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Vacuum Delivery

Vacuum Delivery

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Birth looks different for every woman and baby. No two experiences are alike, and for some, delivering a baby safely may require some assistance.

During a vacuum delivery, your midwife or doctor will determine baby’s position, place your legs into stirrups and then place a suction cup on the top of your baby’s head. This suction will help to guide your baby out while you continue to bear down/push with contractions.

Around 2-3 traction pulls on the vacuum may be required, however these should be abandoned conservatively if no progress (i.e no descent of your baby’s head through the birth canal with each contraction).

The decision for a vacuum delivery is not to be made lightly, and should consider all options and factors before encouraging intervention.

There are many circumstances in labour that may lead to the need for an assisted delivery such as:

  • Baby distressed in labour with abnormal changes in his/her heartrate
  • Inability to feel enough muscle/nerve sensation to push effectively. This might be as a result of a heavy epidural, leading to prolonged second stage (pushing stage).
  • Complications with your health preventing you from pushing (such as very high blood pressure or cardiac issues)

 

What are the risks of a vacuum delivery?

No birth is completely without risk, whether natural or assisted. Every birth comes with a risk of bleeding and/or damage to mother or baby. Vacuum delivery is best chosen at the end of the second stage of labour – when other attempts have been made to support an unassisted delivery.

Risks for baby:

Babies delivered with a vacuum will very likely experience skin swelling on their head where the cup was applied. This is harmless and will reduce rapidly over the first 24-48hours. For some babies, the suction cup may cause cuts or bruising to their scalp. These will also heal over the first week after birth.

In rare cases, the vacuum can damage blood vessels in the scalp, or bruise part of the skull bone. This is called a cephalhaematoma or a subgaleal haemorrhage. These range in severity but rarely do they need intervention or treatment and often resolve with time.

Risks for mother:

The most common risk for mothers is the increased risk of a 3rd or 4th degree tear.

Your doctor will need to ensure they are protecting your perineum from any uncontrolled tearing – this may mean they will need to perform an episiotomy (a controlled incision in your perineum in a safer direction).

Why not have a caesarean?

If your baby has descended far enough into the pelvis, it is often safer to deliver vaginally (when possible). If your baby is still high, an assisted delivery with vacuum or forceps may not be possible, and an unplanned/emergency caesarean may be recommended.

Factors that your midwife and doctor will consider:

  • Urgency of the situation
  • Position of your baby’s head
  • The reason why you need an assisted delivery
  • How far along you are in your pregnancy

 

Is there anything you can do to avoid an assisted delivery?

Most of the time, the reasons for an assisted birth are not for reasons you can control. Your midwife and doctor will explain the circumstances and the rationale for their recommendations if they think you might need a vacuum delivery.

You can reduce your chances of needing a vacuum delivery by:

  • Staying in an upright position during labour and trying to walk around as much as you can
  • Avoiding the epidural (if possible!) as this can partially or fully numb the sensation to push leading to slow or no progress when pushing.
  • Keeping healthy and fit during the pregnancy

Ask your midwife or doctor for more information regarding healthy choices during your pregnancy and labour and how you can reduce the risks of needing intervention.

Written by Keryn Thompson, RM & IBCLC (L-301766)

References:

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Davenport, M. H., Ruchat, S.-M., Sobierajski, F., Poitras, V. J., Gray, C. E., Yoo, C., Skow, R. J., Jaramillo Garcia, A., Barrowman, N., Meah, V. L., Nagpal, T. S., Riske, L., James, M., Nuspl, M., Weeks, A., Marchand, A.-A., Slater, L. G., Adamo, K. B., Davies, G. A., . . . Mottola, M. F. (2018). Impact of prenatal exercise on maternal harms, labour and delivery outcomes: a systematic review and meta-analysis. British Journal of Sports Medicine, 53(2), 99–107. https://doi.org/10.1136/bjsports-2018-099821

Djaković, I., Sabolović Rudman, S., & Košec, V. (2016). Effect of epidural analgesia on mode of delivery. Wiener Medizinische Wochenschrift, 167(15-16), 390–394. https://doi.org/10.1007/s10354-016-0511-9

Gambling, D., Berkowitz, J., Farrell, T. R., Pue, A., & Shay, D. (2013). A Randomized Controlled Comparison of Epidural Analgesia and Combined Spinal-Epidural Analgesia in a Private Practice Setting. Anesthesia & Analgesia, 116(3), 636–643. https://doi.org/10.1213/ane.0b013e31827e4e29

Ghidini, A., Stewart, D., Pezzullo, J. C., & Locatelli, A. (2016). Neonatal complications in vacuum-assisted vaginal delivery: are they associated with number of pulls, cup detachments, and duration of vacuum application? Archives of Gynecology and Obstetrics, 295(1), 67–73. https://doi.org/10.1007/s00404-016-4206-7

Gurol-Urganci, I., Cromwell, D., Edozien, L., Mahmood, T., Adams, E., Richmond, D., Templeton, A., & van der Meulen, J. (2013). Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG: An International Journal of Obstetrics & Gynaecology, 120(12), 1516–1525. https://doi.org/10.1111/1471-0528.12363

Lang Ben Nun, E., Sela, H. Y., Ioscovich, A., Rotem, R., Grisaru-Granovsky, S., & Rottenstreich, M. (2021). Epidural analgesia and vacuum-assisted delivery in primiparous women: maternal and neonatal outcomes. The Journal of Maternal-Fetal & Neonatal Medicine, 1–8. https://doi.org/10.1080/14767058.2021.1929161

Murphy, D. J., Strachan, B. K., & Bahl, R. (2020). Assisted Vaginal Birth. Royal College of Obstetricians and Gynaecologists, 70-112(26).

Ojumah, N., Ramdhan, R. C., Wilson, C., Loukas, M., Oskouian, R. J., & Tubbs, R. S. (2017). Neurological Neonatal Birth Injuries: A Literature Review. Cureus. https://doi.org/10.7759/cureus.1938

Rimaitis, K., Klimenko, O., Rimaitis, M., Morkūnaitė, A., & Macas, A. (2015). Labor epidural analgesia and the incidence of instrumental assisted delivery. Medicina, 51(2), 76–80. https://doi.org/10.1016/j.medici.2015.02.002

Ryman, P., Ahlberg, M., & Ekéus, C. (2015). Risk factors for anal sphincter tears in vacuum-assisted delivery. Sexual & Reproductive Healthcare, 6(3), 151–156. https://doi.org/10.1016/j.srhc.2015.02.005

Schreiber, H., Cohen, G., Shechter Maor, G., Haikin Herzberger, E., Biron‐Shental, T., & Markovitch, O. (2022). Head position and vacuum‐assisted delivery using the Kiwi Omnicup. International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.14367

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