Lack of Consent and Forceps Extraction Injuries in Three Neonates in Mali


Lack of Consent and Forceps Extraction Injuries in Three Neonates in Mali

Forceps application can cause trauma both in neonate particularly when used inappropriately and by an unskillful practitioner. Anyway, the informed consent of the parturient have to be obtained prior to its use otherwise it will be unlawful. We report the case of three babies injured during forceps delivery and whose mothers did not consented before.

Obstetric forceps are to guide fetal movement during delivery, ideally accompanied by active pushing by the mother. Application and traction differ according to the type of instrument and require extensive training and knowledge of obstetric mechanics. Certain deliveries can be difficult and require careful evaluation informed by experience. If the fetus is not progressing after three pulls, this route of delivery can be abandoned. Forceps are used in the cases of delay or maternal exhaustion in the second stage of labour, dense epidural block with diminished urge to push, rotational instrumental delivery for malpositioned fetus, suspected fetal distress The use of forceps has declined in many countries, for instance in the United States, the rates of forceps delivery have decreased despite an increase in operative deliveries. In the United Kingdom, the rates of instrumental vaginal delivery range between 10% and 15%; most obstetricians in North America have abandoned rotational instrumental delivery in favor of caesarean section. In Australia,obstetricians preferred using a vacuum extractor for rotational instrumental delivery. Injury to the pelvic floor and trauma to the baby are more common after forceps delivery. In some countries like Mali, forceps is still being used very commonly by general practitioners and obstetricians; unfortunately many of these doctors are not well trained. In some cases, forceps delivery is associated with huge traumatic injuries; however, there are very few lawsuits and some unconscious doctors continue their malpractice.

Forceps delivery is injurious for the neonate particularly when the practitioner doesn’t master it. It is both prejudicial for the mother who can lose her child but also for the neonate who can bear forever sequelae. Legal actions have to be brought against doctors who continue to use forceps without the informed consent of parturients.

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