When Gina Mathisson of Lawrenceville, Ga., was pregnant with her first child in 1985 and two weeks overdue, her doctor decided to induce labor. The physician broke her water and used forceps to assist the baby through the birth canal. "I think because he was so large for my frame – he was 8 pounds, 4 ounces – the doctor was afraid there would be too much damage from tearing," says Mathisson. "They did an episiotomy and used forceps to help ease him into the world."

Mathisson, however, suffered from excessive tearing she believes was caused by the use of forceps to aid in delivery. "I had a great deal of internal pain that I feel was due to the use of the forceps," she says. "It took me more than four weeks to recover from his birth." Even more frightening was the damage done to her baby's head. "My son's head was cone-shaped and scratched badly," Mathisson says.

When spontaneous vaginal delivery does not occur, doctors may attempt operative vaginal delivery – or instrumental delivery – using the aid of vacuum extractors or forceps to help the baby through the birth canal.

"To intervene in the natural processes of labor by applying instruments mandates a judgment that the benefits outweigh the inherent procedural risks," says Dr. Christian S. Pope, chief resident in obstetrics and gynecology at Baystate Medical Center in Springfield, Mass.

According to Dr. Pope, the general indications for operative vaginal delivery include:

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