Overview of Vacuum Extraction
Operative vaginal delivery is a type of childbirth method used when it becomes necessary to speed up the birth process for the well-being of the mother or the baby. This method can involve either the use of vacuum extraction or forceps delivery. The choice between the two often depends on what the doctor is most comfortable with and what is suitable for the patient’s circumstances.
Some reasons for choosing operative delivery could be that the mother is very tired, the baby’s heart rate is not normal, the birth is taking too long, or it’s important to make the second phase of labor quicker due to certain health conditions the mother might have, like heart problems or neurological diseases. However, it’s not advised to use vacuum delivery for a baby that isn’t at least 34 weeks yet.
Anatomy and Physiology of Vacuum Extraction
In order to use the device correctly, the mother’s cervix, which is the lower part of the womb, needs to be fully opened. The baby’s head should be positioned properly in the birth canal, which is the pathway the baby travels through during birth. The baby should not be born prematurely, there should be no prior procedures like scalp sampling on the baby, and there shouldn’t have been an unsuccessful attempt at delivery using forceps, which are a tool used to assist in delivery. If the procedure fails, the delivery may have to be completed via a cesarean section, which is a surgical operation to deliver a baby.
The mother’s bladder should be empty. The medical facility needs to have the ability to perform an emergency cesarean section if the attempts to deliver the baby with the assistance tool are unsuccessful.
Why do People Need Vacuum Extraction
During childbirth, sometimes the doctor might assist the delivery using special tools in a procedure known as operative vaginal delivery. Before this can take place, certain conditions, or prerequisites, must be met:
- The cervix, or the entrance to the uterus, needs to be fully open.
- The baby’s protective membrane (the ‘water bag’) should have broken.
- The baby’s head needs to have moved into your pelvis and be facing the correct way.
- The doctor should have estimated the weight of your baby beforehand.
- The doctor believes your pelvis is large enough for a vaginal birth.
- You should have sufficient pain relief, often through an epidural.
- The bladder should be empty.
- You must be aware of the procedure and consent to it.
- There should be a backup plan if the operative vaginal delivery fails, usually being a cesarean section, or C-section.
Once these conditions are met, the doctor will classify the type of operative vaginal delivery according to how much the baby’s head has moved down into your pelvis and how much it needs to be rotated during extraction:
Outlet delivery:
- Your baby’s head can be seen at your vaginal opening without the need to open the labia.
- The baby’s skull has reached the bottom of your pelvis.
- The head is at the level of the opening of the vagina or on the skin between the vagina and anus (the perineum).
- The baby’s skull is positioned so that the long axis is in the same direction as your body’s long axis, or slightly turned to the right or left.
- Orientation of the baby’s head does not need correcting by more than 45 degrees.
Low delivery:
- The highest point of the baby’s skull is well inside your pelvis but not at the bottom of it yet.
- Rotation of up to 45 degrees may be required, while more rotation may sometimes be necessary.
Mid delivery:
- The baby’s head has entered your pelvis, but not progressed as far as in a low delivery.
When a Person Should Avoid Vacuum Extraction
In certain situations, a vacuum cannot be used to help speed up delivery due to specific conditions the baby may have. These conditions include blood disorders like hemophilia, neonatal alloimmune thrombocytopenia, and Von Willebrand’s disease, which may cause abnormal bleeding in the baby. There are also bone conditions like osteogenesis imperfecta, which makes the bones extremely fragile.
Additionally, using a vacuum for delivery is not advised if the pregnancy is less than 34 weeks along. Before deciding to use a vacuum, the doctor should check that none of these conditions are present and should make sure that the patient agrees with the plan for their care.
Equipment used for Vacuum Extraction
Vacuum extractors are now more commonly used than forceps to help with vaginal births. When compared to the traditional metal-cup vacuum extractors, the soft-cup versions are not only easier to handle, but they also result in fewer injuries to the baby’s scalp during birth. However, they do have a downside as they tend to come off more frequently.
It’s essential to understand that while vacuum extractors can be helpful, they can also lead to injuries in newborn babies. Therefore, these devices should only be used when really necessary, such as when the baby’s heart rate is worrying or when labor isn’t progressing during the second stage. To lower the chances of complications, doctors are highly recommended to be aware of conditions that could make the use of the vacuum unsuitable. Moreover, doctors should have proper training and hands-on experience before using a vacuum extractor for vaginal delivery.
Who is needed to perform Vacuum Extraction?
During a vacuum-assisted vaginal delivery, there should be a doctor and at least one other helper. They will work together to help the mother give birth. Additionally, there should be other medical workers on standby. They come in if the baby needs extra help, known as ‘resuscitation’, right after being born. This means they’ll make sure the baby starts breathing and keeps warm right from birth.
How is Vacuum Extraction performed
In order to deliver a baby using a method called operative vaginal delivery, a vacuum cup is attached to the baby’s head. This cup is placed in the center of the head, a bit behind the forehead. It shouldn’t be placed directly on the soft spot (fontanelle) on the baby’s head. If it is placed properly, it can help guide the baby’s head to turn, move down, and bend in a way that minimizes the risk of injury to both the baby and the mother.
Before turning on the suction, the doctor will sweep a finger around the cup to make sure it has direct contact with the baby’s head and that no vaginal or cervical tissue is in the way. Once they’ve checked it’s in the right position, the suction can be started. The vacuum’s pressure is turned up to the ideal level, typically indicated with a green zone on many devices.
The doctor then uses their stronger hand to gently pull the cup in a downward direction along the curve of the mother’s pelvis. At the same time, the other hand is used to monitor the baby’s descent and to keep the cup from falling off by counter pressing the cup. This pulling action is done during contractions and when the mother is pushing. When the baby’s head is visible (crowning), the suction is switched off, and the cup is detached. The delivery is then finished in the typical way.
Sometimes, the cup might fall off during the delivery attempts. If this happens, the doctor might try again. However, if it falls off more than two or three times, it might be safer for the mother and the baby to deliver the baby through a C-section, which means making a surgical cut in the mother’s belly and uterus to deliver the baby.
Possible Complications of Vacuum Extraction
Complications that can occur in mothers after delivery include worsening of vaginal tears and pain in the sphincter (the muscle that allows the anus to close) and vagina.
Newborns can also face some complications such as cuts on the scalp, a bruise on the head filled with blood (called a cephalohematoma), bleeding inside the skull, bleeding in the retina (a layer at the back of the eye), a high amount of a substance called bilirubin in the blood (called hyperbilirubinemia), and injuries to the nerves.
Although these complications are generally rare, it’s estimated that bleeding inside a newborn’s skull after a vaginal delivery that required the use of medical tools happens in about one out of every 650 to 850 live births.
What Else Should I Know About Vacuum Extraction?
When a baby’s birth needs a little extra help, doctors might use tools like forceps or a vacuum device. They often check how things are going during the birth process and if it’s not progressing well, they may suggest switching to a cesarean section, which is a surgery to deliver the baby.
Certain movements, like rocking or twisting, should be avoided during these kinds of assisted deliveries because they can potentially harm the baby.
There’s no hard and fast rule for how long it’s safe to try to use a vacuum extractor, or how many times the cup (attached to the baby’s head) can come off before it’s considered unsafe. Most doctors would recommend a limit of three rounds of pulling and no more than two to three times for the cup coming off. They also suggest keeping the total time using the vacuum to between 20 to 30 minutes.
Switching between forceps and the vacuum in the same delivery is generally not advised as this could harm both the baby and the mother.
Vacuum extractors and forceps aid in delivery in different ways. Vacuum extractors are easier to use, speed up delivery, cause less damage to the baby’s face and head, and are less painful and traumatic for mothers. They also require fewer anesthetics. On the other hand, forceps use can potentially cause fewer injuries to babies such as skull bone bruising, bleeding in the eye, or temporary nerve damage affecting eye movement. Forceps have a higher success rate in achieving vaginal childbirth.
