Conference 2017 Anterior non-episiotomy or natural forceps delivery: refining the technique and improving communication as a way of reducing obstetric anal sphincter injuries in instrumental deliveries
Despite the liberal use of episiotomy, instrumental delivery is associated with an increased risk of obstetric anal sphincter injuries (OASIS). Traditionally, lists of the risk factors linked to OASIS have ignored the human factor. The anterior non-episiotomy forceps (ANEF) or natural forceps delivery significantly reduces the rate of OASIS, and indeed, perineal trauma, by refining the human factor and improving the operator’s practice. Furthermore, it is associated with improved maternal recovery because it minimizes the need for episiotomy, and therefore, peripartum blood loss. After implementing ANEF in a series of 360 consecutive Neville–Barnes forceps deliveries in primiparae, the rate of OASIS was 1.9%, compared to the reported prevalence of 8.9% in traditional forceps deliveries with routine episiotomy. Enhanced recovery pathways (ERPs) are increasingly being implemented across surgical specialties to reduce the impact of operative procedures and improve patient experience. Part of the authors’ ongoing work to reduce the rate of perineal injury and OASIS, this article describes the ANEF delivery, which should become part of the ERPs in obstetrics.
Keywords: anterior non-episiotomy forceps, instrumental deliveries, natural forceps, OASIS, obstetric anal sphincter injuries.