Vacuum Assisted Delivery: What Is It And How Is It Done

When the baby cannot be pushed out normally during a vaginal delivery, the doctor may try an assisted delivery method. One such birth method is the vacuum-assisted delivery, which is the most favored option.

You may have heard about the vacuum method, but do you know how the process is carried out? MomJunction tells you more about the vacuum-assisted vaginal delivery method and how it impacts the mother and the baby.

What Is A Vacuum-assisted Delivery?

Vacuum-assisted birth is a type of operative vaginal delivery that makes use of a vacuum or a vacuum extractor to assist in bringing the baby down from the birthing canal. The vacuum uses a soft plastic cup, called the ventouse, which is connected to a suction device with a handle. The doctor, or the midwife assisting the labor, uses the handle to bring the baby out of the birthing canal (1).

Keep reading to know how the procedure is carried out during delivery.

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How Is A Vacuum-assisted Vaginal Delivery Done?

When you are trying to push the baby out during labor, and the cervix gets fully dilated, an epidural is given or numbing medicine is placed inside the vagina to block the pain. The ventouse is then inserted into the vagina in such a way that it firmly fits the baby’s head.

As the mother pushes, the doctor will apply a little suction to the baby’s head to pull it gently and let it pass through the birthing canal.

A vacuum-assisted birth is carried out only if (2):

  • The water breaks and the baby’s head is engaged in the pelvis
  • The cervix is fully dilated with the baby in a vertex position (fetal head station must be ≥ 0/+5)
  • No placenta previa
  • Ideal fetal weight is 2,500–4,500g. Also, the fetal head attitude and presence of caput succedaneum and molding must be noted.

Over the years, there have been many developments in how the vacuum extractors are made. Read here about the most common varieties of extractors used.

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[ Read: Positions For Labor To Ease The Pain ]

What Are The Different Types Of Vacuum Extractors Used?

The different types of vacuum extractors used during the assisted method of delivery include (3):

  1. Metal cups: The instrument uses a mushroom-shaped metal cup with a diameter ranging from 40 to 60mm. It is connected to a detachable handle through a chain that centrally attaches to the cup. The handle is connected to a vacuum port through which the traction is supplied electrically or manually.

A metal cup is advantageous in pulling out a baby that is in occiput posterior (OP) position. However, it could result in fetal scalp injury, and also make the procedure uncomfortable and difficult owing to the hardness of the cups.

  1. Semi-rigid cup: The cup is made of flexible plastic and is used under similar conditions as that of metal cups. Using a semi-rigid cup decreases the chances of fetal scalp injuries. However, it has a lower success rate compared to the metal cups.
  1. Soft-cups: This bell or funnel-shaped cups are fabricated from hard but flexible silicone or rubber material. It has a built-in vacuum release valve that helps attain the desired pressure rapidly and can be controlled accurately. Moreover, soft cups are disposable and reusable. But the soft cups have a lower success rate and can be used only if the baby lies very low in the birthing canal. If the baby lies higher or in the OP position, it becomes difficult to attach the cup properly on the baby’s head.

Usually, a cup is chosen based on three factors:

  • The size of the baby’s head.
  • The position of the baby’s head.
  • Where the baby’s head lies in the birthing canal.

The advantages of using vacuum extractors include:

  • Easy to handle
  • Less maternal genital trauma
  • Quick delivery
  • Less maternal discomfort
  • Less anesthesia required
  • Fewer neonatal craniofacial injuries

This assisted delivery method can be used only when certain criteria are fulfilled.

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[ Read: How To Push During Delivery ]

When Does One Need A Vacuum-assisted Birth?

Before carrying out a vacuum-assisted delivery, the doctor will check how far down your baby is in the birthing canal. This helps them to place the cup and use the traction carefully.

A vacuum-assisted delivery becomes necessary when the cervix is completely dilated and help is needed to pull the baby out. The reasons for vacuum-assisted delivery include (2):

  • Prolonged second stage of labor (if it prolongs for three hours with regional anesthesia or two hours without anesthesia).
  • You are exhausted after pushing and can no longer do it.
  • The baby shows distress and needs to be pulled out earlier.
  • If you are at risk due to any medical condition or complication, and you need to avoid stressing yourself by pushing.
  • A nonreassuring fetal heart tracing.
  • If the mother has cerebrovascular or cardiac disease, then maternal expulsive efforts need to be avoided (3).

If the baby’s head is too high, then a C-section will be recommended by the doctor.

There are specific conditions when the doctor may not go for a vacuum-assisted delivery. Read on to know what they are.

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When Is Vacuum-assisted Birth Not Recommended?

A vacuum-assisted delivery is not recommended in the case of:

  • Fetal prematurity (< 34 weeks with estimated fetal weight < 2,500g)
  • Active bleeding or suspected fetal coagulation defects
  • Abnormalities of labor
  • Incomplete cervical dilatation
  • Non-vertex presentation or other malpresentation (such as breech, transverse lie, brow, face)
  • Fetal bleeding disorders (like alloimmune thrombocytopenia, hemophilia)
  • Inadequate anesthesia
  • Fetal demineralizing diseases (osteogenesis imperfecta)
  • Intact fetal membranes
  • Not fulfilling the requirements of operative vaginal delivery
  • Unengaged vertex
  • Getting no consent from the patient for the procedure
  • Fetal macrosomia (if fetal weight ≥ 4,500g)
  • Suspected cephalopelvic disproportion
  • Uncertainty on fetal position
  • In the case of prior scalp sampling or multiple attempts of fetal scalp electrode placement, which is done to monitor the fetal heart rate when external monitoring becomes unsatisfactory (4).

The medical interventions certainly bring down the incidence of any complications during delivery. But, there are risks involved with these methods.

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[ Read: How To Manage Occiput Posterior ]

What Are The Risks Of Vacuum-assisted Birth?

When correctly applied, this method poses fewer risks. However, in some cases, there may be some risks for the mother and the baby (1, 5):

Risks for the mother (2):

  • Tear in the vagina or on the perineum.
  • Increased risk of maternal trauma and anal sphincter injury, if the fetus is in the occiput posterior position.
  • Urinary and fecal incontinence (loss of bowel control)
  • Pain in the immediate postpartum period
  • Pelvic organ prolapse and fistula formation

Risks for the baby:

  • Subgaleal hemorrhage: The blood accumulates in a larger portion of the skull, under the scalp, due to improper suction. Infants may have a swelling crossing the suture lines, a boggy scalp, and an expanding head circumference. They might also have the signs of tachycardia, pallor, hypovolemia, and a falling hematocrit. This condition occurs in about 1 to 3.8% of vacuum extraction cases.
  • Scalp lacerations and swelling: Small breaks in the skin or cuts on the scalp caused due to multiple detachments of the suction cup. These wounds quickly heal without leaving any marks. The suction uses a lot of pressure to pull the baby’s head, which results in a swelling giving a cone-shaped appearance to the head. This goes away in one or two days after birth.
  • Cephalohematoma (2) (6): It occurs in 14-16% of vacuum-assisted deliveries. It happens when bleeding occurs between the skull and the membrane beneath the skin.
  • Intracranial hemorrhage (bleeding inside the skull): It is found to occur in one out of every 860 vacuum-assisted deliveries.
  • Retinal hemorrhages (bleeding in the back of the eyes): It occurs most commonly with vacuum-assisted deliveries and is associated with prolonged labor. It resolves within a few weeks.
  • Transient neonatal lateral rectus paralysis: It occurs more frequently and in around 3.2% of vacuum-assisted deliveries. It resolves voluntarily.
  • Brachial plexus injuries (7): It is associated with nerve damage.
  • Developmental delays (8): Delays in the development of gross motor skills, fine motor skills, language skills, cognitive ability, and social skills.
  • Cerebral palsy (9): An injury to the brain that causes impairment of movement and motor functions.
  • Chignon: A swelling caused in the area where the suction cup is attached. It gets resolved within two to three days.
  • Neonatal jaundice (10): It occurs when the blood accumulated by the breakdown of the blood vessels, caused due to vacuum extractor, is reabsorbed by the baby’s body. This results in increased production of bilirubin. It adds to the burden of the baby’s liver, which is still not fully developed, hence leading to neonatal jaundice.
  • Shoulder dystocia: This happens when the baby’s shoulder gets stuck behind the mother’s pelvic bone due to an improper vacuum pull.

To avoid these risks, you have to try and minimize the need for a vacuum-assisted birth. Next, we tell you about the measures to avoid vacuum-assisted delivery.

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[ Read: Causes Of Placenta Previa ]

How To Avoid A Vacuum-assisted Birth?

Here are a few tips you can follow to avoid assisted vacuum birth:

  • Stay healthy and fit.
  • Ensure that the baby is in an optimal position, with the help of an ultrasound scan.
  • Take enough rest before labor, since you will need energy during labor.
  • Avoid lying on your back and stay upright during the labor.
  • Eat well and keep yourself dehydrated to reduce the chances of exhaustion.
  • Learn about the active positions of labor such as squatting, lunging, and kneeling.
  • Avoid taking epidural as it can prolong the labor and you may not be able to feel the contraction or push when you need to.

Learn more about the assisted delivery method in the FAQs section next.

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Frequently Asked Questions

1. What can you expect after a vacuum-assisted delivery?

The perineal tears or bruising after vacuum-assisted delivery can be painful, making it difficult for you to sit or walk for some time. The swelling and pain due to the perineal tear will be there for a few weeks. The tear may heal on its own or in the case of stitches it may take a few more days for you to get relief from the discomfort.

2. How to relieve the swelling and pain of perineal tears?

Here are some tips to relieve the discomfort of the perineal tear (11):

  • You can take ibuprofen and acetaminophen for pain relief.
  • Apply an ice pack, cold gel pack or cold pack on the affected area.
  • Sit in a bathtub with your bottom immersed in cold water.
  • Use sanitary napkins with hazel pads for the cooling effect.
  • Use squeeze bottles to spray warm water on the perineum while you go to the bathroom. This makes urination less painful.
  • You can use a numbing spray or cream after consulting your doctor.
  • Use pillows or special cushions while sitting.
  • Add more fiber to your diet and drink plenty of water to avoid constipation as it can be painful.

[ Read: Normal Delivery Vs Cesarean ]

3. Are there any chances of a repeat assisted vaginal delivery in future pregnancies?

There is an increased chance for a vacuum-assisted delivery in a subsequent pregnancy if the method was used in the previous pregnancy. Also, a pregnancy gap of more than three years or a larger fetus size can lead to assisted vacuum delivery.

With the advancements in the medical procedures, there are more assisted vaginal delivery options or techniques today. Vacuum-assisted delivery is the most sought after operative vaginal delivery method across the globe owing to its effectiveness.

However, talk to your doctor about the technique and stay well informed about it, so that you can decide whether or not you should go for it.

Do you have any experiences to share? Share with us in the comments section below.

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