As every pregnancy is unique so is the labor and delivery process. The length of time it takes varies from one woman to the next. In some cases, it can happen in just a few short hours, while for other women it can take a full day -- or more. Sometimes, the delivery process is unusually difficult or it gets to a certain point and fails to progress. The baby is close to being born, but is not quite out. When this occurs, a physician or other healthcare provider may choose to use an instrument to assist in the delivery. One such device is called a vacuum extractor.
A vacuum extractor uses a small, soft cup that is applied to the top and back of the baby’s head. A tube runs from the cup to a vacuum pump that provides suction. During a contraction, the physician pulls or applies gentle traction to the baby’s head while suction from the vacuum assists in pulling the baby’s head out of the birth canal so the baby can be delivered.
Vacuum extractors can be very useful tools when used properly and in the appropriate circumstances. However, used incorrectly or when not indicated, vacuum extractors can be dangerous and cause birth trauma. In Fact, the Food and Drug Administration (FDA) cited its concerns in a Public Health Advisory on vacuum assisted delivery devices:
“This is to advise you that vacuum assisted devices may cause serious or fatal complications…While no instrumented delivery is risk free, we are concerned that some health care professionals who use vacuum assisted delivery devices, or those who care for these infants following delivery, may not be aware that the device may produce life-threatening complications.”
To minimize the risks, vacuum extractions should not be performed when the baby is less than 34 weeks gestation, the baby is too large or the mother’s pelvis is too small, the baby’s head is too far up the birth canal, the baby requires rotation or repositioning in order to be delivered, or the mother is not fully dilated. A cesarean section may be the safer choice in these instances.
Like with any medical device, there is a correct and incorrect method for using it. The cup must be placed on the baby’s head about 3 centimeters back from the soft area of the skull called the anterior fontanel. This placement avoids injury to the baby. The diagram below illustrates the correct placement.
Because a baby’s head is so fragile and susceptible to injury, it is critical that the cup is placed in the right location. Incorrect placement can result in significant and permanent brain damage. The diagram below shows locations where the cup should not be placed. The physician performing the vacuum delivery must have experience using vacuum extractors. Likewise, the practitioner’s technique used to pull the baby out is equally important. Twisting the head or neck, pulling too hard, or pulling for longer than 10 to 15 minutes should be avoided as they can injure the baby. Also, if the vacuum pops off 3 times during use, the physician should move on to c-section to deliver the baby.
Birth injuries associated with incorrect vacuum extractor usage
When vacuum extractors are used improperly or if errors are made by medical professionals during an extraction, birth injuries can occur. These range from minor bruising and lacerations to devastating and permanent brain injuries. Some of the most common are listed below:
o Skull fractures.
o Retinal hemorrhages.
o Brachial plexus injuries/Erb's Palsy. This occurs when the brachial plexus (group of nerves to the arms and hands) is injured. It frequently occurs in births involving shoulder dystocia (difficulty delivering the baby’s shoulders). As a result of this type of injury, the baby cannot flex and rotate his arm Sometimes the injury resolves itself. However, if the nerve is torn, there may be permanent damage.
o Brain hemorrhages or bleeds: Probably the worst potential complication of a vacuum extraction is a subgaleal brain hemorrhage. The vacuum ruptures a vein which bleeds into a space between the scalp and skull. This condition is life threatening with a mortality rate as high as 20%. About 90% of all subgaleal hemorrhages are related to vacuum extraction. This type of bleeding is most likely to occur with excessive force, prolonged cup application, or if forceps are also used. This often leads to neurological impairments and cerebral palsy.
o Prolonged NICU stays, seizures and brain damage and cerebral palsy and hemiparesis.
Symptoms like lethargy and seizures may occur within hours of a vacuum delivery and are usually indicative of a serious brain injury.
For more information on the potential injuries and warnings issued by the FDA, please see "FDA Public Health Advisory: Need for CAUTION When Using Vacuum Assisted Delivery Devices."
Was a vacuum extractor used in your delivery?
If your child was born using a vacuum extractor and sustained permanent damage, we can help. Our birth injury experts at Reiter & Walsh ABC Law Centers have many years of experience in handling complex vacuum extraction cases. We can help you understand your legal rights and the actions you can take to obtain the compensation you and your child deserve. Contact Reiter & Walsh ABC Law Centers.