Instrumental delivery: complex paternity and a fading art

For Sir Thomas NA Jeffcoate (1907–1992), Professor of Obstetrics and Gynaecology at the Women's Hospital, Liverpool and President of the RCOG (1969–1972), the invention of the forceps was ‘probably the most important event in the history of obstetrics’ (BMJ 1953;4843:951–5). As he also stated: ‘it was the first serious incursions of the medical profession into the realms of midwifery’ and ‘it became hated by the midwives, who did everything possible to discredit it in the eyes of parturient women’. Peter Chamberlen the Elder (1560–1631) ‘accoucheur’ to Queen Henrietta (wife of Charles 1) is believed to be the inventor of the forceps (Hibbard. Med Historian 1997;18:41-60). He went to great lengths to keep his forceps secret, bringing it to birthing-rooms in an ornate box, hidden from view, blindfolding his patients and never allowing anyone else in the room during the delivery. The Chamberlen forceps remained under the attic floorboards in the family home at Woodham Mortimer Hall until its accidental discovery in 1813. Many different types of forceps were developed over the following centuries, including those by Willam Smellie (1697–1763, UK); John R. Barton (1794–1871, USA); James Y Simpson (1811–1870, UK); Etienne Tarnier (1828–1897, France); Christian Kielland (1871–1941, Norway); and Arthur Wrigley (1904–1984, UK). In 1957, John Mann, an obstetrician in Toronto, Canada, and inventor of a joint-locking forceps (Figure 1) noted that if the teaching and general use of obstetric forceps had greatly improved in the previous 50 years, the weakest point in the teaching was ‘a failure to grasp a few of the fundamental mechanical principles involved’ (J Obstet Gynaecol Br Emp 1957;64:351–4). The paternity of the ‘ventouse’ is more complicated. John Yonge (1646–1721), a naval surgeon from Plymouth, in 1706 is believed to be the first to have used a suction devise for delivery. James Y. Simpson (1811–1870, UK) similarly developed a suction ‘air-tractor’ in 1849 but his instrument met with very little success (Chalmers. J Obstet Gynaecol Br Emp 1963;70:94–100). The modern suction metal cup ventouse was designed by the French obstetrician, Yves Couzigou (1910–1989), and was used successfully for the first time in 1946 (he patented it in 1948) but its paternity was then attributed to the Swedish obstetrician Tage Malmstrom (1911–1995) who popularised its use. Malmstrom ended the dispute by writing to Couzigou, recognising his earlier contribution (www.infobretagne.com/couzigou-yves). By the 1970s, the vacuum extractor had almost completely replaced forceps for assisted vaginal deliveries in many European countries. By the end of the 1990s, the number of ventouse deliveries surpassed the number of forceps deliveries in the USA (Ali & Norwitz. Rev Obstet Gynecol 2009;2:5–17). Used by skilled operators, both the forceps and the ventouse are safe. There are clinical situations where one instrument may be better than the other but the decision as to which instrument to use depends on the preference and experience of the individual care provider. As highlighted in a review of the trends in operative vaginal delivery in 2005–2013 in the USA (Merriam et al. BJOG 2017;124:1365–72), expertise in instrumental delivery is rapidly disappearing with the rising numbers of caesarean delivery. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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