BARTON'S FORCEPS _,

Bartons forceps
An effective aid in cesarean deliveries
The unique qualities of this classic medical instrument make it an effective, ergonomie
option for cesarean deliveries involving a high transverse position of the fetal head.

BY SARAH GLORIA OBICAN, MD; MELISSA BRUNNER, MD; AND JOHN W. LARSEN JR, MD

I
n a time when repeat cesarean deliver-
ies are becoming more frequent, it can Take-home messages
be difficult to deliver an infant when Designed for use in vaginal deliveries,
the vertex is "floating" high out of the pel- the forceps may be used in c/s when
vis. Ofien, maximal fundal pressure is not the fetal head is in the high transverse
adequate and the physician needs to use a position or for clinicians who are small
vacuum device such as the Kiwi or forceps statured or lack upper body strength.
to complete the delivery. The forceps can be used when large
Lyman G. Barton, MD, designed for- amounts of fluid are present; they don't
ceps with a hinged anterior blade for use pop off during use; and they can be ster-
in vaginal deliveries when the fetal head is ilized and reused.
arrested in the transverse position at the
pelvic inlet.''^ Although this type of op-
erative vaginal delivery is no longer part of FIGURE 1. rton's forceps
obstetric practice, we have found Barton's
forceps to be useful in delivery when the
fetal head is in the high transverse posi-
tion, which frequently is encountered dur-
ing a cesarean delivery. This is particularly
true in repeat cesarean deliveries through a
low transverse incision on a woman with a
thick abdominal wall.
First described by Megison, Barton's for-

40 CONTEMPORARYOBGYN.NET SEPTEMBER 2011

 BARTON'S FORCEPS

ceps were successfully used in 300 cesarean The anterior blade then is applied di-
deliveries without reported complications.' rectly to the correct position on the cheek
in front of the anterior ear. To achieve direct
Method access, either the operator or the assistant
The forceps have 2 fenestrated blades with inserts a finger into the upper open part of
a sliding lock. The posterior blade has a the hysterotomy, lifting gently to facilitate
deep cephalic curve and the an-
terior blade has a hinge that ex-
tends the blade from the shank Guiding the head into position
at about a 50 angle when in use
(Figure 1).
Once the hysterotomy has
been performed and the mem-
branes are ruptured, the opera-
tor confirms the transverse posi-
tion of the head. We recommend
first placing the fixed posterior
blade. This is in contrast to the
procedure described for vaginal
delivery in which the anterior
(hinged) blade is wandered into
position first.
To facilitate placement of
the posterior blade, the opera-
tor places one hand under the
head and slides the curved blade
between the operator's fingers,
moving the fetal head into posi-
tion (Figures 2 and 3).

Orienting the posterior blade relative to the fetal head

t
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BARTON'S FORCEPS
sliding the blade into place. This is easier to do if
the blade is introduced from the patient's left side so
that the shanks will lock without crossing. Once the
shanks are locked, the deeper blade in the uterus is
pulled back to the standard locked position.
At this point, the operator palpates the position of
the forceps on the head to confirm that the sagittal su-
ture is oriented transversely between the blades. Trac-
tion now is applied, without rotation, along the long
axis of the mother. Extraction of the fetus is assisted
by fundal pressure. While guiding the head out of the
incision, the vertex may be flexed by digital pressure
on the bones converging at the posterior fontanel.
Comment
Barton's forceps are useful for cesarean delivery
when the fetal head is high in a transverse position,
particularly when the operative field provides lim-
ited access to the head because of a low transverse
incision and maternal obesity.
Successful application of the blades can be ac-
complished even if large amounts of blood and
amniotic fluid are in the field. The forceps are not
subject to the "pop-off" problems that can occur
with vacuum devices. Furthermore, the forceps can
be sterilized and reused to avoid adding to the vol-
ume of medical waste.
An additional benefit of Barton's forceps is the
instrument's ability to achieve a secure grip on
the fetus by persons of short stature and minimal
muscular strength. Without a secure grasp on the
head, the small-statured physician may be required
to make a larger incision and may require use of a
step stool to gain enough mechanical advantage to
accomplish delivery. [SB
DR OBICAN is assistant professor of obstetrics and gynecology;
DR BRUNNER is a resident in obstetrics and gynecology; and DR
LARSEN IS the Oscar I. and Mildred S. Dodek Professor of Obstetrics
and Gynecology and Chair, Department of Obstetrics and Gynecology,
at George Washington University Medical Facuity Associates, Washing-
ton, DC. The authors report no conflicts of interest, real or apparent, to
disclose with regard to the content of this article.
REFERENCES
1. Bachman C. The Barton obstetric forcepsa review of its use in
fifty-five cases. Surg Gynecoi Obstet 1927;45:805-808.
2. Barton LG, Caldwell WE, Studdiford WE. The new obstetric forceps.
Am J Obstet Gynecoi. t928;15:16-26.
3. Megison, JW. Save the Barton forceps. Obstet Gynecoi. 1993;
82(2);313.
42 CONTEMPORARYOBGYN.NET SEPTEMBER 2011
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