Old Habits: Should forceps be banned for all births?

I will never forget the X-rays.

The baby girl had been born only to die days later. The doctor who delivered her had twisted her head using forceps to free her from the birth canal. In his view, she would not have made it out had he not resorted to forceps. The X-rays showed a severed spine that a pediatric neurologist likened to a frayed rope, torn apart by the force of the physician using forceps. One of the central questions in the case the parents brought against the doctor was whether the forceps technique should have even been used.

That was more than 10 years ago. This past week, Allen Coats and Rachel Melancon in Texas announced plans to sue obstetrician, Dr. George T. Backardjiev, after he used forceps during the delivery of their daughter, Olivia Marie Coats, and she died five days later. Susan Donaldson James at Good Morning America reported:

Coats alleges that the baby was face up and Backardjiev tried unsuccessfully to turn her with his hands.

"When he couldn't do that, he took the small forceps to try to pull the baby out. He kept going and even put his foot up on the bed trying to pull," she said. "He was turning and twisting and she would never come out. He put the forceps one way and the other. When he touched the top and side of the skull, we heard a pop, like clay cracking in pottery and heard her skull crush."

The Coats family started a GoFundMe campaign to raise money for a new law that would ban the use of forceps in all births in Texas. They also started a Facebook page under their late daughter’s name. By Sunday, they’d raised nearly $13,000, and the Facebook likes topped 90,000. That’s more than 10,000 likes per day, more likes than the entire population of Bridge City, Texas, the city where Olivia’s parents live.

Coats and Melancon are a young couple who could have been leveled by the loss of their child. No one would blame them for curling up on their couch and just forgetting about the rest of the world for a while. But they have done something that is starting to become more common with particularly bad patient experiences in hospitals. Instead of just blaming everyone involved, they are being highly selective and using social media to build a community around their cause. As James wrote:

"We're not mad at hospital, this is not their fault. It is one man's fault," Angie Coats, the baby's grandmother told ABCNews.com. "We only want justice for Olivia; we want the person responsible, which is the doctor. We don't want the hospital being shunned. The hospital is great. The nurses were wonderful. It's not their fault."

And beyond the doctor, they are focusing their energies on forceps.

When my wife was pregnant with our first child, I asked about forceps. Our obstetrician told us that it wasn’t even an option. It was an outmoded technique that had been replaced by better learning and better tools, citing the little vacuums that are often used to pull out a baby in a tight situation as an example.

Forceps could be a stand-in for many outmoded tools and techniques still in use, especially in underserved areas like rural Texas. One of the Facebook fans for the Olivia Marie Coats campaign asked:

The question I have is, is it the equipment or the physician using the equipment. Sounds to me like he should be held accountable for his patient care. Just making sure we are blaming the right people or equipment.

I have the same types of questions. When are forceps a viable option? What should be the go-to choice in a difficult birth? Are physicians even adequately trained to use forceps anymore? I’ll explore the answers in future posts.

Have your own answers to those questions? Send them to me at askantidote [at] gmail.com or via Twitter @wheisel.

Image by Salim Fadhley via Flickr