This post will tell a story about a birthing woman being used as a test animal for training in using obstetrical forceps.
Forceps can be an important tool, but learning to use them is difficult. Before the invention of the Chamberlen forceps in the 1600s, removing a stuck baby from the birth canal was a gruesome process, involving anything from surgical instruments to kitchen gadgets (usually the baby was already dead when the removal process began).
Few people got to use the Chamberlen forceps for a long time. The family kept them highly secret, and while many babies and some mothers still died when these forceps were used, not all of them did. The Chamberlens must have seemed like miracle workers every time they were able to end an obstructed birth with a live mother and baby.
Eventually the secret got out, and through the 1700s and 1800s, there were many redesigns of forceps to attempt to make them safer. By the early part of the twentieth century, as birth moved increasingly into hospitals, about half of babies were delivered with the assistance of forceps.
Here is a graphic video depicting a successful and relatively gentle low-forceps delivery–if you are squeamish, you might skip watching. (Note that in this birth there is no episiotomy and the doctor supports the woman’s perineum as the head emerges–this is not typical):
Developing expertise in safe forceps use can take years. Modern day doctors are much more likely to turn to cesareans when problems arise in the birth process. But many doctors do still receive rudimentary training in forceps use. Training is usually done through simulation, but eventually it requires a birthing woman to train on. El Parto Nuestro says,
“Forceps training” are carried out without the woman’s consent and without medical indication, that is, during birth deliveries which are progressing normally without any kind of emergency that requires interventions. The absurd reason for this unnatural practice is just so the students can learn.
No woman in her right mind would consent to unnecessary use of a procedure with risks that include urinary and fecal incontinence and an infant with a fractured skull. According to Dr. Atul Gawande, using forceps safely requires a high level of skill and expertise, which ‘means that the outcome is always uncertain, even for experienced surgeons.’ Thus, practice may be conducted on women who don’t understand what is going on and are perceived as not having the means to complain even if they do. Such was the case of Nancy Narváez, a low-income immigrant woman in Barcelona. According to this press release, Nancy and the friend who accompanied her
witnessed how different students tried one after the other to pull her baby out with the use of forceps, under the supervision of a tutor, who even screamed at one of them, “not like that, you could break the baby’s head!” Finally, the tutor had to pull Nancy’s baby out, who suffered severe craneal fracture, intracraneal bleeding, cortical-subcortical infarction and convulsions which required a [hospital] transfer…[The hospital] confirmed that the baby was also suffering from an epidural hematoma caused by obstetrical trauma during an instrumental birth delivery, hypotonia (lack of muscular tone) and ischemic infarction in the area of the craneal fracture. She was operated on to drain the hematoma. A [neonatology] report…verified that the ischemic injury had caused neurological motor damage to the right hand side of her body; for which she would need physiotherapy. As to the mother, a large episiotomy was carried out on her to insert the forceps.
Poor and oppressed women’s bodies have often been used for medical testing and training without informed consent–or any consent at all. For instance, fistula repair was perfected on unanesthetized enslaved women, and Depo Provera was tested on poor women in Atlanta before much was known about it at all.
Forceps can be a preferable alternative to either vacuum extractors or cesarean if the birth attendant is well trained in their use. Simulations can give good practice on conducting forceps deliveries. But if the training must ultimately be conducted on a living woman who does not need the intervention (because when forceps are needed, there’s usually an emergency that involves getting the baby out fast), at what expense are we doing this training?
Note: for a potential alternative to forceps that is currently in development, see this post.