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Family Health Magazine
CHILDBIRTH

Forceps and Vacuum Extraction
When baby needs help

Childbirth is a very natural event. There are times, however, when some assistance is necessary to help the baby through the birth canal. This is called an assisted vaginal delivery.

The reasons for assistance can be concern for the baby’s or the mother’s well-being, a labour that is not progressing well enough, or a mother too exhausted to carry on pushing. Assistance is given with either forceps or vacuum extractor. Choosing between the two will depend on the doctor’s skill with each instrument, the unique circumstances at that delivery, and the mother’s preference after being informed of her options.

Some things can be done to lessen the chance of needing an assisted vaginal delivery. Women who have a supportive birth companion with them during labour are less likely to need instruments to help deliver the baby. They also experience shorter labours with less need for pain relief and fewer episiotomies (a cut to the perineum, the area between the vagina and the anus).

Frequent changes in position, even during the pushing stage, are also helpful. It is important to wait for the urge to push, as this also results in more unassisted births. This is especially true when an epidural (spinal anaesthetic) is used. Sometimes the contractions are not strong enough to get the baby delivered. Since pushing is better than pulling a baby out, it may help to give the mother some medication (oxytocin) to improve the contractions before considering aiding the delivery.

Forceps

Forceps may appear frightening to some people since they are made from heavy surgical steel. In reality, they are very delicate instruments designed to cradle the baby’s head and guide it through the birth canal. It is important that the mother has an empty bladder and appropriate pain relief before forceps are used. The doctor will check to make sure the baby is low enough down into the birth canal to make the procedure safe.

To learn which way the baby is facing, the doctor will feel the baby’s head for the suture lines (the small spaces between the bones of the skull). It is essential to know the baby’s position so that the forceps can be placed around the baby’s head correctly. The two sides of the forceps are inserted into the vagina one at a time. They are positioned perfectly around the baby’s head. With the mother pushing, the doctor pulls down and eventually up as the baby comes through the birth canal.

Complications can occur when using forceps, just as in all types of deliveries. Since forceps fit around the outside of the baby’s head, there is a larger part moving through the birth canal. As well, since the baby’s head moves down faster than it would if the mother were pushing it out on her own, there is less time to stretch the tissues. Both of these factors lead to a greater chance of an episiotomy being used or significant tears to the mother’s perineum and vagina. Occasionally, there can even be tears into the rectum.

Swelling and pain is often worse after an assisted vaginal delivery. This can be partly due to the use of forceps. This may also happen if the mother pushed for a long time before the forceps were used. This can result in some difficulty passing urine for the first while after delivery. Some women may need to use a catheter (a small tube) to empty the bladder for a little while.

Parents are often concerned about the forceps hurting the baby. Problems are much more likely if the position of the forceps is not correct, the baby is not very low in the birth canal or the doctor needs to use the forceps to turn the baby’s head to a better position. Usually there are only slight red marks on the cheeks of the baby that last for a very short period of time. Sometimes there are bruises or mild scrapes to the baby’s scalp or face. More rarely, the facial nerve may be damaged.

Cephalohematoma, a collection of blood next to the baby’s skull, is more common after forceps are used than in normal birth. It may cause an increased risk of jaundice in the baby. There is no long-term problem from cephalohematomas. Fortunately, more severe bleeding and skull fractures are very rare.

Sometimes, the doctor finds that the baby is not moving down through the birth canal as expected with the forceps. Pulling harder than it is safe to do could result in more trauma to the mother and baby. The doctor will usually stop using the forceps at this time and decide to deliver the baby by caesarean section.

Vacuum Extractor

The vacuum extractor is used more commonly than the forceps, although, in some situations, forceps are more likely to be successful in achieving delivery. Unlike the forceps, which can be used to turn the baby, vacuum can only be used to pull.

Many different types of vacuum suction cups exist, ranging from metal to soft plastic. The more rigid cups are more likely to be successful in delivering the baby. However, they are also more likely to cause some scalp injury to the infant. The vacuum pump that creates the vacuum in the suction cup may be hand operated or electric. The electric pumps make more noise than the handheld pumps, but both are capable of creating a vacuum seal when the cup is put on the baby’s head.

Just as with the forceps, it is important for the mother to have an empty bladder and pain relief. The doctor must know the position of the baby’s head. The vacuum cup is slipped into the vagina and applied to the part of the baby’s head that should come first through the birth canal. Again, the doctor works with the mother to pull down and then up as the baby is born. The cup may pop off just before the baby is born. If the cup pops off repeatedly, the doctor will stop and deliver the baby using forceps or by caesarean section.

Although vacuum use does not lead to any facial injuries for baby, scalp trauma can occur. There is a higher chance of cephalohematoma than with forceps. There is usually less trauma to the mother than with forceps, since the vacuum cup sits on top of the baby’s head and does not increase its size. As well, the birth process is often a little slower with vacuum, so the mother’s tissues have a slightly greater chance to stretch as the baby is born. Babies born by vacuum have a higher chance of retinal bleeding (bleeding at the back of the eyes). There is no evidence that this is a long-term problem for babies. Again, more severe bleeding and skull fractures are very rare.

By far, the best way to give birth is by unassisted vaginal delivery. When this is not possible, and a vaginal birth is still the first choice, there are two instruments available to assist giving birth. By using proper technique, assisted birth by forceps or vacuum is a safe way to deliver your baby.