Forceps delivery tied to lower brain injury risk

When babies need help coming into the world, forceps may carry less risk of newborn seizures compared with vacuum deliveries or Caesarean section, a new study suggests.

In recent years, forceps have fallen out of favour when it comes to aiding a difficult childbirth. Vacuum devices are more often used, while C-section rates have surged.

In 2007, C-sections were performed in one-third of all US births – up from 21 percent a decade before.

But that's all despite a lack of evidence that vacuum or C-section deliveries are actually safer for newborns compared with forceps, according to Dr Erika F. Werner, an obstetrician at Johns Hopkins School of Medicine in Baltimore who led the new study.

For their study, Werner and her colleagues focused on the risk of certain neurologic complications in newborns: seizures and bleeding in or around the brain.

Using data on more than 400,000 births to first-time moms, they found that newborns delivered by forceps were 45 percent less likely to suffer a seizure than those born via vacuum pump or C-section.

On the other hand, babies delivered by C-section were less likely to have one type of bleeding around the brain -- known as subdural haemorrhage.

The risks of any of those complications were low, whatever the type of delivery, Werner told Reuters Health.

Of more than 15,000 babies delivered with forceps, 0.12% had a seizure at birth. That rate hovered around 0.3%for newborns delivered by vacuum or C-section.

C-section has lower risks

Rates of subdural haemorrhage, and another type of brain bleeding called intraventricular haemorrhage, were even lower. Certain risks are lower with C-sections than with forceps or vacuum deliveries -- such as vaginal tearing.

Although the findings are observational and can't prove one method is better than another, they challenge the perception that C-sections are generally safer than forceps. "The C-section rate is going up, without evidence that it's actually better," said Werner, whose study appears in the Journal Obstetrics & Gynecology.

According to Werner, it's possible that the underlying reason for the delivery method is playing a role in her findings. C-sections or vacuum deliveries may be chosen for "sicker babies," she said.

"But," Werner added, "I don't completely believe that's the explanation." Seizures at birth are generally caused by oxygen deprivation to the brain. And doctors can typically get the baby out more quickly with forceps than with a C-section or vacuum.

So that, Werner said, may help explain the lower seizure risk. On the other hand, C-sections were less likely to cause subdural bleeding than either forceps or vacuum deliveries were. Just under 0.1% of those babies had a subdural haemorrhage, versus 0.14 percent of forceps-delivered newborns and 0.19% of vacuum-delivered babies.

Still, Werner's team says, newborn seizures are more likely to cause long-term problems in children's brain development than subdural bleeding is. So the seizure risk may carry more weight.

The bottom line, Werner said, is that women should discuss all of their delivery options with their doctor before they go into labour – in case they end up needing some type of intervention to aid a difficult delivery.

Your doctor, however, may not necessarily be comfortable with forceps.

Forceps-assisted deliveries

In the US, the rate of forceps-assisted deliveries has been steadily dropping in the past couple decades. In 2007, less than one percent of babies were delivered with the help of forceps, versus 5 percent in 1990.

The current study included New York City women who gave birth between 1995 and 2003, and it showed a similar pattern. Forceps deliveries declined over time, to two percent of births in 2003. In contrast, vacuum-assisted birth went in the opposite direction, accounting for almost six percent of births in 2003.

That trend is thought to be related to training, according to Werner. More obstetricians-in-training are learning to use vacuum devices, but not forceps. But it's not clear exactly why training has changed over the years, Werner said – especially given the lack of evidence that vacuum deliveries are better for babies.

If this study had included births from more recent years, she noted, it's likely that even fewer deliveries would have been done by forceps.

(Reuters Health, Amy Norton, December 2011)


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