Midforceps delivery—a vanishing art?

Abstract

The investigative and other intellectual pursuits of obstetrics are receiving increasing emphasis in our curricula and training programs. This is as it should be; but an unfortunate sequella is an increasing disregard of the mechanical aspects of our discipline.The dictum that midforceps delivery is obsolete and that it should be replaced by cesarean section is a convenient platitude which ignores the significant number of midpelvic arrests for which cesarean section is not a reasonable or proper solution. The appraisal of such problems requires a clear concept of pelvic architecture and of the effects of the pelvic features upon the mechanism of labor. Because of the increasing evasion of these principles it has seemed timely to review the classical Caldwell-Moloy precepts, to suggest a means by which they can be taught more readily, and to outline certain aspects of their use.In passing, the observation is made that the currently approved definition of “midforceps delivery” (proposed in 1949 by the authors of four standard obstetric textbooks) has serious disadvantages that may outweigh its single advantage. It is hoped that this question will be reopened, and that the propriety of our present usage will be re-examined. An alternative definition is suggested.