There is a risk of trauma with the use of a vacuum or forceps during labour and delivery. While the risk is small when these tools are used properly, injuries such as retinal hemorrhage and hematomas can result from the use of vacuums and forceps.
As a general rule, it is not acceptable to use both forceps and vacuum to deliver a baby. Forceps and vacuum are always considered to be an interim measure that may require further intervention. This means that when deciding to use forceps or a vacuum to assist a delivery, the obstetrician must also be preparing to proceed to cesarean section if the baby cannot be delivered using forceps or vacuum.
Overview of Vacuum Extraction and Forceps
Both forceps and vacuum extraction are types of assisted vaginal deliveries. Forceps is an instrument that is shaped like a pair of long tongs and they are slid on the sides of a baby’s head to help guide the baby out of the birth canal. Typically this is done while a mother is pushing during a contraction.
Vacuum extraction is a process where a soft or rigid cup is applied to the baby’s head by suction to help guide the baby out of the birth canal. Just as with the forceps, typically, a vacuum extraction would be done while a mother pushes the baby during a contraction.
When Is the Use of a Vacuum or Forceps Appropriate?
Generally speaking, the use of vacuum or forceps is to help guide the baby out of the birth canal during delivery if there are complications such as fetal distress or prolonged labour. They are not used in the course of a normal delivery in the absence of some indication that the mother may not be able to deliver naturally. The use of forceps or a vacuum does not always end with complications and should not in itself cause concern.
Fetal Distress
A baby may experience oxygen deprivation during labour, known as fetal distress. Some of the signs of fetal distress include:
- changes in the baby’s heart rate (an abnormally high heart rate is called tachycardia and an abnormally low rate is called bradycardia);
- decreased or arrested fetal movement, or
- abnormal amniotic fluid levels.
If the baby is showing signs of fetal distress, a doctor may decide to use forceps or vacuum to speed up the labour or to avoid a cesarean (c-section) delivery.
Shortened Second Labour Stage
The second labour stage is more commonly termed the “pushing” stage of labour, it begins when the cervix is completely opened (10 cm) and ends with the delivery of the baby.
The second stage of labour usually lasts about two hours for a first child and usually about one hour thereafter. A shortened 2nd labour stage would be delivering the baby in under 2 hours. This can also be called rapid or precipitous labour. One sign that a mother is experiencing rapid labour is that the contractions could come at too fast a pace and the mother is not getting enough rest. A vacuum may be used to help guide the baby out to prevent intracranial hemorrhage from the change in pressure on the fetal head during rapid expulsion, and reduce the chance of aspiration of amniotic fluid.
Prolonged Second Labour stage
The most common situation where forceps or vacuum may be needed is prolonged second stage. Failure to progress, or prolonged labour, is when the second stage of labour progresses abnormally. Failure to progress can indicate that second stage has taken over 2 hours, the labour has been arrested (slowed), or that the contractions are coming at an abnormal pace. During prolonged labour, the baby could develop fetal distress and this may require an assisted vaginal delivery using instruments such as forceps or a vacuum.
Maternal exhaustion
Maternal fatigue, or maternal exhaustion, is a clinical term to describe the compounding symptoms of dehydration and exhaustion during prolonged labour. An assisted delivery may provide relief to a mother who has been in prolonged labour for over 20 hours. Signs of maternal fatigue include changes in contractions, increased heart rate, and dry mouth.
How Can the Use of Vacuum or Forceps Cause Birth Injuries?
The use of forceps and/or a vacuum can cause complications for both the baby and the mother. Misuse of the tools includes incorrect placement, using excessive force, and using the tools for a long amount of time.
- The incorrect placement of a vacuum can lead to scalp wounds, shoulder dystocia, and skull fracture. Forceps can cause minor facial or eye scratches, facial palsy (weakness in muscles), bleeding in the skull, and seizures.
- There are two types of cups in vacuum extractors: rigid cups and soft cups. Using the wrong size or type of cup can lead to injuries to the scalp, fracture in the skull, and cephalohematoma.
- While using instruments to deliver a baby, the baby can twist its head or neck as it descends the birth canal. This can lead to injury to the nerves in the neck (brachial plexus injury) or injuries to the muscle in the neck (torticollis).
- A vacuum or forceps should only be used to guide the baby down the canal without needing to pull or use excessive force. If the instruments are used with to much force or the baby is pulled in the wrong direction then the babycan suffer serious injury.
- A doctor can spend too long using instruments like a vacuum or forceps before opting for an emergency C-section. A baby can have fractures or injuries to the neck if left in the birth canal for too long.
Types of Birth Injuries Associated with Vacuums and Forceps
The following list does not exhaust all of the complications that a baby or a mother can experience following an assisted-vaginal delivery, but it does touch on some of the more common injuries.
The buildup of fluid in the cavities, or ventricles, deep within the brain is called Hydrocephalus. As the fluid increases, it puts more pressure on the brain and causes brain damage. The physical signs are an unusually large head, changes in the head like bulging or change in size, vomiting, and infant seizures. Hydrocephalus can be congenital (a condition present at birth) or acquired by birth injury caused by excessive force during labour and delivery.
Subgaleal Hematoma is when there is a rupture of the emissary veins, which are connections between the dural sinuses and the scalp veins. Blood accumulates just under the scalp on the top of the head. It would appear as a firm bulge on the infant’s head. A subgaleal hematoma is typically caused by improper use of a vacuum extractor.
Cephalohematoma occurs during the birth process when pressure on the fetal head ruptures small blood vessels. This can happen when the head is compressed against the maternal pelvis during labour or pressure from forceps or a vacuum extractor used to assist the birth. One of the physical signs of a cephalohematoma is a soft, raised area on the newborn’s head.
The mother can experience complications from a vacuum extraction and/or the use of forceps. Typically, the doctor will make an episiotomy which is an incision made in the perineum during childbirth. The episiotomy can become infected, cause pain, or get reopened, stopping the healing process.
Frequently Asked Questions About Trauma from Forceps or Vacuum
How do vacuum and forceps differ from each other?
Both forceps and vacuum extraction are types of assisted vaginal deliveries, and both would be used while a mother pushes the baby during a contraction. Forceps are an instrument that is shaped like a pair of spoons or tongs and is used to slide on the sides of a baby’s head and face while a vacuum extraction is a procedure where a soft or rigid cup is applied to the top of the baby’s head.
Why would a mother need a vacuum extraction or forceps during labour?
A doctor may decide to opt for a vacuum or forceps based on many factors. The most common reasons to turn to assisted vaginal delivery would be because the baby isn’t coming fast enough (this is termed a prolonged second labour stage), changes to the baby’s heart rate (fetal distress), and because the mother is experiencing maternal fatigue or exhaustion.
What can cause trauma from the vacuum during delivery?
A vacuum cup is placed on the top of the baby’s head during delivery. Vacuum extraction can cause cuts or wounds on the scalp, cephalohematoma, bleeding in the brain or retina, and neurological injury.
What can cause trauma from forceps during delivery?
Forceps are placed on the sides of a baby’s head to help guide a baby through the birth canal. Forceps can cause wounds on the face or eyes, nerve injury on the face, skull fracture, intracranial hemorrhage, and subgaleal hematoma.
Is the use of a vacuum or forceps always a sign of medical malpractice?
No, there are many appropriate reasons an obstetrician would use a vacuum extractor or forceps during delivery to help guide the baby out of the birth canal during delivery. If there are complications such as fetal distress or prolonged labour then the use of an instrument can provide relief to the mother and baby.
Contact Experienced Obstetrical Malpractice Lawyers
If you, or a loved one, had a delivery where forceps or a vacuum was used and you have concerns about the medical care you received labour and delivery or the medical care provided to your baby we invite you to contact the birth injury lawyers at BILA for a free consultation. BILA has dedicated lawyers throughout Canada who are experienced and can help your family.
