Forceps Birth

Forceps birth is an assisted birth, sometimes called an instrumental or operative vaginal birth, uses instruments that are attached to baby’s head so that baby can be pulled out. Forceps are described as stainless steel that come in two intersecting parts and have curved end to cradle baby’s head. It can be used as low or outlet forceps or for mid-forceps procedures.
This procedure is done to provide traction or to assist in rotation of the fetus.

Advantages:

• Provide assistance when laboring women is exhausted
• May decrease need for cesarean birth

Disadvantages:

• Maternal complication such as vaginal and perineal lacerations and postpartal hemorrhage
• Neonatal complication such as facial bruising, edema and cerebral trauma.

Nursing care:

• Explain the procedure to woman
• Encourage her to relax perineum and breathe during forceps application
• Advice physician when contraction is present
• Assess newborn for facial bruising or edema.

Induction

Induction labor is a procedure to stimulate uterine contraction during pregnancy before labor begins spontaneously. It is done for various reason, especially for mother and baby health reason. Elective induction may be accomplished by oxytocin infusion.

Advantages:

• IV oxytocin induction is usually successful when labor readiness has been established, fetal maturity is established and Bishop score is 9 or more.
• Maternal and fetal status can be monitored closely.

Disadvantages:
Induction is an invasive procedure.
Hypertonic labor, fetal distress, alterations in blood pressure, ruptured uterus.

Indications:

• Postmaturity
• Premature rupture of membranes
• PIH
• Presence of maternal disease such as diabetes mellitus
• Fetal demise.

Contraindications:

• Grand multiparity
• Placental abdominalities
• Previous uterine surgery
• Fetal distress
• Preterm fetus
• Positive CST
• Abnormal fetal presentation
• Presenting part above inlet
• Cephalopelvic disproportion (CPD).

Nursing Intervention:

• Obtain baseline tracing of uterine contractions
• Follow established protocols
• Increase IV dosage only after assessing contractions, FHR, and maternal blood pressure and pulse.
• Do not increase rate once desired contraction pattern is obtained.
• Discontinue oxytocin if contraction frequency is less than 2 minutes of duration is more than 90 seconds, or if fetal distress is noted.

Amniotomy

Amniotomy is the artificial rupture of membranes, sometimes called as AROM. It is done to stimulate labor.

Advantages:

• Amniotomy can stimulate contractions
• Amniotomy can evaluate the amniotic fluid

Disadvantages:

• Birth must occur within 24 hour when amniotomy is done, and may be need cesarean birth.
• Increased risk of prolapsed cord
• Risk of Infection

Nursing Care:

• Auscultate Fetal Heart Rate before and after amniotomy
• Record the time of Amniotomy, Fetal Heart Rate, and characteristics of fluid (amount, color and odor).
• Instruct woman to remain in bed unless fetal presentation part is well engaged. It is done to prevent prolapsed of umbilical cord.

Risks for Mother:

• Increases the risk of infection.
• Labor may become more aggressive
• The mother increases her chances of having uneven dilation.

Risk for Baby:

• Increase of umbilical cord compression
• The pressure on the baby’s head causes swelling in some part.