Vacuum Extractor Delivery: Serious Potential Risks Involved

Just as every pregnancy is unique, so is the labor and delivery process. The length of time it takes to deliver a baby varies from one woman to the next. In some cases, labor and delivery can begin and end in just a few short hours, while for other women it can take a full day or more. In other cases, the delivery process is unusually difficult. Some deliveries get to a certain point, and then labor fails to progress. When this happens, a physician or other healthcare provider may choose to use an instrument to assist in the delivery. One such device is called a vacuum extractor. A delivery that utilizes a vacuum extractor is often known as an assisted delivery, operative delivery or vacuum extractor delivery.

A vacuum extractor uses a small, soft cup that is applied to the top and back of the baby’s head. A tube runs from the cup to a vacuum pump that provides suction. During a contraction, the physician pulls or applies gentle traction to the baby’s head while suction from the vacuum assists in pulling the baby’s head out of the birth canal so the baby can be delivered.

Vacuum extractors can be very useful tools when used properly and in the appropriate circumstances. However, when used incorrectly or when not indicated, vacuum extractors can be dangerous and cause birth trauma. In fact, the Food and Drug Administration (FDA) cited its concerns in a Public Health Advisory on vacuum-assisted delivery devices:

“This is to advise you that vacuum assisted devices may cause serious or fatal complications…While no instrumented delivery is risk free, we are concerned that some health care professionals who use vacuum assisted delivery devices, or those who care for these infants following delivery, may not be aware that the device may produce life-threatening complications.”

To minimize the risks, vacuum extractions should not be performed when the baby is less than 34 weeks gestation, the baby is too large or the mother’s pelvis is too small, the baby’s head is too far up the birth canal, the baby requires rotation or repositioning in order to be delivered, or the mother is not fully dilated. A cesarean section may be the safer choice in these instances.

As with any medical device, there is a correct and incorrect method for using a vacuum extractor. The cup must be placed on the baby’s head about 3 centimeters back from the soft area of the skull called the anterior fontanel. This placement avoids injury to the baby. The diagram below illustrates the correct placement.

Because a baby’s head is so fragile and susceptible to injury, it is critical that the cup is placed in the right location. Incorrect placement can result in significant and permanent brain damage. The diagram below shows locations where the cup should not be placed. The physician performing the vacuum extractor delivery must have experience using vacuum extractors. Likewise, the practitioner’s technique used to pull the baby out is equally important. Twisting the head or neck, pulling too hard, or pulling for longer than 10 to 15 minutes should be avoided as they can injure the baby. Also, if the vacuum pops off 3 times during use, the physician should move on to C-section to deliver the baby.

When vacuum extractors are used improperly or if errors are made by medical professionals during a vacuum extractor delivery, birth injuries can occur. These range from minor bruising and lacerations to devastating and permanent brain injuries. Some of the most common are listed below:

• Skull fractures
• Retinal hemorrhages
• Brachial plexus injuries/Erb’s Palsy: This occurs when the brachial plexus (a group of nerves to the arms and hands) is injured. It frequently occurs in births involving shoulder dystocia (difficulty delivering the baby’s shoulders). As a result of this type of injury, the baby cannot flex and rotate its arm. Sometimes the injury resolves itself. However, if the nerve is torn, there may be permanent damage.
• Brain hemorrhages or bleeds: Probably the worst potential complication of a vacuum extractor delivery is a subgaleal brain hemorrhage. The vacuum ruptures a vein which bleeds into a space between the scalp and skull. This condition is life-threatening with a mortality rate as high as 20%. About 90% of all subgaleal hemorrhages are related to vacuum extraction. This type of bleeding is most likely to occur with excessive force, prolonged cup application, or if forceps are also used. This often leads to neurological impairments and cerebral palsy.
• Hypoxic ischemic encephalopathy (HIE)
• Prolonged NICU stays
• Seizures
• Brain damage
• Cerebral palsy
• Hemiparesis

Symptoms including lethargy and seizures may occur within hours of a vacuum extractor delivery and are usually indicative of a serious brain injury.

For more information on the potential injuries and warnings issued by the FDA, please see “FDA Public Health Advisory: Need for CAUTION When Using Vacuum Assisted Delivery Devices.”