Cerebral palsy is a lifelong condition that affects movement, muscle tone, and posture. It is caused by damage to a developing brain, usually before birth, during labor and delivery, or in the first years of life. The question many parents ask is whether the use of forceps during delivery can play a role in that brain damage.
The short answer is that forceps themselves do not always cause cerebral palsy, but improper or unsafe use of forceps can contribute to the kind of brain injury that may lead to cerebral palsy in some cases. Most forceps deliveries are performed safely. Problems usually arise when the instrument is used incorrectly, used when it is not appropriate, or when warning signs of distress are missed.
To understand the link, it helps to know how cerebral palsy develops. According to medical and legal resources like Cerebral Palsy Guide and the Centers for Disease Control and Prevention, cerebral palsy is usually the result of one of the following types of brain damage: lack of oxygen or blood flow to the baby’s brain, bleeding in or around the brain, infections, or direct trauma to the brain.[5][3] Lack of oxygen (sometimes called birth asphyxia or hypoxia) and brain bleeding are particularly important when we talk about forceps use.
Forceps are metal instruments shaped somewhat like large spoons or tongs. They are used to carefully grasp the baby’s head and assist in guiding the baby out of the birth canal during a vaginal birth. They may be considered when the baby is low in the pelvis but is not moving down despite pushing, when the fetal heart rate suggests the baby may be in trouble and birth needs to happen quickly, or when the mother is too exhausted or has medical conditions that make prolonged pushing risky.[1] Used correctly by a trained clinician, forceps can speed up delivery, which may actually reduce the time a baby spends in a low oxygen state.[2] In this way, an appropriate, skilled forceps delivery can sometimes lower the risk of serious oxygen deprivation.
However, forceps are powerful tools and can cause injury when used in the wrong way or in the wrong situation. Organizations that review birth injuries note that possible baby complications from forceps deliveries include skull fractures, bleeding inside the skull, and restricted oxygen that may cause long term brain damage or cerebral palsy.[1][6] For example, if the blades are placed incorrectly, if too much traction is used, or if repeated attempts are made when the baby is too high or in an unsuitable position, the baby’s skull and brain can be harmed.[6] Bleeding inside the skull, called intracranial hemorrhage, can damage brain tissue and may later be associated with cerebral palsy.[1][6]
Some birth injury and cerebral palsy resources also list improper use of forceps as a specific risk factor for cerebral palsy. Triumph Therapeutics notes that misuse of birth assisted tools during labor, such as forceps, is one of several events that can increase the chance of brain damage leading to cerebral palsy.[4] Legal and medical-legal sites, such as Sokolove Law and similar cerebral palsy law resources, state that misuse of delivery room instruments like forceps and vacuum extractors can cause skull fractures, severe head swelling, or brain bleeding, which in turn may result in cerebral palsy.[5][8][9] These sources focus heavily on preventable injuries and medical negligence, but they reflect a real concern: when forceps are not used according to accepted standards, the risk of permanent brain injury rises.
Forceps related cerebral palsy often involves more than just the instrument itself. It may be part of a chain of events, such as prolonged or obstructed labor, fetal distress, and delays in changing the delivery plan. Prolonged labor, for example, is a known risk factor for complications like hypoxic ischemic encephalopathy (HIE), a type of brain injury from lack of oxygen and blood flow that can lead to cerebral palsy.[7] If a baby is already in distress from a long, difficult labor and then is also exposed to rough or repeated forceps attempts, the combination of ongoing oxygen shortage and physical trauma can greatly increase the chance of brain damage.
Many guidelines about safe forceps use stress that the baby’s position and station in the pelvis must be checked and that forceps should not be used when the baby is too high or facing the wrong way.[6] If the delivery is not progressing safely with forceps, the clinician should stop and move to a cesarean section. Continuing with repeated, forceful attempts can cause avoidable injuries, such as excessive traction on the head, twisting of the neck, and further compression of the skull.[6] These errors may worsen bleeding in the brain or prolong the time the baby spends in a poorly oxygenated state.
At the same time, research comparing different delivery methods suggests that, when performed properly, forceps deliveries can have neonatal outcomes similar to vacuum extraction or cesarean section in many cases. A retrospective study comparing forceps, vacuum, and cesarean for certain complicated second stage labors found that neonatal outcomes were broadly comparable across the three groups, while tradeoffs appeared mostly in maternal outcomes and specific types of injury.[2] This supports the idea that it is not the mere presence of forceps that determines risk, but how and when they are used.
Cerebral palsy is often multi factorial. That means several risk factors can act together. Prematurity, very low birth weight, maternal infections, placental problems, and severe jaundice are all known contributors.[3][4][5] In some children with cerebral palsy, there is no history of forceps use at all. In others, forceps were used correctly to shorten a dangerous labor and may have helped prevent worse damage. In a smaller subset, there is evidence that incorrect or aggressive use of forceps directly contributed to brain injury.
Medical legal organizations that help families investigate cerebral palsy cases often look closely at how delivery tools were used. They examine whether fetal heart rate patterns showing distress were recognized in time, whether the baby’s position was correctly assessed before deciding on forceps, and whether the clinician stopped and switched to a cesarean when a forceps delivery was clearly not working.[6][8][9] If there is evidence of skull fractures, brain bleeding, or clear signs of oxygen deprivation after a difficult forceps delivery, and records show that standards of care were not followed, they may argue that the misuse of forceps played a significant role in causing the cerebral palsy.[5][6][8]
From a parent’s point of view, it is usually impossible to know right away whether a forceps delivery caused a particular child’s cerebral palsy. Cerebral palsy is typically diagnosed later, when developmental delays and movement problems become clearer. If parents have concerns about how the birth was managed, they often start by reviewing medical records with a pediatric neurologist or another independent specialist. In cases where questions remain, some families choose to speak with a birth injury attorney or advocacy organization that has experience reviewing forceps related injuries and cerebral palsy.[5][6][8][9]
It is important to remember that many forceps deliveries are safe and even life saving. When used by well trained clinicians who follow proper guidelines
