What are the alternatives to vacuum extraction delivery?

When a baby is not progressing with the use of a vacuum extraction, the physician must be prepared to quickly change the plan and move to a C-section delivery. There are certain situations in which forceps can be used in place of vacuum extractors, but they should not be used sequentially, one after the other.

C-section delivery when vacuum extraction fails

C-section; cesarean section; surgical birth; pregnancy; baby; emergency C-section

When ventouse delivery fails, C-section is often the safest way to delivery the baby

If a vacuum extractor is not resulting in prompt delivery of the baby, the physician must not attempt to use forceps. In many situations, the physician cannot delay delivery. Some conditions that require the baby to be delivered immediately include fetal distress, placental abruption, uterine rupture, and cord prolapse. Sometimes, physicians fail to perform an emergency C-section when one is required, or they wait too long to perform one. Other times, the C-section may be ordered, but the physician lacks skill in the procedure, or the hospital is ill-equipped for it. Delay in performing a C-section can cause a baby to suffer a permanent brain injury from, such as  hypoxic-ischemic encephalopathy (HIE). This can result in developmental delays and cerebral palsy (CP).

Forcep use instead of vacuum extraction

Forceps may be used instead of vacuum extractors in certain instances, such as the following:

  • When the baby is less than 34 weeks of gestation. Forceps may be used to deliver preterm babies, in certain cases.
  • When the mother is exhausted or cannot participate in delivery, forceps may be used since they require very little maternal participation.  Vacuum extractors, however, do require maternal participation.

Several studies have confirmed that forceps may sometimes be more  successful at delivering a baby than vacuum extractors. Some studies have also shown that the risk of serious brain hemorrhage is more common with vacuum extractors than forceps although both can cause this. Due to the pressure of the suction cup applied to the baby’s head, intracranial hemorrhages – especially subgaleal hemorrhages – are more common with vacuum extraction delivery compared to delivery with forceps (1). Furthermore, there is an increased risk of stroke with vacuum extractor use than with use of forceps. In general, most researchers agree that a forceps delivery is safer for the baby than a vacuum extraction delivery. However, delivery with forceps also has its own risks.

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Related Reading on Birth Injuries


  1. Johanson RB, Menon BK. Vacuum extraction versus forceps for assisted vaginal delivery. Cochrane Database Syst Rev. 2000;(2):CD000224. doi:10.1002/14651858.CD000224