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Comment and Controversy

Down but not out: Some of us still use forceps

September 2006 · Vol. 18, No. 9
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“Safe use and enduring value of operative vaginal delivery,” by Maeve Eogan, MD, and Colm O’Herlihy, MD (June)

It is reassuring to know there are still some advocates of appropriate operative vaginal delivery. I was trained to use forceps during my residency, and our teaching service had a forceps rate of approximately 21%, with a cesarean section rate of 18%. In contrast, our residents have an operative vaginal delivery rate of 4% to 5% and a C-section rate of 25%. Of course, many other variables have come into play, but less training and fear of litigation are 2 important factors.

I take issue only with the authors’ comments about the Kielland forceps. Along with many of my colleagues, I was trained to use rotational forceps for a fetus in occiput transverse position that has not completed its descent. While the Kielland forceps is limited to this specific condition, I find them quite helpful.

As for episiotomy, I have not found a need for its routine use (much less for “large and early episiotomy”) with the Kielland forceps or any other type of forceps. In fact, when I use forceps, I often bring the baby’s head below crowning and, once I am able to effect a modified Ritgen maneuver, remove the blades and control the delivery manually.

Ricky Friedman, MD
Associate Clinical Professor
Department of Obstetrics, Gynecology, and
Reproductive Sciences
Mount Sinai School of Medicine
New York, NY

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