Declining forceps use in “era of mediocrity”


I appreciated Dr. Robert L. Barbieri’s thoughtful editorial in the September issue (“It’s time to target a new cesarean delivery rate”). A primary C-section rate of 15% to 17% with excellent fetal and maternal outcomes is very achievable, but only by obstetricians skilled in the safe and judicious use of forceps, including rotation procedures. These skills are rapidly disappearing, with their demise accelerated by a lack of skilled instructors in training programs, fear of litigation among operators uncertain of their competency, and misconceptions among patients and their families regarding the use and safety of forceps.

The best we can do with oxytocin, vacuum assistance (in the United States), ordinary delivery skills, and watchful waiting is a 25% to 35% primary C-section rate—but perhaps that is good enough in this era of managed care and mediocrity.

Donald J. Moore, MD
San Diego, Calif

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