decision-making, many of these risks can be lowered. That’s why it’s so important to talk to your healthcare team, understand your options, and make a plan that’s best for you and your baby.

When Is a Forceps Delivery Recommended?

Forceps delivery isn’t something doctors do for every birth. It’s actually not very common anymore. But sometimes, it’s the best way to help a baby be born safely and quickly. Let’s talk about when doctors might decide to use forceps during delivery.

One reason is when pushing during labor takes too long. This is called the second stage of labor. If a mom has been pushing for hours and things aren’t moving, doctors may use forceps to help avoid a C-section. For first-time moms, this might mean 3-4 hours of pushing with an epidural, and a little less for moms who have had babies before.

Another reason is if the mom is too tired to push anymore. Labor can be exhausting, and some moms just don’t have the strength to keep going. In that case, forceps can help finish the delivery safely.

Medical problems can also make pushing dangerous. If a mom has heart, lung, or nerve conditions, she might not be able to push safely. Forceps can help get the baby out without putting her at risk.

Sometimes the baby shows signs of trouble, like a slow or irregular heartbeat. This is called fetal distress. In these cases, doctors may use forceps to speed up the delivery and help the baby right away.

There are also some special situations when forceps are a better choice than other methods:

Preterm births (before 34 weeks): Vacuum tools can be risky, so forceps are safer.
Breech births: When the baby’s feet or bottom come out first, forceps can help deliver the head.
Face-first births: If the baby’s face comes out first, forceps give more control.
Baby facing the wrong way: If the baby is face-up instead of face-down, forceps can help turn the head.
Umbilical cord problems: If the cord comes down before the baby, forceps might be used to deliver the baby quickly.

Before forceps can be used, a few things must be true:

The cervix must be fully open (10 cm).
The water must have broken.
The baby’s head must be low in the pelvis and in a known position.
The mother’s pelvis must be the right size for the baby.
The mom should have pain relief (like an epidural).
Her bladder needs to be empty.
She must understand what’s going on and agree to the use of forceps.

Doctors also make sure they’re ready to do a C-section if the forceps don’t work. Forceps aren’t used if the baby is too small, too big, or in an unknown position. If the mom isn’t fully ready or if she has a bleeding problem, doctors will usually pick a different method.

So, why use forceps at all? When used by a trained doctor, forceps can:

Help avoid an emergency C-section
Make labor shorter if it’s stuck
Help both mom and baby in an emergency

Like any tool, forceps can have risks. They might cause small tears or bruises. But with a skilled doctor and a good plan, those risks can be managed. That’s why it’s important for the doctor and parents to talk and make decisions together.

In the end, forceps delivery is only used when it’s the safest choice. It’s all about doing what’s best for both the mom and the baby.

How Can Hemorrhage Risk Be Reduced?

Heavy bleeding, which is hemorrhage, is one of the most serious risks during a forceps-assisted birth. But the good news is that with the right steps, doctors can lower that risk and help keep both mom and baby safe. Let’s look at what helps.

For Moms: How to Lower Bleeding Risk?

The biggest factor is having an experienced doctor. When a skilled provider uses forceps the right way, it can prevent injuries that cause bleeding, like tears in the birth canal.

Before labor even starts, it's important to check for health issues that could raise the risk of bleeding. These include low iron (anemia) or problems with blood clotting. Treating these before delivery helps lower the chances of problems.

After the baby is born, doctors often give a medicine called oxytocin. This helps the uterus squeeze and shrink back down, which reduces blood loss. Doctors also gently pull the placenta out and may massage the uterus to help it stay firm and avoid heavy bleeding.

Sometimes a doctor may need to do a small cut called an episiotomy to help the baby come out. But this should only be done when really needed, because cutting too often or in the wrong way can actually cause more bleeding.

The hospital team should always be ready in case bleeding becomes a problem. That means having emergency supplies like medicine and blood on hand, and practicing what to do in a real emergency.

For Babies: Keeping Bleeding Risk Low

Forceps can also cause bleeding in babies if they aren’t used carefully. The goal is to guide the baby out gently, without squeezing too hard. If forceps are used with too much pressure or in the wrong spot, it can lead to bruising or, in rare cases, bleeding inside the baby’s head.

Doctors try not to use forceps if the baby is in a risky position or has a known bleeding disorder. Also, if the baby is born too early and is very small, doctors might choose another delivery method like a C-section.

Planning Ahead Makes a Big Difference

There are many ways to plan ahead to keep bleeding risks low:

Make sure forceps are only used when the baby is in a safe position and the mom is fully ready.
Keep hospital teams trained and fully prepared.
Use forceps with gentle, steady pressure.
Fix any tears or injuries right away.
Watch both mom and baby closely after birth.

And if it doesn’t feel safe? Doctors can switch to a different method, like vacuum extraction or a C-section, depending on what’s best for mom and baby.

So Basically, bleeding risks during a forceps delivery are real, but they can be handled. The most important things are good planning, careful technique, and having a skilled team ready to help. It’s not just about the tool it’s about how and when it’s used that makes the biggest difference.

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