Forceps may be safer than Caesareans in difficult deliveries, suggests birth study

The rapid rise in the popularity of Caesarean births is being challenged today by research that suggests the use of forceps may be safer in difficult deliveries.

A study of almost 400 women with obstructed labour – where the baby becomes stuck in the womb – has found that women who had Caesarean sections were twice as likely to have serious bleeding as those who had forceps used in delivery.

Babies born by Caesarean also ran double the risk of requiring treatment in an intensive care unit.

The finding, published in The Lancet, comes less than a fortnight before the Royal College of Obstetricians and Gynaecologists is due to publish a major survey of the use of Caesareans in the UK. The survey is expected to show that Caesareans now account for more than one in five of all births, and that they have more than doubled since 1980.

The rise in Caesareans has prompted widespread concern that normal childbirth is in decline and the method is being chosen by obstetricians and women for convenience rather than for its medical benefits.

Allegations that celebrities, such as Victoria Beckham and Patsy Kensit, were "too posh to push" prompted the Royal College of Midwives to call at its annual conference last May for women to be helped to understand the role of pain in labour and the proper use of pain relief.

Deidre Murphy and colleagues from St Michael's Hospital, Bristol, who conducted The Lancet study, said that babies delivered by forceps were more likely to have bruising, lacerations, nerve injuries and rarely, cerebral bleeding.

Despite this they conclude that unless there is clear evidence that the baby will not fit through the cervix – because its head is too large or in the wrong position, for example – they favour forceps delivery over Caesarean. "Our findings support the use of safe vaginal instrumental delivery for the management of arrested progress," they said.

The study also found that the most experienced obstetricians had the best results. "These deliveries should be done in theatre by skilled obstetricians," the authors wrote. "Women ... were less likely to proceed to Caesarean section or to have a major haemorrhage if they were managed by a senior operator."