Obstetric forceps are surgical instruments that are sometimes used to assist in a vaginal delivery. When using forceps, which look like a pair of metal spoons, the OB guides the baby through the birth canal. Each blade has two curves, the cephalic, which conforms to the head of the baby, and the pelvis, which conforms to the mother's pelvis.
Unlike a vacuum, another medical device to facilitate childbirth, the use of forceps requires a higher level of skill and training. How well you use forceps and knowing when to use forceps matters a great deal to the safe delivery of the child.
There is nothing wrong with a competent obstetrician using forceps in some circumstances during childbirth. There are even some cases where it is negligent not to use forceps.
But those cases are rare exceptions. Even cheerleaders of greater use of forceps to reduce the number of C-sections agree that "extreme caution" is required when using forceps. Malpractice cases arise when the delivering doctors either should not be using forceps, are using the wrong forceps, or using the wrong technique to deliver the child safely.
Often the best path for the mother and child is a C-section because the messages the baby is sending from the fetal heart monitor is that delivery must be immediate to avoid oxygen deprivation that causes a permanent brain injury.
Using the wrong forceps or the wrong technique is becoming more common because younger obstetricians are not getting trained in how to properly use forceps. Our obstetrician experts are telling us that the new generation of OBs are using vacuums far more often because they are easier to use. So when these younger doctors have a baby in distress - which is why the forceps are used about half the time - they do not know when or how to use forceps.
If you believe your child has been harmed during childbirth by doctors, who did not do what they should to safely deliver your child, call us today at 800-553-8082. You can also get a free, confidential online case evaluation. Let's talk about what happened and what the options might be for you and your child.
- What is the expected settlement value of a forceps birth injury case?
- Forceps birth injury frequently asked questions
There are four times of forceps: low, mid, high, and outlet. Low forceps means the child's head is visible at the mother's vaginal opening without doing anything.
Mid forceps means that the baby's head has entered the mother's pelvis but is not quite visible at the opening of the vagina.
High forceps are the application of forceps when the baby's head is just entering the mother's pelvis (known as station zero). We can take this one off the table because it is no longer performed in modern obstetrics.
Outlet forceps is when the baby's head fetal head is underneath the pelvis and its child's scalp is appears between contraction.
No alarms are going off during low or outlet forceps deliveries. The baby is progressing nicely and the doctor is choosing to used low forceps to speed up childbirth.
Mid forceps means that the baby's head has entered the mother's pelvis but is not quite visible at the opening of the vagina. Doctors are using mid-forceps in only 1% of deliveries. Alarms are going off -- or should be -- when mid forceps is required.
Mid-forceps deliveries are typically used when there is more of a problem such as the baby head being positions against the mother's back. The baby should also be horizontal in the uterus or other positions where the baby's head has entered the birth canal at an odd angle.
Mid-forceps might also be indicated when a baby is in distress or bradycardia (slow heartbeat) during the delivery process.Mid-Forceps Deliveries and Malpractice
Many birth injury medical malpractice cases for forceps injuries involve mid-forceps deliveries. These are higher-risk birth processes. The higher the baby's head, the greater the risk. There is no question that the mid-forceps delivery is more technically demanding on the OB. The risk of shoulder dystocia may go up as high as 10-to-17 fold.
Mid forceps should never be used by an inexperienced OB, cases of cephalopelvic disproportion, or when the mother with a full urinary bladder. A mid-forceps delivery causes potential harm to the child in all of the
Often, the safer path is a C-section. Mid forceps deliveries are way down from what they were 20 years ago. Many medical malpractice birth injury cases are botched mid-forceps delivery where the OB never bothers to investigate the availability of back-up of how quickly a C-section team can be assembled.
There are four types of breaches of the standard of care we often see in forceps cases.
- Forceps application timing - Forceps delivery should not be attempted unless and until the station of the fetal head is low enough to ensure a safe operative procedure
- Forceps placement - The obstetrician must know the appropriate position of the fetal head to properly place the device on the child
- Only one mechanical instrument - The doctor can only use one mechanical device. If the forceps fail, you cannot turn to a vacuum or vise versa.
- Careful application - Forceps traction must not be applied until proper forceps placement is verified. The use of this delivery device with improperly placed forceps presents a risk of harm to the child, not the least of which is a brain bleed. It is also important to use the appropriate amount of traction. Intense squeezing or pulling puts the child at risk for fetal injury.
If you love your newborn child and believe your child has suffered a birth-related injury because a doctor misused or never should have used forceps, you have already gone through so much. But you do not want sympathy. You want to do figure out what you can do for your child. Does that involve trying to get as much money as you possibly can to care for your child? It absolutely does.
There is a formula to calculate the damages in these cases. It is all of the expected medical bills and ongoing care costs over a lifetime plus the child's noneconomic pain and suffering damages.
While the settlement formula is easy to state, it is hard to know what numbers to put into the formula to make the calculation. To make this determination, we need to bring aboard medical experts to offer their opinion on what expenses and needs your child will have.
To synthesize those numbers, we need a life care planner and an economist who can calculate the costs of this care. In birth injury cases, the cost of medical care can sometimes approach or exceed $50 million. These are big, important cases and you need the best birth injury malpractice lawyer in Maryland, and you need medical experts and economic experts that can stake out your claim to the doctors and hospital's attorneys and, if necessary, a jury.Settlement and Verdicts in Forceps Cases
One great tool to help understand the value of your case is prior settlements and verdicts in other forceps birth injury lawsuits. These are a powerful tool in understanding the settlement compensation for your child's lawsuit. That said, take these all with a grain of salt. You cannot summarize a case in a paragraph, and you cannot look at a seemingly comparable case and assume you will get the same result.
One forceps related medical malpractice case cannot predict another because there are just too many variables at play. So use these to gain a better understanding of the range of your potential settlement or verdict but keep in mind you need to use these in conjunction with other case evaluation tools to come up with the value of your claim.
We do not have Maryland cases in recent years that have been reported although there have been many unreported cases.
- 2018, Pennsylvania $42,000,000 verdict: The pregnant plaintiff mother arrived at a hospital complaining of contractions and leaking of fluid. The following morning, the fetus entered the birth canal and the defendant doctor began using forceps to pull on the fetus. After using the forceps, the child was delivered naturally by pushing. Once the baby was out, the child’s head showed molding and forceps marks. As a result of his traumatic birth, the plaintiff asserted that the infant suffered fractures of the occipital and parietal bones, which in turn caused extensive bleeding within the cerebellum. The resulting hydrocephalus, hemorrhaging, and swelling in the newborn's brain created a mass effect, pushing the brain stem against his skull and causing an acquired Chiari malformation as well as encephalomalacia, which is permanent damage to large areas of the brain's white matter. The plaintiff maintained that as a result of the hydrocephalus, the newborn had to have a shunt placed in his brain to drain excess fluid. The child has since had at least six brain surgeries and is at permanent risk of needing multiple shunt revisions which will require multiple future surgeries. The plaintiff filed for medical malpractice on the basis of improper use of forceps of delivery resulting in permanent brain injury to the newborn. They sought damages for past and future medical expenses, as well as damages for pain and suffering. The defendants denied liability. The judge ruled in favor of the plaintiff and awarded them with $42,000,000.
- 2017, Pennsylvania $1,000,000 settlement: A pregnant female patient came to the hospital for labor and delivery and doctors found she also had shoulder dystocia. The patient mentioned to the doctor about her maternal weight gain and obesity during pregnancy. During delivery, doctors had trouble with vaginal birth and used forceps to pull the baby out. The infant was born with Erb’s Palsy, a right brachial plexus injury, left 6th nerve/abducens palsy and a fractured and dislocated right arm. The plaintiff's mother contended the defendant physicians failed to appreciate the risks associated with the pregnancy, failed to appreciate the risks of maternal weight gain and obesity during pregnancy, failed to offer the plaintiff a C-section, failed to properly manage the shoulder dystocia and utilized forceps and excessive force and traction on the infants head during delivery. The defendants all denied negligence and maintained that the shoulder dystocia was unexpected and managed properly once encountered. The defendants maintain that the birth cord was wrapped twice around the fetus' neck which was properly managed and contributed to birth complications and the need to move quickly in delivering the fetus. The defendants argue that the infant's birth injury will not impact his earning ability as an adult and argue that his limitations are minor. The infant's parents settled with the defendant for a lump sum of $1,000,000.
- 2017, Pennsylvania: $42,000,000 Verdict. A mother goes to the hospital to deliver her baby. After one push - just one push - the OB/GYN handling the delivery decides to use forceps. He pulled four times using a vacuum which is counterindicated. (The doctor, helpfully, admitted this fact.) Within a few hours, the infant exhibited signs and symptoms of intracranial bleeding and pressure. Tragically, the now 5-year-old boy is confined to a wheelchair, is not expected to be able to read and write. He also has executive brain function injuries that cause an easy to activate temper. He has also had to endure six brain and spinal surgeries.
- 2016, Nebraska: $11,520,000 Verdict. A woman is a patient at a hospital. While giving birth to her infant, defendants fail to properly use forceps and fail to monitor the mother and her baby. The infant is delivered with forceps, during which he suffers a trauma-induced lack of oxygen to his brain, causing permanent neurological impairment and seizure disorders. His mother files this claim against the doctor and hospital. The defendants deny liability and argue that the infant's injuries were caused by an intrauterine stroke. A jury awards the mother and baby $11,520,000. This was the rare case when the verdict was delivered by a judge instead of the jury.
- 2016, Illinois: $11,000,000 Verdict. A 34-year-old woman is under the care of defendant when she endures an excessively long second stage of labor, followed by a forceps delivery. During the delivery, the woman suffers a fourth-degree tear, which is not repaired immediately. The tear becomes contaminated and subsequent attempts to repair the wound fail. The woman files this claim against the OB/GYN and hospital, alleging that he improperly performed a forceps delivery, caused a fourth-degree perineal laceration during the improper forceps delivery, failed to recognize and immediately repair the laceration, and failed to perform a C-section. A jury awarded the newborn child, the woman and her husband $11,000,000, which was later tragically reduced to $1,000,000 due to a high-low agreement reached before trial.
- 2016, Texas: $10,200,575 Verdict. A woman 40 weeks pregnant goes to the hospital with contractions. She is placed on Pitocin, which is discontinued due to fetal response. Pitocin is later resumed and increased. An hour later, the fetal heart monitor indicates that the infant is in distress, and the defendant is instructed to stop the Oxytocin. Defendant doctor disagrees with this and instead orders a nurse to increase the dosage. An expedited vaginal delivery is attempted a few hours later, during which defendant uses forceps three times three times in an attempt to extract the baby. Cracking noises are heard. After he is unsuccessful with the forceps, the infant is delivered via C-section. She is born limp and unresponsive and is diagnosed with a lack of oxygen to her brain. Five days later, the infant is taken off life support and passes away. The woman files this claim, alleging that the use of forceps caused three-inch fractures on each side of the infant's skull and damaged the vertebral arteries. She also claims that defendant used excessive force with the forceps. A jury awards the woman $10,200,575, which is ultimately reduced to $750,000 due to the state cap on medical malpractice awards.
- 2016, Alabama: $600,000 Settlement. Plaintiff receives prenatal care from defendants. When she is 35 weeks into her pregnancy, her membranes spontaneously rupture and she goes to the hospital. Her doctors induce labor early in the morning. That evening, defendant uses forceps to aid in delivery, but he is unsuccessful. He then uses a vacuum and delivers the baby's head. Shoulder dystocia is encountered, and despite many attempts, defendant does not have success in delivering the baby. Just prior to delivery the fetus suffers fetal stress, and the baby undergoes resuscitation after birth. He has a fractured left humerus and lab results reveal an injury due to a lack of oxygen to his brain. A later CT scan reveals a left hemorrhage in his head, for which the infant is hospitalized for almost two months. The parties settle for $600,000.
- 2015, Massachusetts: $6,250,000 Settlement. Plaintiff is pregnant with her second child. A month before her due date, she goes to the hospital as her membranes spontaneously rupture. There is a clear fluid and she has no contractions. The woman is placed on fetal monitoring under the care of defendant nurse and defendant obstetrician. Twelve hours later, fetal monitoring shows an increase in the infant's heart rate, however, defendants tell her she is doing well. She alleges that both defendants are aware of the concerning fetal monitoring but do not take any steps. They deliver the infant, with forceps a few hours later, and he immediately has respiratory issues. A feeding tube is placed and he is diagnosed with a global brain injury that leaves him unable to speak or walk. The woman files this claim, and defendants argue that the infant's injury was suffered prior to the woman's arrival at the hospital. The parties settle for $6,250,000 prior to trial.
- 2015, New York: $1,150,000 Settlement. Plaintiff is 34 weeks pregnant when defendant OB/GYN attempts to deliver her infant naturally. Several hours into the delivery he uses forceps and a vacuum. The infant suffers a subdural hematoma and hemorrhage, causing brain damage. This results in language deficits and cognitive disabilities. The woman files this claim alleging that the defendant breached the standard of care by using the forceps and vacuum improperly on a premature infant. The defendant denied liability but settled the case for $1,150,000.
- 2014, Texas: $400,000 Settlement. A woman goes to the defendant for labor and delivery. During this time, she requests a Caesarean section as her baby is large. Defendants ignore this request and instead use forceps to delivery the infant. As a result, the baby is born with shoulder dystocia and Erb's palsy. She files this claim and eventually settles the case for $400,000.
- 2013, North Carolina: $10,000,000 Settlement. A woman is giving birth to twins and she delivers the first boy without complications. The second infant, a girl, develops a prolapsed cord during the delivery of her twin. This results in a lack of oxygen requiring immediate vaginal delivery or a C-section. However, defendants allow the woman to continue labor. For the next hour, the girl develops a lowered heart rate. It is not until a third doctor is called in that immediate delivery is recommended. Once this recommendation happens, the attending doctor decides to perform a forceps delivery instead of a C-section. It then takes 15 minutes to locate the forceps. As a result, the infant suffers brain damage and cerebral palsy, requiring 24-hour care. The parties settled for $10,000,000.
- 2013, Michigan: $4,250,000 Settlement. A woman 35-weeks pregnant goes to defendant hospital as she notices slight bleeding. She has a history of three miscarriages. The woman is evaluated for premature membrane rupture and she is placed on a fetal monitor. Pitocin is administered to start her labor and is gradually increased. This results in excessive uterine activity and fetal heart decelerations. During delivery, the fetal heart rate monitor switches to the mother's heart rate, causing defendants to misinterpret the increase in heart rate. Defendants employ the use of forceps and misuse them as they struggle to extract the infant. The baby is born twelve minutes later with a bruised head and severe brain damage. He has a subdural hematoma and intracranial bleeding. The plaintiffs file this claim alleging the misuse of Pitocin and the negligent use of forceps. Defendants denied that the use of forceps caused the infant's injuries. The case settled for $4,250,000.
- 2013, Pennsylvania: $4,000,000 Verdict. Plaintiff is giving birth to her daughter under the care of defendant obstetrician. He attempts a forceps delivery but the baby's shoulder becomes impacted on the woman's pelvic bone. Defendant uses various maneuvers to deliver the child, but she is deprived of oxygen for three and a half minutes. As a result, she has mild cerebral palsy, struggles with balance issues, and has speech delays. The woman files this claim against the OB/GYN, alleging the failure to perform a C-section instead of delivery via forceps. A jury awards the woman $4,000,000.
The use of obstetrical forceps to facilitate vaginal delivery not medically appropriate under the following circumstances:
- The baby’s head is too high up. Forceps should not be used unless and until the baby’s head has entered the mother’s pelvis.
- The doctor does not know exactly where the baby’s head is. Knowledge of the exact position of the fetal head is critical for proper forceps placement.
- The doctor is not able to get a firm grasp of the baby’s head with the forceps or loses a grip on the head.
- If the baby is overly large (fetal macrosomia) forceps should not be used.
Negligent use of forceps can result in several different types of birth injuries. The most common are injuries to the child’s head and skull from improper placement or unskilled use. In some cases, head injuries from forceps negligence can result in permanent damage to the baby’s brain. Forceps misuse can also result in nerve injuries such as Erb’s Palsy. These injuries occur when the doctor uses excessive force or lateral traction when pulling the baby out.
Another common injury associated with the use of forceps are facial nerve injuries. This relatively common injury (1% of live births) is often caused by pressure on the facial nerve by forceps during delivery. This can cause loss of movement or motion on the affected side of the face. Parents often identify the problem because the child's face is asymmetric when crying. This injury is traumatic for the parents but it usually resolves without treatment after a few weeks.
The settlement value of a medical malpractice case involving misuse of obstetrical forceps depends largely on the type and severity of birth injury involved. In general, however, birth injury cases have the highest value of any type of medical malpractice case. Cases involving serious neurologic birth injuries such as cerebral palsy can be worth $10-20 million or even more.
If your child has suffered a birth injury because a doctor improperly or unnecessarily used forceps during the birth of your baby, our law firm has the experience and resources to help you both get the cash compensation you deserve for the harm that has been caused. Call Miller & Zois today and speak to a childbirth injury medical malpractice attorney at 800-553-8082 or get an online case evaluation.More Malpractice Claim Information
- Oxygen deprivation is brutal for a newborn child. This is called a hypoxic-ischemic injury.
- Uterine rupture malpractice claims that include some settlements and verdicts in Maryland involving the use of Pitocin
- Caput succedaneum malpractice cases