Forceps in Childbirth - History

History

The obstetric forceps, allowing during birth, the extraction of a living child, was invented by the eldest son of the Chamberlen family of surgeons. The Chamberlens were French Huguenots from Normandy origin but working in Paris before they immigrated to England in 1569 to flee from religious violence perpetrated in France. William Chamberlen, the patriarch of the family, was most likely a surgeon; he had two sons, whom he both named Pierre, who became maverick surgeons that specialized in midwifery. William and the eldest son practiced in Southampton and then settled in London. The inventor was probably the eldest Pierre (then Peter in England), who became obstetrician-surgeon of Queen Henriette, wife of King Charles I of England and daughter of Henry IV, King of France.

He was succeeded by his nephew, Dr. Peter Chamberlen (also known as Doctor Peter, being the first to be graduated "Doctor", because barbers-surgeons were not Doctors), as royal obstetrician. The success of this dynasty of obstetricians with the Royal family and high nobles was related in part to the use of this "secret" instrument allowing release of live child in difficult cases.

In fact, the instrument was kept secret for 150 years by the Chamberlen family, although there is evidence for its presence as far back as 1634. Hughes Chamberlen, Grand nephew of Peter the eldest, tried to sell the instrument in Paris in 1670, but the demonstration he did in front of François Mauriceau, responsible for Paris Hotel-Dieu maternity, was a resounding failure which resulted in the death of mother and child. The secret may have been sold by Hughes Chamberlen to Dutch obstetricians at the start of the 18th century in Amsterdam, but there are doubts about the authenticity of what was actually provided to buyers.

The forceps were used most notably in difficult childbirths. The forceps could avoid some infant deaths when previous approaches (involving hooks and other instruments) extract them in parts. In the interest of secrecy, the forceps were carried into the birthing room in a lined box and would only be used once everyone was out of the room and the mother blindfolded.

Models derived from the Chamberlen instrument finally appeared gradually in England and Scotland in 1735. About 100 years after the invention of the forceps by Peter Chamberlen Sr. a surgeon by the name of Jean Palfyn presented his obstetric forceps to the Paris Academy of Sciences in 1723. They contained parallel blades and were called the Hands of Palfyn.

These "hands" were possibly the instruments described and used in Paris by Gregoire father and son, Dussée, and Jacques Mesnard.

In 1813, Peter Chamberlen’s midwifery tools were discovered at Woodham Mortimer Hall near Maldon (UK). In the attic of the house, the instruments were found along with gloves, old coins and trinkets. The tools discovered also contained a pair of forceps that were presumably invented by the father of Peter Chamberlen, assumed so because of the barbaric nature of the design.

The Chamberlen family's forceps were based on the idea of separating the two branches of "sugar clamp" (as those used to remove "stones" from bladder), which were put in place one after another in the birth canal. This was not possible with conventional tweezers previously tested. However, they could only succeed in maternal pelvis of normal dimensions and on fetal heads already well engaged (i.e. well lowered into maternal pelvis). Abnormalities of pelvis were much more common in the past than today, which complicated the use of Chamberlen forceps. The absence of pelvic curvature of the branches (vertical curvature to accommodate the anatomical curvature of maternal sacrum) prohibited blades from reaching upper-part of the pelvis and exercising traction in the natural axis of pelvic excavation.

In 1747, French obstetrician Andre Levret, published "Observations sur les causes et accidents de plusieurs accouchements laborieux" (Observations on the Causes and Accidents of Several difficult Deliveries), in which he described his modification of the instrument to follow the curvature of the maternal pelvis, this "pelvic curve" allowing a grip on a fetal head still high in the pelvic excavation, which could assist in more difficult cases.

This improvement was published in 1751 in England by William Smellie in the book " A Treatise on the theory and practice of midwifery." After this fundamental improvement, the forceps would become a common obstetrical instrument for more than two centuries.

The last improvement of the instrument was added in 1877 by a French obstetrician, Stephan Tarnier in "descriptions of two new forceps." This instrument featured a traction system misaligned with the instrument itself, sometimes called the "third curvature of the forceps". This particularly ingenious traction system, allowed the forceps to exercise traction on the head of the child following the axis of the maternal pelvic excavation, which had never been possible before.

Tarnier's idea was to "split" mechanically the grabbing of the fetal head (between the forceps blades) on which the operator does not intervene after their correct positioning, from a mechanical accessory set on the forceps itself, the "tractor" on which the operator exercises traction needed to pull down the fetal head in the correct axis of the pelvic excavation. Tarnier forceps (and its multiple derivatives under other names) remained the most widely used system in the world until the development of the cesarean section.

Forceps had a profound influence on obstetrics as it allowed for the speedy delivery of the baby in cases of difficult or obstructed labor. Over the course of the 19th Century, many practitioners attempted to redesign the forceps, so much so that the Royal College of Obstetrics and Gynecologists' collection has several hundred examples. In the last decades, however, with the ability to perform a cesarean section relatively safely, and the introduction of the ventouse or vacuum extractor, the use of forceps and training in the technique of its use has sharply declined.