What Are Forceps, Vacuum and Assisted Births?

We’ve previously blogged about a study recently published by the Canadian Medical Association Journal (CMAJ) which shows a rise in injuries related to forceps and vacuum use during child birth. This week we explore these delivery methods in more detail and outline when and why forceps and/or vacuums may be used, and when these methods are not appropriate.

Assisted Births

An assisted birth, also known as an operative vaginal birth or an instrumental birth, uses either forceps or a vacuum to assist a baby to be pulled out of the birth canal.

How a Forceps Delivery Works

Forceps are a stainless steel medical instrument which are most commonly described as resembling large sugar tongs or salad tongs. They have curved ends that cradle a baby’s head. There are actually several different types of forceps that can be used in a delivery.

During a forceps delivery, a physician or other health care provider will apply the forceps to the baby’s head. In order to apply the forceps, the doctor may make a cut to the back of the mother’s vagina (called an episiotomy) in order to enlarge the opening so that the forceps can enter.

Once the forceps are around the baby’s head, the doctor will (gently but firmly) pull on the forceps while the mother is pushing during a contraction to help ease the baby down the birth canal. The doctor should not yank the baby or apply too much force or pressure.

Forceps births have been noted to result in a higher success rate than vacuum births, but are also more likely to result in damage to a mother’s perineum or pelvic floor as compared to a vacuum birth.

How a Vacuum Delivery Works

A medical vacuum extractor consists of a cup with a handle for gripping onto and pulling on, attached to a small vacuum pump. The cup is applied to the back of a baby’s head and, like forceps, is used to assist the baby in coming through the birth canal.

There are several different types of vacuums and vacuum cups, including:

• Soft plastic cups;
• Semi-rigid plastic cups;
• Metal cups.

The type of cup used during a delivery will depend on how a baby is positioned during birth, and how difficult the OB-GYN or other health care provider believes a birth is going to be.

During a vacuum delivery, a physician or other health care professional will place the vacuum cup on the baby’s head while it is still in the birth canal. The air will then be sucked out of the cup with a pump (creating a vacuum). Once the cup is secure, the mother will push on her next contraction, and the doctor will simultaneously pull on the cup. Again, the doctor should not yank the baby or apply too much force or pressure.

Many physicians prefer to use a vacuum rather than forceps in assisted births as the process tends to be less painful for the mother. With a vacuum delivery, women are less likely to require an episiotomy (i.e. a surgical cut made at the opening of the vagina during childbirth) and there is a lower risk of perineal tearing. A cephalohematoma may appear on the baby’s head following the use of vacuum.

If a vacuum delivery is unsuccessful, a doctor may then attempt using forceps before finally resorting to a c-section.

Why Assisted Births Occur

Assisted births may be recommended in situations such as where:

• A mother is pushing but her labour is not progressing (i.e. where a labour is “stalled”);
• A mother can only push for a limited period of time due to an underlying health condition, such as a heart condition;
• There is a change to or a problem with the baby’s heartbeat;
• The baby is facing up (occiput posterior position) instead of down (occiput anterior position).

Assisted births will only be considered once a mother meets certain criteria:

• Her cervix is fully dilated;
• Her membranes have ruptured;
• The baby has entered the birth canal headfirst; and
• The baby is low enough in the birth canal.

Assisted births should only be attempted in a hospital where an emergency c-section can be carried out, if needed. Generally, where an assisted birth is recommended, a c-section is also offered as an alternative option.

When Assisted Birth Should Not Be Attempted

Doctors will caution against an assisted birth if:

• The position of the baby’s head is unknown;
• The baby’s shoulders or arms are leading the way through the birth canal; or
• The baby may not be able to fit through the mother’s pelvis due to the size of the mother and/or the size of the baby.

How Can a Medical Malpractice Lawyer Help?

Children or mothers injured due to medical error or negligence during childbirth, including injuries suffered during assisted births, may be entitled to compensation for their injuries and can bring an obstetric malpractice claim to recover damages.

At Sommers Roth & Elmaleh, we consider obstetrical negligence/obstetrical malpractice to be our ‘sub-focus’. We have recovered millions of dollars for clients affected by birth injury, as demonstrated by the cases we have successfully litigated. A consultation with our team is completely free– you pay us nothing unless we win.