Delivery with forceps cause a fractured skull, severed spine and ultimate death

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Olivia Coats story

A 5-day-old baby, Olivia Marie, from Texas died after her skull and spine were allegedly cracked with forceps during delivery.  She died after five days on life support. Now, Olivia’s parents have launched a Facebook campaign to stop the use of forceps in all births.  Allen Coats, 25, and his fiancee Rachel Melancon, 24, say they will sue their obstetrician, Dr. George T. Backardjiev, but not The Medical Center of Southeast Texas,  where their daughter was born on Dec. 28.
ABCNews.com reported on the story.  The baby’s grandmother, Angie Coats, said the parents had repeatedly asked the doctor to perform a cesarean in advance of the Christmas Day due date because of the large size of the baby, but Dr. Backardjiev refused.  “Rachel had a normal, healthy pregnancy and the day she went in to see if she could be induced, it was already after Christmas,” she told ABCNews.com. “The baby was so gigantic inside of her. She asked, ‘Can you please give me a C-section? This baby isn’t coming out of me.'”

Olivia weighed 7 pounds, 14.9 ounces and 22 inches long at birth.  Angie Coats, 43, of Bridge City, Texas, said her daughter-in-law was “itty bitty” — 4-feet-11 and 95 pounds — before she was pregnant.  “[Backardjiev] said, ‘No, you don’t want a C-section. You’ll have a scar,” said Coats, who was present at the birth. “During her delivery, the baby’s heart rate kept going up. He said, ‘One more hour, one more hour.’ Her water broke, but it was 18 hours until the delivery. [Rachel] was running a 103 fever… Five hours passed, then he came in and she started to push. But she was so worn out and the baby wasn’t even in the birth canal.” 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.”

Olivia was ultimately delivered by emergency C-section, according to the family, but they allege it was too late. “My son said, ‘I don’t think my baby is alive.’ She was not breathing and she never cried,” said Angie Coats. She said the medical staff told the family the baby was alive and would be transferred to Hermann Hospital.

But once the family arrived at Hermann, they allege that doctors told them Olivia was not breathing on her own and had suffered “numerous skull fractures.”

ABCNews.com twice called the office of Backardjiev and spoke to an assistant, asking for comment. But the obstetrician did not return calls.

The family has urged others to call for an end to forceps deliveries nationwide. So far, their Facebook page has garnered 55,000 “likes.”  ABC’s Dr. Jennifer L. Ashton, an obstetrician and gynecologist, said that a forceps delivery can be risky.

“Forceps are used less often today versus vacuum extraction, but skull fracture is a known risk of this procedure,” Ashton said. “Often times there is no other option when delivery needs to occur and even a C-section could be not an option.”

But Ashton said forceps should not be outlawed. “In the right hands they can save a baby’s life,” she said. “It takes a lot of skill and practice to perform a forceps delivery and most younger [obstetricians] have been trained in vacuum extraction.”

What are forceps and how are they used?

PR_12Obstetric forceps consist of two branches that are positioned around the fetal head. These branches are defined as left and right depending on which side of the mother’s pelvis they will be applied. The branches usually, but not always, cross at a midpoint which is called the articulation. Most forceps have a locking mechanism at the articulation, but a few have a sliding mechanism instead, allowing the two branches to slide along each other. Forceps with a fixed lock mechanism are used for deliveries where little or no rotation is required, as when the fetal head is in line with the mother’s pelvis. Forceps with a sliding lock mechanism are used for deliveries requiring more rotation.

The blade of each forceps branch is the curved portion that is used to grasp the fetal head. The forceps should surround the fetal head firmly, but not tightly. The blade characteristically has two curves, the cephalic and the pelvic curves. The cephalic curve is shaped to conform to the fetal head. The cephalic curve can be rounded or rather elongated depending on the shape of the fetal head. The pelvic curve is shaped to conform to the birth canal and helps direct the force of the traction under the pubic bone. Forceps used for rotation of the fetal head should have almost no pelvic curve.

The handles are connected to the blades by shanks of variable lengths. Forceps with longer shanks are used if rotation is being considered.

The cervix must be fully dilated and retracted and the membranes ruptured. The urinary bladder should be empty, perhaps with the use of a catheter. High forceps are never indicated in this era. Mid forceps can occasionally be indicated but require operator skill and caution. The station of the head must be at least +2 in the lower birth canal. The woman is placed on her back, usually with the aid of stirrups or assistants to support her legs. A mild local or general anesthetic is administered (unless an epidural anesthesia has been given) for adequate pain control. Ascertaining the precise position of the fetal head is paramount, and though historically was accomplished by feeling the fetal skull suture lines and fontanelles, in the modern era, confirmation with ultrasound is essentially mandatory. At this point, the two blades of the forceps are individually inserted, the posterior blade first, then locked. The position on the baby’s head is checked. The fetal head is then rotated to the occiput anterior position if it is not already in that position.

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Forceps and vacuum-assisted births are relatively rare in the United States, according to a 2006 report by the Centers for Disease Control and Prevention. That year, less than one percent of births involved forceps, and less than 4 percent involved vacuum assistance.

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