Forceps and vacuum in childbirth increases risk of physical trauma, Canadian study finds

on 13 January 2022

Researchers found that the use of forceps and vacuum during childbirth was associated with a higher risk of physical trauma.

The study, published in the Canadian Medical Association Journal, found physical trauma, such as perineal tears, occurred in one in four births where forceps were used.

Researchers analysed 1.3 million births in Canada, between April 2013 and March 2019 using data from the Canadian Institute for Health Information’s Discharge Abstract Database that includes all hospitals in Canada, except those in Quebec.

The study focused on single births to women who had not had a previous caesarean section.

From the data used, 38,500 births involved forceps and 110, 987 were attempted vacuum deliveries.

Approximately 96% of forceps births were successful, with around 92% of vacuum deliveries successful.

More than a quarter of successful forceps births involved maternal trauma, and around 13% of successful vacuum deliveries also experience maternal trauma.

Injuries included injury to the anal sphincter, cervical tears, vaginal lacerations, damage to the urethra or bladder, perineal tears, and other pelvic trauma.

The most common injury was Obstetric Anal Sphincter Injury (OASI) in women, especially in those women who had forceps used during childbirth.

Researchers said in the paper that “OASI occurred in 87 per cent of deliveries with maternal trauma, following OVD and accumulating evidence shows the severe long-term consequences of these injuries, such as urinary and fecal incontinence, dyspareunia and other pelvic floor disorders.”

According to the study deliveries with forceps make up around 10-15% of childbirths in Canada, Australia and the UK.

Another study from August 2021 suggests that Canada has the highest rates of OASI.

Researchers are now calling for new safety measures in Canada stating in their conclusion that: “Rates of maternal and neonatal trauma following OVD are high in Canada compared with other countries with similar rates of OVD, and are especially high in some provinces. These high rates call for a reassessment of the safety of OVD, not just in Canada, but in all settings where the rates of OVD and the opportunities for training in OVD are changing. 

The study ‘Maternal and neonatal trauma following operative vaginal delivery’ can be found here.