Vacuum delivery
What It Means For You and Your Baby
A vacuum delivery is a modified normal delivery where uterine pressure that expels the baby is supplemented with a vacuum extractor. This equipment applies pressure on the head resulting in a pulling effect, and helps to expel the baby from the mother’s birth canal. It is as if, literally, the uterus needs a little help!
When and why is a vacuum delivery done
Mother’s Health
A pregnant mother’s health conditions for example, the presence of heart disease, may require careful handling during delivery because the mother may be at risk. Second-stage labour, where a mother is required to push the baby out, exerts increased pressure on the cardiovascular (heart and blood) system which may lead to a fatal heart condition.
Care is also necessary in a situation where the mother has severe anaemia-deficiency in haemoglobin, the red protein containing iron in blood-or low levels of red blood cells. Labour can lead to heart failure in women with severe anaemia.
To prevent the above risks, most obstetricians prefer to assist the expulsion of the baby with a vacuum extractor so that the heart does not undergo the full rigours of labour.
Prolonged Labour
During second-stage labour, the cervix (neck of the uterus which opens into the vagina) opens, a process known as dilation. Dilation may at times take unacceptably long. Determining whether labour is prolonged or not is a subjective decision which depends on the observations of the doctor or medical attendant. This is because one may not be totally certain at which point the mother actually attained full dilatation. In general, however, if the baby does not come out an hour after full dilation this is considered to be prolonged labour. The mother or baby or both risk getting exhausted and may end up with complications upon birth, or even risk death. Vacuum extraction can then assist to quickly conclude the labour.
Foetal Distress
During delivery the baby may get distressed and a Caesarean section may not be a reasonable option. For instance, if a mother has achieved full dilation and the head of the baby has descended to quite some extent but the exit is slow, it makes sense for the doctor to hasten the delivery by performing a vacuum extraction.
Abnormal Position
A vacuum delivery may also be performed when the head of the baby is oriented in an abnormal position while exiting the birth canal. In normal circumstances the baby faces the ground, while in some abnormal situations the baby faces the sky when the woman is lying down.
Poor Maternal Effort
When a mother is unable to push out the baby, due to exhaustion, this is referred to as poor maternal effort. The doctor or midwife will make first-hand assessment of the mother’s ability to get the baby out, and may opt to ‘assist’ the mother by applying vacuum extraction.
What are the risks during vacuum delivery?
There are major advantages of vacuum delivery because it is applied where the mother’s or baby’s health or life is believed to be at risk.
However, complications arise if the diagnosis that led to a vacuum delivery was inaccurate or vacuum extraction was an inappropriate solution. For example, prolonged labour may be an indication (symptom) of a maternal passage that is smaller than the baby requires and a vacuum extractor forces the head of the baby to come out through an outlet that is inadequate. This may injure the baby or become fatal. In such a case a Caesarean section would have been more appropriate.
If one performs a vacuum delivery incorrectly, for instance by applying the cap of the vacuum extractor on maternal tissues instead of the baby’s head, it can harm the mother by causing genital tears.
Vacuum delivery is contraindicated (meaning medically prohibited) in certain situations. First, is when the foetal size and the maternal passage are disproportional. Second, in the case of malpresentation, a vacuum extraction can be performed only if the baby’s head presents first. Vacuum extraction cannot be done on the buttocks of a baby. Third, if the baby’s head is too high in the birth canal, a vacuum delivery is not recommended. This is because the extraction efforts could fail, fatally injure the baby and put both mother and baby at risk.
Almost all babies who have a vacuum delivery will have a temporary swelling on the scalp where the cap was applied. But this is not a major problem as it resolves within a day or two.
Major complications depend on the skill and efficiency of the care provider in accessing the delivery and conducting the vacuum. extraction. A failed vacuum procedure means the patient will need a Caesarean section.
What are the effects to mother and baby?
There ought not to be any significant effect on either mother or baby if the vacuum extraction was appropriate for the situation and was performed well.
Genital tears for the mother may occur if the vacuum extractor is wrongly, accidentally or inadvertently applied on the genital tissues instead of on the baby’s head.
In very rare cases, the baby may have brain damage.
You can have some internal bleeding or a clot just beneath the scalp. This area is called Cephalo haematoma, on which the cap of the vacuum extractor is placed. It is not within the brain (scalp is the soft tissue on top of the skull).
Can subsequent deliveries be normal?
It does not automatically follow that one vacuum delivery leads to all subsequent deliveries being assisted by vacuum. It all depends on the reasons why the vacuum extraction was necessary.
If the indication was malpresentation of the baby, one should not assume that the next baby will present poorly. If the reason was a maternal disease, it depends on whether the same disease is present in subsequent deliveries. A vacuum delivery is determined on a case by case basis upon the advice of the doctor or midwife at the time of delivery.
What kind of vacuum extractors exist?
There are minor differences in the types of vacuum delivery equipment in use. The caps used to apply pressure on the head of the baby may be metallic or plastic. The older machines have metallic caps while current machines have a plastic cap which tends to fit better on the baby’s head. Some of the older machines need to be pumped manually to generate the vacuum pressure. Current equipment generate pressure automatically by just pressing a knob.
These are minor differences that do not substantially influence the outcome.
What treatment is given to the baby after vacuum delivery?
It is not necessary to medicate the baby primarily because of a vacuum procedure unless the doctor has other concerns. Likewise, it is not necessary to place the baby in an incubator. How the baby is managed after delivery depends on the doctor’s assessment of every individual delivery.
END:PG 05 FEB-MAR 07/45-46