‘A permanently weakened pelvic floor’: why we need to talk about forceps
The use of forceps in birth carries an increased risk of injury to the mother – yet, in contrast with other European countries, they are still widely used in the UK. Freelance journalist Sarah Jewell investigates
When Amy White*, 33, gave birth to her daughter she had a complicated delivery. She was not alone in her experience, she explains: “In my NCT group two years ago there were seven of us expecting at the same time and we had five caesareans, a ventouse delivery and I had forceps – it was a real shock that we all ended up with interventions and many of us had complications as a result.”
This little snapshot of new mothers is a familiar story as statistics show that giving birth is becoming more complicated due to rising maternal age, an increasing ratio of chronic health conditions, and higher rates of medical intervention. A recent report in the New Scientist made the controversial claim that “the female pelvis may become too narrow for vaginal childbirth, meaning that caesareans could become the only option for delivering babies.” (1)
Morgan Martin is a retired midwife who worked in a home birthing centre in Seattle and a high-risk maternity care hospital in Auckland, and she has seen how giving birth has changed: “New mums are getting older, IVF births have reached record highs, the general population is not as active and healthy as it used to be and childbirth is becoming increasingly medicalised with many women now opting for caesareans.” With more medical interventions, she adds, “there is also a real need for better antenatal education and better communication about birth outcomes and post-birth care.”
The latest NHS data for 2024-25 backs up this changing picture with the revelation that the number of caesarean sections has overtaken the number of unassisted vaginal births for the first time - 45% of births in England were through caesareans, 44% were unassisted vaginal births and 11% were assisted with instruments such as forceps or ventouse. (2)
Instrumental deliveries, where forceps or vacuum suction cup (ventouse) are used to help manoeuvre the baby’s head through the birth canal, can be lifesaving in emergency situations, but instruments carry a higher risk of injuries to both mother and baby compared to spontaneous vaginal deliveries.
Forceps births carry a higher risk
In many high-income countries, however, the use of forceps has declined significantly, and in some European countries, forceps rates are so low as to be negligible because doctors prefer to use ventouse rather than forceps. This is because forceps carry a higher risk to the mother than ventouse, sometimes resulting in damage to a woman’s pelvic floor, anus and perineum leading to urinary and bowel incontinence. The reason, Morgan explains, is that “the forceps have to be inserted into the pelvic canal between the maternal tissue and the baby’s head, while the ventouse is applied only to the baby’s head so only the size of the head is contributing to instrumental complications.”
There are new alternatives to forceps and ventouse instruments, however, currently being trialled, including OdonAssist, a soft inflatable device that sits around the baby’s head and helps doctors guide the baby down the birth canal. The design aims to minimise soft tissue injuries to both mother and baby and offers a gentler alternative to existing assisted delivery instruments.
For Amy the experience of giving birth was not the natural water birth event that she had hoped for. “I was four days overdue when my waters broke so I had to go into hospital and I was put on a drip to speed up contractions. It was very painful so I started on gas and air”. As the contractions increased the pain became unbearable and Amy decided to have an epidural: “I naively thought if they present me with forceps after the epidural then I can always say, ‘No, I’d rather have a caesarean instead.’
As her labour progressed the midwives became worried about the baby’s heart rate and they called in the doctor who decided they needed to use forceps: “They wanted to get the baby out quick so I had an episiotomy and they used forceps to guide me through pushing, but I had a second-degree tear and afterwards felt numb and had no bladder control.” Amy was retaining urine and had to have a catheter put in. She stayed on the ward for three nights and remembers it as a terrible time: “Every day something happened that led to new waves of pain and anxiety, there was blood in the catheter, my stitches broke and I ended up being on pain killers for 10 weeks.”
But what was most traumatic was that Amy felt things would never go back to normal: “I had no reassurance that my bladder control would ever come back and I kicked myself for a long time thinking I should have gone for a c-section.” Eventually she got referred to a perineal midwife and had six months of physiotherapy but now has a permanently weakened pelvic floor. She believes there should be better education around why instrumental deliveries are often necessary and that “they should be seen as a real possibility in emergencies and there should be more specialised support for women who have had an instrumental birth.”
Better antenatal education is needed
Clare Taube, 34, had her first baby three years ago and had written in her birth plan that she would prefer to have a c-section than use forceps. Her baby was overdue, however, and she was induced 12 days after her due date. She had an epidural and was given the Syntocinon drip to speed up contractions. “After two hours of pushing the doctor said that the baby was back-to-back and they decided to get her out quick with forceps.”
The birth has left Clare with lasting health issues: “I now have a prolapse of the posterior vaginal wall because of prolonged pushing, the high forceps, episiotomy, and a secondary tear.” The prolapse has affected her bowel movements and “it is uncomfortable if I walk for long time.”
Chloe Lazenby is the Welsh officer for the Birth Trauma Association and she says that evidence from the report by The All-Party Parliamentary Group on Birth Trauma shows that far too many new mothers feel let down by their birth experience and that “antenatal education is woeful”. The report is calling for better education for women around their birth choices and says that at 34 weeks all mothers-to-be should have, as Lazenby says, “robust conversations with their midwives about their birth plans and go through the risks of what might happen during birth”. Expectant mothers should be able to discuss the risks of instrumental interventions and “understand their options rather than at the point of crisis in birthing”
The report also recommends that every mother should have a postnatal, six-week check and debrief. As Lazenby explains: “Many women don’t understand why they had to have forceps or medical interventions and if they can have a proper explanation of what happened it may help to lessen their trauma.”
Morgan agrees that better information and education is essential for women in childbirth and too often goes missing: “Women want to be prepared, they don’t want to be scared but they do need to be supported with the facts about when an intervention is necessary and the likely outcomes so that they are empowered by true, informed choice.”
1. Barras, Colin (2026) Why is childbirth so hard for humans – and is it getting even harder? New Scientist. 4 February.
2. NHS Digital (2025) NHS Maternity Statistics 2024-25
3. APPG on birth trauma (2024). Ending the Postcode Lottery on Perinatal Care - A report by The All-Party Parliamentary Group on Birth Trauma. 13 May
*Amy White is a pseudonym
