By Giles Manley, MD, JD
CPFN Medical Advisor

When a mother is unable to deliver a child on her own, assistive equipment may be used to help speed the birthing process. Because the need for vacuum extraction (VE) is always a possibility during childbirth, parents need to be aware of what it entails and what questions to ask of their doctor.

Vacuum extraction is a mechanical means of helping a baby move down the birth canal. It involves attaching a suction cup to the scalp of the baby, while it’s still in the womb, and then pulling gently. The need may arise if labor has gone on for too long, the mother is exhausted, or fetal monitoring shows the baby isn’t getting enough oxygen and needs to be born more quickly.

Because a baby’s head is fragile, the suction cup can cause minor injuries, such as bruising or cuts, or even pull the head out of shape. These conditions usually clear up in a month or so. More serious injuries can also occur, including subgaleal hemorrhage (bleeding between the scalp and the skull), direct trauma to the skull or brain, or severe shoulder injury.

Questions Parents Should Ask Their Doctor

A couple’s obstetrician should go over the topic of vacuum extraction prior to delivery. At this time, the parents should ask about the OB’s experience with deliveries that involve vacuum equipment or forceps. In experienced hands, forceps are safer if the station of the baby is not very low. Parents should ask to be informed as soon as possible about the possibility of such a procedure becoming necessary.

Should the need for vacuum-assisted delivery arise, the doctor should review the pros and cons of the procedure and why he or she thinks it is necessary. At this time parents should:

• Ask “What station is my baby?” Unless at least plus two, and preferably plus three, a vacuum should not be used.
• Ask that if the procedure isn’t effective within 2-3 pulls, mechanical extraction be discontinued in favor of a C-section.
• Request that the hospital prepare for a C-section immediately, in case it is needed.
• Make sure that the child is evaluated at birth and re-evaluated later for signs of injury.

By knowing what questions to ask about the procedure, expectant parents can better advocate for their child. As a practicing obstetrician for 20 years, I know that attentive parents often have the effect of making doctors and nurses more attentive as well.