Tools of the Trade: Vacuum-Assisted Delivery and Forceps Delivery
Some natural deliveries do not move as quickly or as smoothly as the doctor or midwife might like. In these cases, he or she may use forceps or a vacuum device to help deliver the baby. When forceps or a vacuum device are used in a vaginal delivery, it is called an operative vaginal delivery.
How a vacuum-assisted delivery works
In a vacuum-assisted delivery, the device is intended to be used when the mother has a contraction. The physician or midwife usually uses a vacuum while the mother in pushing. It is also used in situations where the mother has a health condition that may make pushing dangerous for her, such as a heart condition.1 The suction cup of the vacuum is applied to baby’s head by the physician or midwife. The tubing is handed to an assistant.
The assistant connects the tubing to a hand-held device that is used to apply suction to the head. The suction cup remains on baby’s head, but suction should only be applied when the mother is pushing. As she pushes, the assistant uses the device to create suction. The physician or midwife pulls on the suction cup, provides traction to help the mother push baby’s head out. The main reason that a vacuum is used is to help the mother with the delivery of her baby’s head in situations where the second stage of labor has lasted longer than usual (second stage of labor is pushing).2 Compared to forceps, the suction cup used with a vacuum extractor is easier to apply to baby’s head, and it does not wrap around the head like forceps do.
If it is the mother’s first baby, the second stage of labor may last up to 3 hours if she has an epidural. After 3 hours, it is considered to be longer than normal. If she does not have an epidural, pushing for longer than 2 hours is considered to be longer than normal. If it isn’t Mom’s first baby, pushing longer than 2 hours with an epidural in place is considered to be longer than normal. If she doesn’t have an epidural, pushing for longer than 1 hour is considered to be longer than normal.2
It may also be used if the baby’s fetal heart rate pattern shows that baby needs to be delivered as quickly as possible, and baby’s head is low enough to safely use a vacuum device. If baby’s head is not low enough, a cesarean section should be performed.
A vacuum should not be used on babies unless the mother is in her 34th week of pregnancy or more.2
Risks associated with vacuum-assisted deliveries
As with all things, there are some risks associated with these devices. The mother may need for an episiotomy if more room is needed to help deliver the baby. She may also sustain lacerations to her vagina, cervix, and rectum as a result.
The risks to the baby are more serious. The type of injury, and how severe the injury is, usually depends upon how much suction applied to the head, where the suction cup is placed on baby’s head, and how low baby’s head. The higher the baby’s head, the higher the risk for injury. Those injuries can include:
- Cephalohematoma, or blood under the scalp
- Subgalel hemorrhage, or between the scalp and the skull
- Retinal hemorrhage, or bleeding blood vessels in the baby’s retinas
- Jaundice as a result of the hemorrhage
- Shoulder Dystocia caused by traction applied in a direction that may cause a shoulder to become stuck
- Fracture of the baby’s collarbone
- Fracture of the baby’s skull
- Lacerations on the baby’s scalp
- Intracranial hemorrhage, or bleeding in the brain of the baby
How forceps work
Forceps are sometimes used to help delivery baby. Your physician or midwife can rotate baby’s head with forceps. This should not be attempted with a vacuum device. Some forceps are small enough to be used when baby is premature, but should not be used to deliver a baby that is in the breech position.1
Risks associated with forceps
Similar to injuries that may occur with the use of a vacuum, injuries due to the use of forceps also depend upon how much force is used, and the position of baby’s head. There is a great risk of injury to baby when the head is higher.2 Errors made with forceps can lead to:
- Damage to the nerves in baby’s face, if one of the forceps puts too much pressure on the face.
- Brachial Plexus injuries
- Fracture of the baby’s skull
- Corneal abrasions, or cuts/scratches to the baby’s eyes
- Intracranial hemorrhage
If you or your loved one was seriously injured by an act of medical negligence, Crandall & Pera Law may be able to help. We are a nationally recognized team of medical malpractice and birth injury attorneys serving clients throughout Ohio and Kentucky. To learn more about who we are, or to schedule a consultation with an experienced birth injury attorney, please call 877-955-0020 or fill out our contact form.
- Wegner, E., & Bernstein, I. (2016). Operative vaginal delivery. UpToDate. Retrieved from http://www.uptodate.com/contents/operative-vaginal-delivery
- Cunningham, F., Leveno, K., Bloom, S., Spong, C., Dashe, J., Hoffman, B., Casey, B., & Sheffield, J. (2013). Operative Vaginal Delivery. In Cunningham, F., Leveno, K., Bloom, S., Spong, C., Dashe, J., Hoffman, B., Casey, B., & Sheffield, J. (Eds). Williams obstetrics (24th ed.). New York, NY: McGraw-Hill