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Forcep and Vacuum-Assisted Deliveries

Occasionally, labor and delivery do not go according to plan and the baby needs a little help emerging into the world. In these situations, a doctor may choose to use either a vacuum or forceps to gently pull the baby through the birth canal. But how safe are these procedures and what do you need to know before you go into labor?

According to the U.S. Centers for Disease Control, forceps or vacuum were used in 5.2 percent of deliveries in 2004. The two most common reasons a birth may require the assistance of forceps or a vacuum are when the baby becomes distressed and its heart rate indicates he or she needs to be delivered immediately, and during prolonged labors when the mother is so exhausted she cannot push any more.

If an assisted delivery becomes necessary, your doctor will decide whether to use forceps or a vacuum based on several factors, including the position of the baby's head, his or her condition, as well as your doctor's level of training and experience. Before using forceps or a vacuum, your doctor will break your membranes (if they haven't ruptured already) and drain your bladder with a catheter. You may also be given a pudendal block or epidural as insertion of the forceps or vacuum can be painful.

Forceps are designed with spoon-like ends, called blades (although they are not sharp), specially suited to holding your baby's head, with shanks to give the forceps more length, locks for articulation, and handles. The forceps are inserted into your vagina on either side of your baby's body and then the handles are locked together. Your doctor will pull gently while you push during contractions to ease your baby through the birth canal. Forceps may cause bruising or small cuts to your baby's head, which will heal in a few days, and you may experience tearing of your cervix, vagina, perineum and anal sphincter.

To avoid the use of forceps in your delivery, avoid epidural anesthesia if possible. Often, when a laboring woman receives an epidural, she cannot feel what she is doing or her contractions, making her pushing ineffective. An epidural also makes alternative, more effective, pushing positions (such as squatting) impossible.

In some cases, the use of a vacuum extractor is the best way to help your baby be born. Your doctor will place a flexible cup that is connected to an electric or manual suction pump on your baby's head and will gently pull as you push with a contraction. Babies born with the assistance of a vacuum may have a raised bruise, or cephalohematoma, on the top of their head that will heal in a couple of weeks, and you may experience tears in your vagina, perineum and anal sphincter.

Vacuum and forcep deliveries do carry an increased risk of injury to your baby, such as nerve damage, intracranial hemorrhage (bleeding into the brain), skull fractures, and subgaleal hemorrhage (bleeding between the scalp and skin). A recent study conducted by obstetricians at the University of California, Davis, found that intracranial hemorrhage occurred in 1 in 860 vacuum extraction deliveries and 1 in 664 forcep deliveries, as compared to 1 in 1,900 spontaneous deliveries and 1 in 907 c-section deliveries. However, when necessary, both methods are considered safe and effective for an assisted delivery when used properly by trained and experienced medical professionals.