Vacuum Extraction and Forceps Deliveries
Vacuum extractors and forceps are birth-assisting tools that are used to guide the baby through the birth canal. When used improperly, both of these tools can cause serious injuries. These include trauma and brain hemorrhages (bleeds), brain swelling, skull fractures, stroke, seizures, and brain damage such as cerebral palsy and HIE. The decision to use a birth-assisting tool should be made very carefully. Moreover, each of these two methods (vacuum extractors and forceps) has advantages and disadvantages, which doctors should weigh when deciding between the two.
Operative Vaginal Deliveries vs Unassisted Vaginal Deliveries
Operative vaginal deliveries, also known as assisted deliveries, are those in which birth-assisting tools like vacuum extractors or forceps are used. Unassisted vaginal deliveries are what many people think of as “natural” births. There are situations in which the use of vacuum extractors or forceps is called for and can be a life-saving measure. However, there are also substantial risks associated with these tools.
Benefits of Operative Vaginal Deliveries
Approximately 10 – 15% of all babies born are delivered via operative vaginal delivery, of which about one-third are vacuum extraction deliveries and the remaining two-thirds are forceps deliveries. One important benefit of operative deliveries is that a baby who is showing signs of fetal distress (such as an abnormal heart rate) can be delivered quickly, evaluated, and resuscitated as needed. Also, these deliveries can sometimes be done if a woman has been in the second stage of labor for several hours and, for whatever reason, is unable to make further progress.
Risks of Operative Vaginal Deliveries
A baby’s head can become compressed and brain vessels injured during a vacuum extractor or forceps delivery. This can result in a number of medical conditions, such as seizures, stroke, and cerebral palsy. There is also a possibility of injury to the mother, especially with forceps deliveries in which the baby’s head is relatively high in the birth canal or is in a suboptimal position. Damage can occur to the mother’s vagina, bladder, or rectum.
Advantages of Vacuum Extraction Deliveries Over Forceps Deliveries
Vacuum extraction exposes the baby to less traction in comparison to forceps delivery. Less force is applied to the baby’s head. One study found that vacuum extraction exerted approximately 40% less force to the baby’s head than delivery with forceps. Although vacuum extraction may be associated with trauma and hemorrhaging, forceps may cause similar injuries and may result in more serious nerve or skull injuries.
Ease of placement. One advantage of the vacuum extractor is that it is typically easier to place than forceps. Due to its design, the vacuum extractor may be applied to the top of the baby’s head as it becomes visible in the birth canal. The soft, plastic cups are pliable and can be folded for insertion and maneuverability. Forceps, on the other hand, must encircle the baby’s head, and it therefore is crucial to know the exact position of the head. There is also significant risk of injury to the vaginal walls during placement of the forceps. If the baby’s head is tilted slightly to one side (asynclitic presentation), application of the forceps may be impossible. However, there are contraindications to vacuum extractor use when the baby’s head is in certain positions as well, so it is still a requirement to know head position.
Less anesthesia is required. Since the vacuum extractor is easier to apply and is associated with less trauma to the vagina, it requires less anesthesia. Although epidural anesthesia is preferable, vacuum extraction may be performed after injection of a local anesthetic that numbs the lower vagina. When anesthesia techniques like epidural or spinal block are not possible because of time constraints or unavailability, vacuum extraction may be performed safely and comfortably after local injection of medication.
Less injury to the mother’s soft tissues. The vacuum extractor is associated with less injury to the mother’s soft tissues than forceps. The vacuum extractor does not increase the width of the presenting part of the baby, as can happen with forceps. The amount of vaginal trauma is directly related to how much control the physician has over the force of the traction. In most cases, the amount of traction that can be applied by the vacuum is less than that produced by forceps. Therefore, the descent of the baby’s head occurs in a more controlled fashion when a vacuum extractor is used. When the head is delivered slowly, less tearing occurs.
Reasons Vacuum Extraction Deliveries May Be More Dangerous Than Forceps Deliveries
Increased risk of intraventricular hemorrhage. This is especially true in preterm babies because their blood vessels are not yet fully developed. Vacuum extraction should not be used to assist in delivery prior to 34 weeks of gestation. In certain instances, forceps may be used to deliver preterm babies.
Increased risk of intracranial hemorrhage. It has been well documented that the risk of serious bleeding inside the baby’s skull is greater with vacuum extraction than with forceps. Due to the pressure of the suction cup applied to the baby’s head, intracranial hemorrhages – especially subgaleal hemorrhages – are much more common with vacuum extraction delivery. A subgaleal hemorrhage occurs when the vacuum ruptures a vein and then the vein bleeds into a space between the scalp and the skull. This condition is life-threatening, with mortality rates as high as 20%. Approximately 90% of all subgaleal hemorrhages are due to vacuum extractor use.
Increased risk of stroke. A vacuum delivery also increases the risk of the baby having a stroke. A stroke occurs when blood supply in the brain becomes blocked or restricted. Fetal stroke is one of the most common causes of cerebral palsy in term and near-term babies.
The vacuum cup may become dislodged. When the second stage of labor is prolonged, it is common to find that the baby’s head has a large amount of swelling at the presenting point. If the swelling is significant, it may be difficult to obtain optimal application of the cup against the baby’s head, and the cup may become detached. Improper placement of the vacuum cup may also result in detachment.
Delivery may take longer. Vacuum traction should be applied only during contractions; therefore, vacuum extraction may be slower than forceps delivery. Forceps delivery may be performed with very little maternal effort, while vacuum-assisted delivery requires maternal participation. A woman who has a medical condition that prevents her from pushing in the second stage of labor can likely benefit from the use of forceps. The most common examples of this include women with significant heart disease, respiratory compromise, or certain neurological conditions.
Success rates are slightly lower for vacuum deliveries. Several large studies comparing the success of forceps delivery with that of vacuum extraction delivery confirmed that forceps are more often successful in safely delivering the baby.
The Importance of C-Section Deliveries
In any labor and delivery situation, the physician must be prepared to quickly move on to a C-section delivery when an operative vaginal delivery is not progressing as it should. If one device does not result in prompt delivery of the baby, the physician must not attempt to use a different operative delivery device. Some conditions that require the baby to be delivered immediately include fetal distress, uterine rupture and cord prolapse. Sometimes physicians fail to perform an emergency C-section when one is necessary, 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 lead to permanent injuries in the baby, such as cerebral palsy and hypoxic-ischemic encephalopathy (HIE). Indeed, in many cases, a C-section is the safest way to deliver the baby. Thus it is critical that physicians be skilled and prepared for the procedure.
Vacuum Extractors, Forceps, and Medical Malpractice
In certain situations and when properly used, forceps and vacuum extractors can be helpful during birth. Due to the risks involved with these devices, however, it is imperative that physicians be very skilled in using them. Moreover, they must understand which device is the most appropriate for each situation. Physicians must be ready to move on to a C-section delivery when operative delivery is not proceeding as it should, and standards of care must be followed at all times. Failure to provide proper care in a timely manner during delivery is negligence. If negligence leads to injury of the mother or baby, it is medical malpractice.
Legal Help for Vacuum Extractor and Forceps Injuries
If your baby was delivered using vacuum extractors or forceps and now has a condition such as cerebral palsy, the attorneys at Reiter & Walsh ABC Law Centers can help. Our award-winning United States birth injury lawyers have extensive experience in the investigation and litigation of complex birth injury cases. We will fight to obtain the compensation you and your family deserve for lifelong care and treatment of your child.
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