Forceps vs. Vacuum Delivery: How the Decision Is Made and When It Raises Red Flags

When labour becomes too strenuous, doctors usually turn to assisted delivery tools. Forceps or a vacuum extractor can help guide the baby through the birth canal. Both methods can help ease birth during labour when used appropriately and safely under the right circumstances.

But delivery complications can occur when these tools are used incorrectly. If used too aggressively, it can lead to physical injuries and long-term health complications.

For families who had complications that led to a birth injury due to assisted delivery, the truth provides better insights into what happened and what should have been done differently.

How Doctors Decide Between Forceps and Vacuum Delivery

Both forceps and vacuum extractors are used during the second stage of labour. After pushing has begun, the baby might sometimes need help to complete a vaginal delivery.

Forceps are similar to a pair of large tongs that are used to cradle a baby’s head. A vacuum extractor is a device that uses a suction cup attached to the scalp to apply gentle traction as the mother pushes.

The decision on which device to use depends on a number of factors:

• How far has the baby descended into the birth canal?
• How is the baby’s head positioned?
• Urgency of the situation.

Overall, a forceps delivery has a higher chance of success for completing a vaginal birth. The downside is that it can easily cause severe tearing and other types of trauma for the mother.

A vacuum delivery may be appropriate in different circumstances and generally involves different risks for the mother and baby than a forceps delivery. But it has its own set of risks, such as a scalp injury from the suction.

The choice depends on the circumstances of the delivery, the position of the baby, the stage of labour, and the experience of the healthcare provider. It should take into account the conditions of the mother and the baby, along with all the risks, benefits, and alternatives.

The Risks Involved With Each Method

There are no risk-free tools. Even properly performed procedures can lead to complications. The nature and severity of the complication can, however, provide key insights.

When it comes to a forceps delivery, common issues that might appear include facial bruising or lacerations and nerve damage that affects the face. In rare cases, skull fractures can even occur. Mothers have a high risk of getting severe perineal tearing, which leads to long-term pelvic floor issues.

A vacuum delivery, on the other hand, poses a different risk entirely. Babies can experience bruising, swelling, or scalp lacerations that would heal without lasting effects. However, more serious injuries like brain bleeds, skull fractures, and nerve damage can also happen.

The risk of injury may increase when the vacuum is applied repeatedly, excessive force is used, or the procedure continues beyond recommended limits. 

When the Decision and Its Execution Raise Red Flags

It is important to know that not all delivery complications that happen through assisted delivery are a result of malpractice. But some circumstances can justify closer scrutiny, such as:

• Repeated attempts with a vacuum extractor after it detaches (pop-offs) without switching to another method.

• Continued use of forceps or vacuum despite noticeable signs that the baby is not descending.

• Failing to properly pinpoint the baby’s position or the mother’s pelvis before attempting an assisted delivery.

• Continuous use of force or prolonged traction beyond what the guidelines allow.

• Choosing assisted delivery when a C-section may have been more appropriate..

• Improper monitoring of the baby afterdelivery and delaying the recognition and treatment of an injury.

• No clear communication about the risks involved, leaving the family unable to truly give informed consent.

On their own, none of these necessarily point to negligence. It is a different matter when a serious injury follows one or more of these warning signs. These circumstances may raise questions about whether the care provided met the appropriate standard of care. 

Why are cases of delivery complications difficult to evaluate?

Whether an assisted delivery was handled appropriately or not is determined by medical record reviews. These include fetal monitoring strips, delivery notes that document the approach used in delivery, and the newborn’s condition immediately after birth. It also requires that medical experts give their own input on if the provider’s action met the standard of care for the specific situation.

This is not something a family can handle on their own. Medical records are complicated, dense, written in clinical shorthand, and sometimes incomplete when it comes to explaining the reason a decision was made. For these reasons, a legal and medical team becomes very important. With a review of the medical records and expert evidence, it may be possible to determine whether the injury could have been prevented or whether a different approach would have changed the outcome. 

Sommers Roth & Elmaleh: Choosing the Right Team to Find the Truth

If a complication followed a vacuum or forceps delivery, it is normal to want answers about why it happened. At Sommers Roth & Elmaleh, we acknowledge how staggering it can be to relive traumatic moments in your life. This is particularly true when also trying to determine if your child’s injury could have been avoided.

Our expert team works hand in hand with trusted medical experts to review the delivery record. We help you determine if delivery complications are a result of a doctor or nurse’s failure to meet the accepted standard of care.

Over the years, we have represented families across Ontario in complex birth injuries and medical malpractice claims. Some of the cases we have handled include a compensation award of $12 million for failure to order a cesarean section and recovery of funds to rebuild after a family lost a newborn to the actions of the Labour Delivery Unit.

Are you looking to discuss delivery complications involving a loved one? Sommers Roth & Elmaleh are committed to helping you pursue the accountability and compensation your family deserves. Reach out to us at 1-844-940-2386 or online here.