Forceps Delivery Injuries: When Assisted Birth Goes Wrong

Forceps are surgical instruments designed to help guide a baby through the birth canal during difficult deliveries. While forceps can be life-saving tools when used properly, improper or unnecessary use can cause devastating injuries to newborns, including skull fractures, facial nerve damage, and permanent brain damage. If your child suffered injuries during a forceps-assisted delivery, understanding what happened and whether medical negligence played a role is the first step toward getting answers—and getting your family the support you deserve.

If you believe your baby was injured due to improper forceps use during delivery, you may have legal options. A birth injury attorney can review your case at no cost and help you understand whether medical malpractice occurred. Because statute of limitations deadlines apply to these cases, it’s important to seek legal guidance sooner rather than later. Contact a birth injury lawyer today for a free, confidential case evaluation.

On this page:

• What are forceps deliveries
• Types of forceps injuries
• Common complications from forceps use
• When forceps use becomes malpractice
• Warning signs after forceps delivery
• Diagnosis and treatment
• Long-term effects and prognosis
• Filing a forceps injury lawsuit
• Choosing a birth injury attorney
• Frequently asked questions

What Are Forceps Deliveries?

Forceps are metal instruments that resemble large tongs or salad servers. During a forceps-assisted delivery, an obstetrician carefully places the curved blades around the baby’s head while the baby is in the birth canal, then gently pulls to help guide the baby out during contractions and maternal pushing efforts.

Medical professionals may recommend forceps delivery in several situations. When labor stalls during the second stage and the mother cannot push the baby out after prolonged effort, forceps can provide the necessary assistance. If the baby shows signs of distress and needs to be delivered quickly, forceps offer a faster alternative to an emergency cesarean section in certain circumstances. Maternal exhaustion after hours of labor, or medical conditions that make prolonged pushing dangerous for the mother, may also warrant forceps use.

According to the American College of Obstetricians and Gynecologists, forceps deliveries have declined significantly over recent decades, now occurring in fewer than 1% of all births in many hospitals. This decline reflects both the increased use of vacuum extraction as an alternative and the specialized training required for safe forceps application.

When performed correctly by an experienced physician under appropriate circumstances, forceps deliveries can be safe. However, the procedure requires significant skill, proper judgment about when forceps use is appropriate, and careful technique during application and traction.

Types of Forceps Birth Injuries

Forceps delivery injuries range from minor and temporary to severe and permanent. Understanding the different types of injuries helps families recognize potential problems and seek appropriate medical and legal help.

Skull Fractures and Head Injuries

The rigid metal blades of forceps can fracture a newborn’s delicate skull bones when excessive force is applied or when the instruments are positioned incorrectly. Linear skull fractures—cracks in the skull bone—are the most common type, though depressed skull fractures, where a portion of the skull is pushed inward, can also occur. While some skull fractures heal without intervention, others require surgical repair and may lead to complications.

Subgaleal hemorrhage, bleeding between the scalp and skull, represents a potentially life-threatening complication of forceps delivery. This type of bleeding can cause a newborn to lose a significant portion of their blood volume, leading to shock and requiring immediate transfusion and intensive care.

Brain Damage from Forceps

Brain injuries represent the most serious category of forceps delivery complications. Infant brain damage from forceps can occur through several mechanisms, including direct trauma from the instruments, bleeding within the brain, or oxygen deprivation if the delivery is prolonged despite forceps assistance.

Intracranial hemorrhage—bleeding inside the skull—can damage delicate brain tissue and lead to permanent neurological impairment. Subdural hematomas occur when blood collects between the brain and its outer covering, while intraventricular hemorrhages involve bleeding into the brain’s fluid-filled spaces. Both types of bleeding can cause lasting developmental delays, seizures, and conditions like cerebral palsy.

Forceps brain damage may also result from prolonged compression of the skull during difficult extractions. When the delivery takes too long despite forceps use, the baby may experience oxygen deprivation, leading to hypoxic-ischemic encephalopathy (HIE), a serious brain injury caused by lack of oxygen and blood flow.

Facial and Nerve Injuries

Facial nerve palsy occurs when the forceps compress the facial nerve, which runs along the side of the face near the ear. This compression causes weakness or paralysis on one side of the baby’s face, most noticeable when the infant cries. While many cases of facial nerve palsy resolve within weeks to months, severe compression can cause permanent facial asymmetry and weakness.

Eye injuries, though less common, can occur if the forceps are positioned too close to the baby’s face. These injuries range from bruising around the eyes to more serious damage to the eye itself, including retinal hemorrhages or direct trauma to the eyeball.

Skin lacerations and deep bruising at the forceps application sites typically heal without long-term consequences, but they cause pain and distress for the newborn in the immediate postpartum period.

Neck and Spinal Cord Injuries

Excessive pulling or twisting during forceps delivery can injure a newborn’s neck and spinal cord. Spinal cord birth injuries from forceps use may cause weakness, paralysis, or breathing difficulties. Brachial plexus injuries, typically associated with shoulder dystocia, can also occur during forceps deliveries when lateral traction stretches the nerves controlling the arm and hand.

If your baby shows signs of weakness, unusual positioning, or breathing problems after a forceps delivery, immediate medical evaluation is necessary. These symptoms may indicate serious nerve or spinal cord damage requiring urgent intervention.

Common Forceps Delivery Complications

Beyond direct injuries to the baby, forceps use carries risks of complications that can affect both mother and child. Understanding these potential problems helps families recognize when something has gone wrong.

Maternal injuries from forceps delivery include vaginal and perineal tears that extend deeper than would typically occur during unassisted birth. These severe tears can damage the anal sphincter muscles and cause long-term bowel control problems for the mother. Uterine rupture, though rare, represents a catastrophic complication that endangers both mother and baby.

Failed forceps deliveries occur when the physician cannot successfully deliver the baby despite multiple attempts with the instruments. Continuing to pull with forceps when the delivery is not progressing increases injury risk dramatically. When forceps fail to facilitate delivery, an emergency cesarean section becomes necessary, but the delay may have already caused harm to the baby through prolonged oxygen deprivation or direct trauma from the failed attempts.

Infection risks increase with forceps deliveries, particularly when the procedure causes lacerations to the baby’s scalp or face. These wounds create entry points for bacteria, potentially leading to serious infections like meningitis or sepsis if not properly monitored and treated.

When Does Forceps Use Become Medical Malpractice?

Not every forceps injury constitutes medical malpractice. Complications can occur even when a physician follows proper protocols and exercises reasonable care. However, forceps malpractice occurs when a healthcare provider’s actions fall below the accepted standard of care, causing preventable harm to the baby or mother.

Improper Candidate Selection

Medical malpractice may occur when a physician attempts forceps delivery despite contraindications. Forceps should not be used when the baby’s position is uncertain, when significant cephalopelvic disproportion exists (the baby is too large to fit through the birth canal), or when the baby’s head has not descended sufficiently into the pelvis.

Attempting forceps delivery on a baby in breech position or when the cervix is not fully dilated represents a dangerous deviation from standard obstetric practice. Similarly, using forceps when the baby’s skull bones show signs of a bleeding disorder or bone fragility condition creates unreasonable risk.

Excessive Force Application

The amount of force applied during forceps delivery directly correlates with injury risk. While some traction is necessary to assist delivery, excessive pulling—particularly pulling at angles that twist or rotate the baby’s head unnaturally—can cause skull fractures, brain bleeding, and spinal cord injuries.

Medical guidelines specify that if a baby does not descend with appropriate forceps traction, the physician should abandon the attempt and proceed to cesarean section rather than continuing to pull harder. Physicians who ignore this guideline and apply escalating force to complete a vaginal delivery may be liable for resulting injuries.

Lack of Experience or Training

Forceps delivery requires specialized training and regular practice to maintain proficiency. Physicians who lack adequate experience with forceps or who attempt the procedure without proper supervision when they are still learning the technique may commit malpractice if their inexperience leads to injury.

Hospitals have a responsibility to credential physicians appropriately and ensure that only qualified practitioners perform complex procedures like forceps deliveries. When hospitals allow inadequately trained physicians to use forceps without supervision, both the physician and the institution may bear liability for resulting harm.

Failure to Switch to C-Section

When a forceps delivery is not progressing or when the baby shows worsening distress despite assistance, the standard of care requires switching to an emergency cesarean section. Delayed C-section after a failed forceps attempt represents a common form of birth injury malpractice.

Physicians who persist with forceps despite clear signs that the approach is not working—such as lack of descent after several pulls, worsening fetal heart rate patterns, or obvious malpositioning of the instruments—may be held liable for injuries that result from the delay in performing a necessary cesarean delivery.

A birth injury attorney can review your delivery records to determine whether your physician’s decision-making during forceps use met the applicable standard of care. Contact a qualified lawyer for a free case evaluation if you have concerns about your child’s forceps delivery.

Improper Instrument Placement

Correct positioning of forceps blades is absolutely necessary to avoid injury. The instruments must be placed symmetrically on either side of the baby’s head, along the sides rather than pressing on the face or applying pressure to the fontanelles (soft spots). Improperly applied forceps can directly damage the skull, facial structures, or eyes.

Physicians must also ensure proper locking of the forceps handles before applying traction. Instruments that slip during pulling can cause severe lacerations and uneven pressure distribution that leads to skull fractures.

Warning Signs After a Forceps Delivery

Parents should watch for specific signs that may indicate their newborn has sustained a forceps injury. While some degree of bruising and molding of the head is normal after forceps delivery, certain symptoms warrant immediate medical attention.

Visible marks from the forceps typically appear as bruises or indentations on both sides of the baby’s head where the instruments were placed. While superficial marks usually fade within days, deep indentations or areas where the skull feels soft or irregular may indicate a fracture requiring imaging and treatment.

Neonatal seizures represent a medical emergency and often signal brain injury. Seizures in newborns may appear different from those in older children and adults. Warning signs include repetitive movements, stiffening of the body, unusual eye movements, changes in breathing patterns, or periods of unresponsiveness. Any seizure activity after a forceps delivery requires immediate evaluation and treatment.

Difficulty breathing, weak or absent crying, or poor muscle tone may indicate serious neurological injury or spinal cord damage. Babies who require extensive resuscitation after forceps delivery or who need ventilator support in the hours following birth should be carefully evaluated for brain and spinal cord injuries.

Unequal facial movement, particularly noticeable when the baby cries, suggests facial nerve injury. While many cases resolve spontaneously, severe or persistent facial weakness requires specialized evaluation and may indicate more extensive nerve damage.

Swelling of the scalp that continues to increase after delivery, particularly a soft, fluid-filled swelling that crosses the skull bones, may indicate subgaleal hemorrhage. This condition represents a medical emergency requiring immediate intervention to prevent life-threatening blood loss and shock.

Diagnosis and Treatment of Forceps Injuries

Prompt diagnosis of forceps injuries allows for early intervention that may improve outcomes. Healthcare providers should maintain a high level of suspicion for injuries when forceps have been used, particularly if the delivery was difficult or required multiple attempts.

Diagnostic Imaging

Skull X-rays can identify fractures and help determine their severity. Computed tomography (CT) scans provide detailed images of the skull and brain, revealing bleeding, swelling, and structural damage. Magnetic resonance imaging (MRI) offers superior visualization of brain tissue and may be used to assess the extent of brain injury, particularly when HIE is suspected.

Ultrasound examinations of the brain can be performed at the bedside in the neonatal intensive care unit, making them useful for screening and serial monitoring of bleeding or swelling. However, ultrasound provides less detailed information than CT or MRI scans.

Neurological Evaluation

A pediatric neurologist should evaluate newborns who show signs of brain or nerve injury after forceps delivery. This evaluation includes assessment of muscle tone, reflexes, alertness, and ability to move all extremities normally. Electroencephalography (EEG) monitoring may be used to detect seizure activity, including subclinical seizures that are not visible externally.

For babies with suspected facial nerve palsy, ophthalmologic examination ensures that the eye on the affected side is protected and receives adequate lubrication, as the inability to close the eyelid completely can lead to corneal damage.

Treatment Approaches

Treatment depends on the specific injury. Minor skull fractures without associated brain injury typically heal on their own with careful monitoring. Depressed skull fractures may require surgical elevation if the depression is significant or if bone fragments press on the brain.

Intracranial hemorrhages require intensive monitoring and supportive care. Some bleeds resolve spontaneously as the body reabsorbs the blood, while others require surgical intervention to remove blood clots or relieve pressure on the brain. Babies with significant bleeding often need neonatal intensive care unit admission for close observation and management of complications like seizures or increased intracranial pressure.

Therapeutic hypothermia—cooling treatment administered within six hours of birth—represents the standard of care for moderate to severe HIE. When forceps delivery is prolonged and results in oxygen deprivation, prompt initiation of cooling therapy may reduce the severity of brain damage and improve long-term outcomes.

Facial nerve palsy treatment typically involves protecting the eye on the affected side with artificial tears and sometimes taping the eyelid closed during sleep. Physical therapy and massage may help maintain muscle tone during recovery. Most cases improve within three to six months, though severe injuries may require surgical intervention.

Ongoing developmental monitoring is necessary for all children who sustained forceps injuries, as some effects may not become apparent until the child misses developmental milestones or begins school. Early intervention services, including physical therapy, occupational therapy, and speech therapy, can significantly improve outcomes for children with lasting impairments.

Long-Term Effects and Prognosis

The long-term outlook after a forceps injury depends on the type and severity of damage sustained. Minor injuries like superficial bruising and small cephalohematomas (blood collections between the skull and its outer covering) typically resolve completely without lasting effects.

Moderate injuries such as facial nerve palsy and minor skull fractures usually heal within weeks to months. Most children with these injuries recover fully and do not experience developmental delays or ongoing problems.

Severe injuries including skull fractures with brain damage, significant intracranial hemorrhage, and HIE can cause permanent disabilities. These may include cerebral palsy, intellectual disabilities, epilepsy, vision or hearing impairments, and behavioral or learning difficulties that become apparent as the child grows.

Children who experienced oxygen deprivation during prolonged forceps attempts may develop spastic cerebral palsy, the most common type, which affects muscle tone and movement. The severity ranges from mild, affecting only fine motor skills, to severe, requiring full-time mobility assistance and personal care.

Cognitive impairments from forceps-related brain damage vary widely. Some children have normal intelligence with specific learning disabilities, while others experience global developmental delays affecting all areas of cognition, communication, and adaptive functioning.

The financial impact of severe forceps injuries extends throughout the child’s lifetime. Families face costs for ongoing medical care, therapies, medications, adaptive equipment, special education services, and home modifications. Many parents must reduce work hours or leave their careers entirely to provide necessary care, further straining family finances.

If medical negligence caused your child’s forceps injury, a birth injury lawsuit may provide compensation for these extensive damages. An experienced attorney can help your family pursue the financial resources needed for your child’s care.

Filing a Forceps Injury Lawsuit

When medical malpractice causes forceps delivery injuries, families have the right to seek compensation through a birth injury lawsuit. Understanding the legal process helps families make informed decisions about pursuing a claim.

Determining If You Have a Case

Not every bad outcome constitutes malpractice. To have a valid forceps injury claim, several elements must be present. First, the healthcare provider must have owed you a duty of care, which exists whenever a physician-patient relationship is established. Second, the provider must have breached the standard of care—meaning their actions fell below what a reasonably competent physician would have done in similar circumstances.

Third, this breach must have directly caused your child’s injuries. Even if errors occurred, you do not have a malpractice case unless those errors actually caused harm. Finally, your child must have suffered damages—physical injuries, pain, disability, or medical expenses resulting from the malpractice.

Birth injury lawyers typically work with medical experts who review delivery records to determine whether the standard of care was met. These experts can identify whether forceps use was appropriate, whether proper technique was followed, and whether a reasonable physician would have abandoned the forceps attempt sooner or chosen a different approach entirely.

Statute of Limitations Considerations

Every state imposes time limits on filing medical malpractice lawsuits. These statute of limitations deadlines vary by jurisdiction but typically range from two to six years. Many states have special rules for birth injuries that extend the deadline, often allowing claims to be filed until the child reaches a certain age, such as their eighth or tenth birthday.

However, waiting until just before the deadline creates risks. Medical records may become harder to obtain, witnesses’ memories fade, and expert witnesses may need substantial time to review complex cases. Consulting a birth injury attorney as soon as you suspect malpractice allows adequate time for thorough investigation and preparation.

The Legal Process

Birth injury litigation typically begins with a free consultation, during which an attorney reviews your case basics and determines whether investigation is warranted. If the attorney believes you have a potential claim, they will obtain your medical records and have them reviewed by qualified medical experts.

If expert review confirms that malpractice likely occurred, your attorney files a complaint initiating the lawsuit. The discovery phase follows, during which both sides exchange information, take depositions, and gather evidence. This phase often takes a year or more in complex birth injury cases.

Many forceps injury cases settle during or after discovery once the strength of the evidence becomes clear. Settlement negotiations may result in compensation without the need for trial. If settlement cannot be reached, the case proceeds to trial, where a jury decides whether malpractice occurred and what damages should be awarded.

Most birth injury attorneys work on contingency, meaning they charge no upfront fees and only receive payment if they secure compensation for your family through settlement or verdict. This arrangement allows families to pursue justice regardless of their financial situation.

Potential Compensation

Damages in forceps injury cases typically include economic and non-economic categories. Economic damages cover measurable financial losses such as past and future medical expenses, therapy costs, special education needs, assistive devices, home modifications, and lost parental income when a parent must leave work to provide care.

Non-economic damages compensate for intangible losses including the child’s pain and suffering, reduced quality of life, loss of enjoyment of life’s activities, and emotional distress. Some states cap non-economic damages in medical malpractice cases, limiting the total compensation available.

In cases involving particularly egregious conduct, such as a physician continuing forceps attempts while ignoring obvious signs of fetal distress, punitive damages may be available in some jurisdictions. These damages aim to punish the wrongdoer and deter similar conduct by others.

The specific value of a forceps injury case depends on numerous factors including the severity of injury, the strength of evidence showing malpractice, the child’s prognosis and life care needs, and the jurisdiction where the case is filed. A birth injury attorney can provide a more specific evaluation after reviewing your particular circumstances.

Choosing a Birth Injury Attorney

Selecting the right legal representation significantly impacts your case outcome. Birth injury litigation involves complex medical and legal issues that require specialized knowledge and experience.

Experience with Forceps Injury Cases

Look for attorneys who have successfully handled birth injury cases, particularly those involving forceps and vacuum injuries. Ask about their case results and whether they have taken cases to trial, not just settled them. While many cases settle, you want an attorney willing and able to try your case if necessary.

Resources to Handle Complex Litigation

Birth injury lawsuits require substantial financial resources for expert witnesses, medical record review, demonstrative exhibits, and depositions. Top birth injury law firms invest hundreds of thousands of dollars in major cases. Ensure your attorney has the resources to fully investigate and litigate your claim.

Compassionate Communication

You need an attorney who understands the emotional weight of your situation and communicates with compassion and clarity. During your initial consultation, assess whether the attorney listens carefully, explains legal concepts in understandable terms, and treats your family with respect and empathy.

Track Record and Reputation

Research the attorney’s reputation through client reviews, peer ratings, and professional recognition. Membership in organizations like the American Association for Justice Birth Trauma Litigation Group suggests specialized focus on birth injury cases.

Most importantly, trust your instincts. Choose an attorney you feel comfortable with and confident in, as you will work together closely throughout your case.

Your family deserves answers about what happened during your child’s birth and access to the resources needed for their care. Contact an experienced birth injury lawyer today to explore your legal options through a free, confidential consultation.

Frequently Asked Questions About Forceps Delivery Injuries