Forceps-Assisted Vaginal Deliveries in West Texas

Abstract

INTRODUCTION: The incidence of operative vaginal delivery was 10–15% in the United States in 2000. By 2006, the rate had fallen to less than 5%, of which less than 1% were forceps deliveries. Questions have arisen regarding whether the volume of procedures is sufficient to train residents. The objective of this study was to review the training and experience with forceps deliveries of residents graduating from a major southwestern residency program that focuses on training for forceps-assisted vaginal deliveries. METHODS: This was a retrospective chart review of forceps deliveries performed by nine residents who graduated from the Texas Tech University Health Sciences Center Department of Obstetrics and Gynecology residency program from July 1, 2007, through June 30, 2013. Annual and cumulative experience with forceps deliveries was recorded for each resident. Indication, classification, and type of forceps used were noted in all cases. Pertinent maternal and neonatal outcomes were obtained from the maternal medical record only. Important aspects of training that may have contributed to those salutary outcomes will be evaluated. RESULTS: A total of 303 procedures were identified. The mean number of procedures per resident was 33.7; the median was 29. The cumulative number of forceps deliveries by year of training was recorded. The mean (median) number of forceps deliveries by year of training (year 1–year 4) was 3.4 (3), 7.1 (6), 12.3 (9), and 12.3 (10), respectively. Indications for the forceps deliveries included 171 fetal, 95 maternal, and 37 not recorded. The majority of deliveries were classified as low forceps (187), with some outlet (38) and very few midforceps (9). The incidence of third- and fourth-degree perineal lacerations was 8.5%. CONCLUSION: Forceps have been used for hundreds of years to assist in the safe delivery of neonates. It is believed that the special emphasis placed on forceps-assisted deliveries in this program as well as the number of forceps-assisted deliveries performed combine to give residents the confidence needed to use this important mode of delivery when necessary for superior patient care.