There was a time when the Obstetric Forceps was a closely
guarded family secret that was kept from others for three generations by the
inventor. Fortunately it was opened up, and then there was a progress at a such
a pace that it was mind boggling. The training of a resident doctor used to
include use of Obstetric forceps applications, and we used to feel proud after
teaching undergraduate students obstetric forceps in detail as much as after
application of obstetric forceps to a fetus without producing a single mark on
its head and without lacerating the mothers birth passage even a single bit.
Years passed, when the art of teaching juniors was taken over by our juniors
while we got busy with more advanced training. My first inkling of something
being amiss was when I found a forceps mark on a baby’s head. I have written
about that before. They did not read that blog before coming for the interview
today, I guess.
It was an interview for selection of new Assistant
Professors. Most of the candidates were young, recently qualified doctors.
“How many cesarean sections have you performed so far?” O
asked one candidate.
“One fifty” she said.
“How many times have you applied obstetric forceps?”
“Fifteen.”
“Your cesarean section to obstetric forceps ratio is 10:1” I
said surprised. “Is that not odd?”
“…….” Probably she did not find odd at all.
“Please tell me the axis of correct cephalic application of
obstetric forceps” I said.
“The head should be …”
“No. Just the axis” I said.
“It is over the parietal bones” she said. So it looked like the
blades could be applied almost all over the fetal skull. I gave up. She went
away.
“She is a very good candidate” the expert from her institute
said. That did not speak very highly of the other candidates, considering this
candidate as a yard stick. Some time passed, a few more candidates came and
went away. Then I asked another candidate about obstetric forceps and vacuum
extraction.
“If you have to deliver a fetus with acute fetal distress at
station +2 and occiput at 3 o’clock position, what will you do? Obstetric
forceps, vacuum extraction …?”
“I will use obstetric forceps. Vacuum can slip.”
I was aghast. This meant obstetric forceps rotation, which
is practically given up as a dangerous procedure in most centers. “Which
forceps will you use? I asked.
“Wrigley’s forceps” she answered promptly. I was aghast
again. I could not understand how she could use such short forceps for a
rotation operation.
“That is for outlet operations” I said.
“OK. I will use longer forceps.”
“Which one? Kielland’s” I asked, terribly afraid that she
would say yes.
“No” she said. “I will use Simpson’s forceps.”
“How will you rotate the head?” I asked.
She made a movement like moving a key in a lock. So she
killed the baby and opened up the patient’s bladder and rectum at one go. I was
sort of numb by this time and could not get aghast again. I let her go away
before she could traumatize the woman, her fetus, and me any more.
“She is a very good candidate” said the same professor who
had praised the other candidate some time ago. My physiological state prevented
me from getting aghast, even if the causative agent was different.
