Vacuum Extraction: Is It Safe?

Please tell me about the use and safety of vacuum extraction during labor.

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

The use of a vacuum extractor (and forceps) for delivery of the fetal head is termed an "operative delivery." The rate of operative deliveries in the U.S. has fallen dramatically since the early 1970s. Concurrent with the decline in the rate, however, has been a rapid increase in the cesarean delivery rate.

Forceps deliveries were and are associated with an increased risk of maternal injury (lacerations, hematomas), hemorrhage, infection and fetal injury. The introduction of the vacuum extractor in the 1970s was meant to be a safer method for delivery of the fetal head. A vacuum extraction, however, is not without risks and cannot be used in all cases where forceps were once (and are) used. The fetal head must be lower and manipulations such as flexing or rotating the head are more difficult or impossible with a vacuum. On the other hand, there are fewer cases of maternal trauma and hemorrhage when the vacuum is used. Jaundice and eye hemorrhage are more frequent with vacuum extraction. Cephalhemotomas (blood under the scalp) are more common as well. Lacerations and blisters on the scalp also occur.

As in all interventions, a vacuum should never be done by inexperienced providers or in lieu of cesarean if a judgement is made that this is required. It is used only when the head is low, to facilitate the last few minutes of the birth in cases of late fetal distress or maternal fatigue or inability to push effectively (after other remedies have been attempted).

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