Midwifery Instruments: Where One Size Doesn't Fit All

When it comes to choosing midwifery instruments there is never a one-size-fits-all option. Quite often there is a lot of confusion around surgical instruments that are commonly referred to by different names. Let us clear up some of the most common misconceptions about instruments and provide an easy guide to choosing the right instruments for your purposes.

Instruments differ in two significant ways: quality and style. Two major things to consider when making a decision are: how frequently do you plan to use each instrument, and what is your budget? Below we have broken down the three major categories to consider when correctly choosing your next instruments.


Instructors often have personalized preferences when teaching midwives and others skill sets that require surgical instruments. From suturing and cord clamping to episiotomies and other gynecological procedures, each instructor is likely to have a specific type and size of instrument that they will recommend. In most cases these general recommendations work well, but there are exceptions.

One example of an exception to the general rule is the 6.25” Mayo-Hegar Needle Holder. This is great for the average size female hand, but women with larger hands may find the length too short for their grip. Likewise, those with smaller than average hands may find the length too long, and in both cases you may prefer going with a smaller or longer needle holder for personal comfort.

Another important option to keep in mind is for those who are left handed. Where available, we offer Quick-Release instruments that are designed specifically for left-hand users including Quick-Release Carb-N-Sert Mayo Hegar Needle Holders and Quick-Release Carb-N-Sert Crile Wood Needle Holders. Like anything, it will always be easier to perform when using an instrument designed for your prominent hand.

When it comes to size, the bottom line is that personal preferences should also be taken into account when ordering instruments. This leads us to the next category to consider when training versus practicing: Brand Quality.


Keeping it simple and affordable: Floor-Grade

Vantage is the most affordable brand we supply and although it doesn’t offer longevity and high quality, it does have many uses. Vantage instruments are a great choice for training or when trying out a new instrument style. These quality floor-grade instruments are also a good choice when purchasing seldomly used instruments or when you need a back-up set of commonly used instruments.

Vantage floor-grade quality brand of instruments are made in Pakistan, as are virtually all floor-grade surgical instruments. However, not all instruments are made equal. A lot of less expensive floor-grade instruments are made of chrome and are offer poor quality. Vantage instruments are made of Japanese stainless steel and the factory where they are made produces high quality floor-grade instruments. When properly cleaned and sterilized, Vantage instruments will provide a reasonable amount of service; however, they are not designed for long term use. It is also important to note that the blades on floor-grade scissors are not as sharp as higher quality brands and tend to dull quickly; the locking mechanisms are not as smooth; and the blades on needle holders do not hold as securely as higher-grade brands. 

Good quality at a reasonable price: Mid-Grade

When you’re ready to invest in a higher quality brand, you have two great choices that offer German-made instruments with strong German stainless steel: Konig and Miltex. Konig is our generic line of mid-grade German quality instruments and is a good brand for those looking for high-quality at a reasonable price. All Konig instruments are manufactured in Germany and made of German stainless steel. The scissor blades are sharp and the forceps’ locks are very smooth. The blade clearances – also known as the gaps between blades - are minimal, which is especially important for needle holders. With proper care, Konig instruments will last you for many years. We have sold Konig at Cascade for 20 years without any significant customer complaints.

The top brand: High-Grade

For those wanting to invest in a high-quality brand of instruments, Miltex is the top of the line for high-grade, German made stainless steel instruments. We have carried Miltex for 33 years without any negative feedback. The quality of Miltex instruments is superb and guaranteed to be free from material defects. Miltex backs all of their products with a lifetime guarantee that ensures instruments are free from manufacturing or material defects for as long as it is being used by the purchaser. Although more expensive than other brands, Miltex is the ideal choice for practitioners who will be using their instruments frequently because they are designed to withstand repetitive cleaning and sterilization. Where cost is not an issue, you can’t go wrong with Miltex.

When strength meets quality: Premium-Grade

A relatively new development in the world of surgical instruments are premium-grade Carb-N-Sert German stainless steel instruments with Tungsten Carbide blades. The Carb-N-Sert type of instrument is offered by Miltex and Konig and includes scissors, needle holders and dressing forceps.

Why are Carb-N-Sert instruments unique? Well firstly they have easily identifiable gold-plated ring handles. In terms of quality, the scissors offer precision-cutting performance and the durability of Tungsten Carbide cutting edges which maintain their sharpness much longer than standard stainless steel instruments. The needle holder and forceps have replaceable Tungsten Carbide jaw inserts in the tips to ensure optimum grip on sutures and needles, as well as long-lasting performance against wear.

As you can see, the main difference between the high-grade Miltex instruments and the Carb-N-Sert premium-grade instruments is the increased strength, durability and longevity of blades and teeth. Speaking of teeth, our next category covers some commonly made mistakes when it comes to identifying obstetrical instruments that are regularly used in midwifery.


Within the world of midwifery there are some commonly misidentified instruments. Worst of all is the instruments most often misidentified are also the most commonly used, which can be very confusing for student and seasoned midwives alike.

The ‘Correct’ Cord Clamping Forceps

Case in point, Kelly Forceps. These are very useful little forceps but because they have small blades they are not good for cord clamping. Somewhere along the line the term ‘Kelly’ has incorrectly become known as the ideal forceps used to clamp umbilical cords. There are many forceps with blades big enough for cord clamping but the one most commonly used are the Rochester Pean 6.25” Forceps.

“Tissue Forceps Without Teeth”

Another misused phrase for instruments that a lot of midwifery students have struggled with is "tissue forceps without teeth". All tissue forceps have teeth. If someone mentions ‘tissue forceps without teeth’ what they are referring to are Dressing Forceps. Dressing forceps have serrated tips and are sometimes referred to as “pick-ups”.

The most important thing to remember when confused about any aspect of instrument selection, is that we are always here to help. Having supplied instruments for over 30 years, we are well-versed on all of the instruments and brands that we carry and can assist you with every step of the selection process.

We have also assembled two bestselling Suturing Kits that contain the instruments most commonly used by midwives for perineal repair. The Basic Suturing Kit is ideal for midwives with an existing collection of instruments and the Deluxe Suturing Kit is more comprehensive for midwives, especially new midwives, who don't already have a thorough selection of instruments. See below for links to our full selection of Instruments, Instrument Care products and Sterilization products.

Written By: Samantha Darling for Cascade HealthCare Products



Surgical Instruments: www.1cascade.com/miltex-konig-vantage-carb-n-sert-surgical-instruments

Midwifery Suturing Kits: www.1cascade.com/suturing-kit-miltex-konig-vantage-instruments

Autoclaves and Sterilizers: www.1cascade.com/medical-and-hospital-autoclaves-and-sterilizers

Instrument Sterilization: www.1cascade.com/surgical-instrument-sterilization-products

Instrument Care: www.1cascade.com/miltex-instrument-care-products

Instrument Disinfectants and Lubricants: www.1cascade.com/surgical-instrument-disinfectant-lubricant