What is vacuum extraction in pregnancy?

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A vacuum delivery occurs when a doctor uses a vacuum extractor device to help a child exit the womb during a prolonged or difficult delivery. This type of delivery may be used if a child is unable to exit the birth canal naturally as the mother pushes.

Assisted delivery occurs in about 3% of vaginal deliveries in the US, according to the American College of Obstetricians and Gynecologists (ACOG).

A doctor may perform an episiotomy (surgical cut of the perineum) to guide the child through the vaginal opening. The doctor may also give the mother an epidural to ease any pain.

Types of injuries caused by vacuum extractors

Vacuum delivery can lead to a number of medical conditions and injuries to both the mother and child when performed incorrectly. Vacuum birth can lead to Erb’s palsy, brain bleeds, cerebral palsy, skull fractures, and more.

Brachial plexus injuries

Vacuum-assisted deliveries can cause brachial plexus injuries — including Erb’s palsy and shoulder dystocia — if a baby’s arm, head, shoulder, or neck is being pulled by the extractor while they are stuck in the birth canal.

Injuries to the brachial plexus network of nerves vary in severity and may result in long-term complications. According to Dalhousie University and the IWK Health Centre in Nova Scotia, around 80% to 96% of babies will completely recover from Erb’s palsy.

Brain bleeds

Bleeding in the brain is another common risk of vacuum delivery. Brain bleeds can occur when excessive suction from a vacuum pump causes blood vessels to rupture and accumulate in the tissue covering the skull. Ruptured blood vessels can put excessive pressure on the child’s brain.

The condition can take several weeks or months to heal itself, but may lead to serious health complications and brain damage in more severe cases. Brain damage from brain bleeds may cause physical and neurological issues depending on the area of the damage.

Other injuries

In addition to brachial plexus injuries and brain bleeding, there are several other injuries that can occur from a delivery with a vacuum.

Other injuries caused by vacuum delivery include:

• Blindness
• Bruising or swelling of the head or brain
• Cerebral palsy
• Facial nerve palsy
• Hearing loss
• Kernicterus
• Scalp lacerations
• Severe jaundice
• Skull fractures
• Stroke

If your child experienced any type of birth injury from improper use of vacuum delivery, it may be considered medical negligence.

What are vacuum extractors?

A vacuum extractor is an assistive delivery device used during an operative vaginal delivery to progress a difficult childbirth.

The vacuum extractor is a large device with a soft suction cup at the end. A doctor will place the vacuum cup onto the fetal head and use a gentle amount of suction from the vacuum to aid the child through the birth canal during a contraction.

Assisted delivery using a vacuum device is encouraged during prolonged labor. According to a study from ACOG, fetal mortality was higher when the second stage of labor (cervix has been fully dilated) exceeded two hours.

Why are vacuum extractors used?

Vacuum extractors are used during difficult or prolonged vaginal births. There are several reasons for vacuum delivery. One reason is to adjust the infant’s position in the womb.

During a typical childbirth, an infant will naturally descend into the mother’s birth canal as the mother pushes. If a doctor detects that an infant is struggling to exit the womb on their own, they may opt to use vacuum delivery to assist the process.

Doctors may use assisted vacuum delivery if:

• The mother is pushing, but labor is not progressing
• The mother is too tired to continuing pushing
• The mother has a health condition preventing her from pushing too long
• The baby has an abnormal heart rate

When used appropriately, vacuum extractors can be beneficial in delivering a healthy baby during a stressful childbirth.

When should doctors not use vacuum extraction?

Although vacuum delivery can be a helpful option for prolonged or difficult vaginal birth, there are vacuum-assisted delivery guidelines that outline when not to use vacuum delivery in certain situations.

Doctors should not consider vacuum delivery if:

• The mother is less than 34 weeks pregnant
• The baby has been diagnosed with a bone or bleeding disorder
• The baby’s head has not moved past the middle of the birth canal
• The baby cannot fit through the pelvis due to the child’s size or size of pelvis
• The baby’s arms, buttocks, feet, or shoulders are leading the way through the birth canal

Doctors that use vacuum delivery during high-risk situations like those above can cause serious complications for both the mother and child. You may be able to take legal action against medical professionals that perform improper assisted vacuum deliveries.

Vacuum delivery side effects

Vacuum delivery may also result in short-term and long-term side effects for both the mother and child.

Most assisted birth injuries are visible within ten hours after birth. However, some side effects may take weeks to develop.

Additionally, many vacuum extractor-related injuries are able to heal themselves within a few weeks or months. More severe side effects may become chronic and require intense medical intervention.

Vacuum delivery side effects for mothers may include:

• Anemia due to blood loss
• Blood clots
• Chronic pelvic pain
• Incontinence
• Pain during sexual intercourse
• Pelvic pain
• Vaginal tears leading to infection

Vacuum delivery side effects for babies may include:

• Bleeding under the brain
• Bleeding under the scalp
• Bruising and swelling of baby’s head
• Lacerations
• Misshapen head
• Skull fractures
• Weakness or paralysis on one side of body

Both the mother and child can make a full recovery depending on symptom severity and prompt treatment. It is important to consult a doctor or specialist to treat any injuries sustained from a vacuum delivery.

Get help after a vacuum extraction injury

Doctors are trained and expected to be prepared during emergency situations that may occur during a difficult delivery.

Parents who suspect their child’s vacuum delivery injury was preventable and caused by medical malpractice may be entitled to financial compensation. Birth injury lawsuits can help families get life-changing compensation to help pay for their child’s treatment.

Get a free legal case review today to learn more about taking legal action for your child’s vacuum delivery injury.

Imagine you are in labor and you’ve been pushing for hours. The doctor brings up the idea of using forceps or a vacuum to deliver your baby.

Did you imagine horror music and picture metal instruments attached to your baby’s head? If so, take a deep breath. It’s not that scary.

Operative vaginal delivery – which includes the use of forceps or vacuum – isn’t used very often anymore. From 2016-2019, 3% of births were delivered using forceps or vacuum. Meanwhile, approximately 32% percent of births in the same time period were delivered by cesarean section.

That one in three babies is delivered by C-section is a pretty startling concept, and some of those surgeries may have been avoided if physicians were more experienced in operative vaginal delivery. These methods – particularly forceps – are a dying art form. Few physicians coming out of training know how to use them or are comfortable using them.

But as we become more concerned with the rising C-section rate and related complications, there’s been an effort to revive physician training in the use of forceps and vacuum extraction. The American Congress of Obstetricians and Gynecologists(ACOG) in recent years affirmed the use of forceps and vacuum as a way to safely avoid some C-sections.

The use of forceps or vacuum during delivery needs your consent. To help you avoid having to make a stressful decision during labor, let’s take a moment to learn more about when these methods might be beneficial.

How do forceps and vacuum work?

Forceps and vacuum extraction function in much the same way: they both guide the baby out of the birth canal during delivery. We do not really pull the baby out, but help direct the baby while you push – we still need your help! Before we perform an operative vaginal delivery, we make sure we know the position of the baby’s head, that your bladder is empty, and that you have adequate anesthesia on board.

Forceps look a little like oversized salad tongs. We gently slide one half along one side of the baby’s head, and repeat that on the other side, so the device cradles the baby’s face. During the next contraction, we’ll ask you to push and use the forceps to help guide the head out.

The vacuum looks and acts like a suction cup. We place the cup on the baby’s head – not on the fontanel (or soft spot), but on a portion of the skull – and use a pump to create suction. Just like the forceps, we then use the vacuum to guide the baby’s head out as you push.

When might forceps and vacuum be used?

Operative vaginal delivery methods are used during the second stage of labor – after your cervix is completely dilated and you’ve been pushing. There are multiple reasons we might recommend the help of the forceps or vacuum, including:

• The baby just isn’t coming: For first-time moms or women who are making their first attempt at a vaginal delivery, we typically allow two hours to push if you don’t have an epidural, and three hours to push with an epidural, before we consider intervention. Women who have had children previously have one hour to push without an epidural, and two hours if they’ve had an epidural.
• Mom is exhausted: Labor is hard work, and the longer it goes on, the harder it is to keep up the effort. If a mother tells me, “I’m so tired. I can’t keep pushing,” she may just need a little assistance to finish the job.
• Baby’s heartbeat indicates a problem: If we become concerned about a change in your baby’s heart rate pattern on the fetal monitor, a quicker delivery may be needed.
• Mom’s health history: For a small number of women with certain medical conditions like some cardiac diseases, we may want to shorten the amount of time you need to push.

There may be times when using the forceps or vacuum would not be recommended, including when:

• We can’t accurately determine the position of the baby’s head.
• Your baby’s head has not moved down very far into the birth canal.
• Your baby has a condition that affects the strength of the bones or a bleeding disorder.
• We are concerned about the size of the baby not fitting through your pelvis.

And as an FYI, forceps or vacuum also may be used during breech deliveries or C-sections to help deliver the baby.

What are the benefits and risks of using forceps and vacuum?

The main advantage to trying an operative vaginal delivery is it could save you from having major surgery that you may not need. A second stage C-section is more difficult and complex than when it is performed earlier in the labor process. The baby’s head, which is now wedged in the birth canal, may first need to be pushed up so the baby can be delivered through the incision in the uterus. Second stage C-sections also come with higher risks of bleeding and infection.

Sometimes a baby’s head is not positioned so it’s coming straight out, but instead is cocked to the side, making it more difficult to pass through the birth canal. We may be able to correct the head position with the forceps. It’s amazing how some simple maneuvers can correct the position of the head; some moms can even push from that point forward without the assistance of the forceps.

Using an operative vaginal delivery method also may result in a faster delivery for your baby than a C-section, which at times is really important. Women can give birth within minutes with the use of forceps or a vacuum delivery, but with a C-section, a woman will need to be taken to an operating room, positioned on an OR table, and have adequate anesthesia in place before undergoing the surgery.

Although rare, there are risks associated with these delivery methods. Possible risks to the mother include:

• Increased potential of lacerations (tearing around the vagina, rectum, or urethra)
• Short-term urinary incontinence
• Increased blood loss

Possible risks to the baby include:

• Minor facial injuries including bruising
• Temporary facial muscle weakness
• Skull fracture (but realize that this can also happen with delivery via a C-section when the head is already low in the pelvis)
• Bleeding

What questions should you ask your physician?

I recommend discussing operative vaginal delivery methods with your physician during your prenatal care, so you have all the information you need before you’re asked to make a decision in the heat of the moment.

Ask your physician how comfortable they are in using the forceps or vacuum. For instance, I am very experienced in using forceps, but I do not have training or expertise in using a vacuum extractor. Some physicians prefer one over another, and some prefer to go straight to a C-section. These are procedures in which the skill of the physician matters, and it’s important they not attempt it if they can’t do it.

While making a birth plan, you can learn about your delivery options and let your physician know what you are comfortable with. I have patients who desperately do not want a C-section, and while I tell them that we will do everything we can, sometimes events dictate that we can’t safely use the forceps or vacuum to deliver vaginally. I am always a little sad when someone’s baby is too high in the birth canal to even attempt using forceps and I have to resort to cesarean delivery. But the safety of the baby and mother is our top priority. I also have patients who tell me they prefer to not use forceps or vacuum. In those cases, I tell them that I also prefer to not have to use these methods, but I explain the situations in which they may be beneficial.

You need to have accurate information to weigh the risks of a possible operative vaginal delivery so you can make a decision that is best for you and for your baby. Talk to your physician about each option well before you are in labor.

If you have questions about delivery options, call 214-645-8300 or request an appointment online with one of our Ob/Gyns.