YOUR HEALTH - MEDICINE 101

FORCEPS
So, you think you’re pretty smart.

Well, like a lot of folks, you may be too smart for your own good – especially if you are a baby.

As a species we humans are quite smart – in fact we’ve got so much brain we have, in evolutionary terms, had quite a bit of difficulty trying to fit it all into our brain. We humans excel in the part of the brain called the cortex. It is the "so called" higher part of the brain, the part that does the thinking, the reasoning, the calculating, and the imagining. The word cortex means bark and just like this piece of bark we’ve got so much cortex it has to be folded in on itself to fit within our skull.

Cortex is wonderful if you’re an Einstein or Beethoven but it is not so great if you’re a newborn. You see, the more cortex you have the bigger your head is and, for a newborn, having a huge head increases the chances that you will have difficulty when you deliver.

Here is a plastic model of an infant’s skull. Notice how the skull is not made of one single piece of bone, but rather it consists of plates or sheets of bone, which are joined together or fused. In fact there are a couple of areas where they don’t touch at all, the "so called" soft spot on the baby’s scalp. No matter how you slice it, on your birthday this skull, with its precious cargo of brain, has to travel down through the mother’s pelvis and out into this shining world.

As a species, human’s aren’t that good at delivery. Without any help at all 90 percent of women deliver their babies without any problems – but in ten percent of cases something goes wrong. One of the commonest problems is called disproportion, a fancy way of saying that this baby’s head is too big for this mother’s pelvis., Now, in labour, there is some “give” to the mother’s pelvis – the ligaments loosen so the pelvis actually becomes a little wider. There is also some “give” in the infant’s skull – these plates or sheets of bone can be compressed a little to make the whole package smaller - but in the situation of disproportion, the infant simply gets stuck. It’s a mechanical problem, which can have disastrous consequences.

Faced with this “obstructive labour” as it is called there are two things that we can do.

The first thing is that we can try to grasp the infant’s head and help it descend into the pelvis and out into the outside world. We could use forceps. The word forceps comes from the Latin for tong or grasper and these instruments are spectacularly suited for grasping the infant’s head without putting pressure on the precious brain within. Forceps were invented in the 17th century and their design has changed little since that time. There are two forceps and they fit together and when properly applied they grasp the infant by the stronger bones of cheek and jaw protecting the skull.

There is another way to help deliver the infant, and that is to apply suction to the infant’s scalp. The instrument is called a vacuum extractor. The soft plastic cup is applied to the infants scalp and then suction is applied to make the plastic cap stick well so that the obstetrician can help pull the infant out, again without damaging that precious cortex. It’s an amazingly simple mechanism, which is often very helpful.

There is one other option of course and that is that we can perform a caesarian section, an operation to deliver the baby by opening the uterus in the mother’s abdomen. It is called caesarian section because Julius Caesar, the first emperor of Rome was supposedly delivered by this dramatic method. In Canada today, about 15 percent of babies are born by caesarian section.