In some cases during a difficult vaginal childbirth, the baby may require more than just normal pushing to pass through the birth canal. When this difficulty is encountered OB/GYNs have various delivery assistance tools at their disposal. One of the most widely used obstetrical tools is what is known as a vacuum extractor or vacuum pump. The vacuum is an assistive device that is meant to augment maternal expulsive efforts by gently guiding the fetal vertex through the birth canal.
How does it work? A vacuum extractor has a soft suction cup attached to a leverage handle. The suction cup is designed to grip onto the baby’s head and it is connected to a vacuum pump to create a suction seal on the head. The doctor basically places the suction cup over the accessible portion of the baby’s head, turns on the pump to create a sealed grip, and then uses the handle attached to the cup to pull and maneuver the baby out.
Whenever the doctor uses tools, such as a vacuum extractor or obstetrical forceps, the procedure is referred to as an “operative vaginal delivery.” Current research suggests that approximately 1 out of every 20 (or 5%) live births in the U.S. are the result operative vaginal deliveries. However, in certain regions of the country operative delivery rates are as high as 20-25%. Vacuum extractors have extensively replaced obstetrical forceps as the tool of choice for operative vaginal deliveries. Over 80% of all operative deliveries are done with some type of vacuum extractor pump rather than forceps. Part of the reason for this trend has been the high rate of injuries associated with the use of forceps. Outside the obstetrical community, forceps have become notorious for causing head injuries to babies. Even though vacuum devices are generally considered safer than forceps, vacuum pump extractors actually causes thousands of birth injuries every year.
Because vacuum extractors increase the risk of injury, doctors are only supposed to use them under certain circumstances. The American College of Obstetricians and Gynecologists (ACOG) published guidelines in 2000 setting forth a list of circumstances in which vacuum extractor may be appropriate. The ACOG guidelines list the following circumstances as indications for vacuum-assisted delivery:
| Indicator | Definition |
|---|---|
| Prolonged 2nd Labor Stage | Prolonged labor in the 2nd phase is generally defined as no progress after 3 hours (with epidural anesthesia) or 2 hours (without epidural) |
| Fetal Stress | Indicators of potential fetal stress (e.g., abnormal fetal heart rate) may call for vacuum assisted delivery – but only if delivery with vacuum assistance can be accomplished faster than C-section. |
| Shortening of 2nd Labor Stage | For mothers with health conditions that make pushing difficult or problematic (e.g., maternal cardiovascular disease), vacuums can be used to electively shorten the 2nd labor stage and help them along. |
| Maternal Exhaustion | Vacuum extraction may be appropriate when the mother has become physically exhausted from pushing. This is a highly subjective indication with no universal definition. |
It is important to note that all of these indicators are far from absolute because in each of these situations an emergency C-section might also be an appropriate and possibly better response than vacuum extraction.
If everything goes right and the doctor employs the required level of skill and technique, vacuum extraction is a perfectly safe way to facilitate a difficult vaginal delivery. Unfortunately, the labor and delivery room is not a place where things always go according to plan and even the best OB/GYNs occasionally make errors in judgment and/or skill. No matter what the surrounding circumstances may be, using a vacuum device immediately increases the overall risk of a birth injury. Birth injuries related to vacuum-assisted deliveries usually happen in one of several ways: (1) the doctor incorrectly places the cup of the vacuum pump in the wrong position on the baby’s head; (2) the doctor chooses the wrong vacuum cup size or type for the baby’s head; (3) the doctor twists the neck and head too much; (4) the doctor pulls with excessive force or in the wrong direction; or (5) the doctor spends too long using the vacuum before opting for an emergency C-section. The doctor cannot over commit to vacuum-assisted vaginal delivery and must be willing to abandon the effort in favor of a C-section when necessary.
When vacuum-assisted deliveries go wrong, they tend to result in certain types of birth injuries which can range from minor to very severe. External head trauma from vacuum extraction errors can often lead to serious infant brain damage.