Vacuum Extraction Delivery

What is vacuum extraction delivery?

Vacuum extraction (or vacuum-assisted delivery) is one way obstetricians can assist with the delivery of your baby while you’re pushing. During the pushing stage of labor, sometimes things slow down. You’re pushing, but your baby isn’t coming out. This can last for hours without much progress. While you’re in labor, your healthcare team will monitor your vital signs and your baby’s heart rate for signs of fetal distress. If you or your baby’s health is in danger or labor isn’t progressing, your healthcare team may look for other ways to deliver your baby.

Vacuum extraction is one such option. The vacuum extractor consists of a suction cup attached to a pump. The cup is applied to your baby’s head while the pump provides traction to pull while you push.

In the United States, vacuum extraction accounts for about 3% of vaginal births.

What are the indications for vacuum extraction delivery?

Your healthcare team may suggest vacuum extraction if:

• You’ve been pushing for a long time, but the baby isn’t coming out
• Your baby’s heart rate isn’t within the normal range (110 to 160 beats per minute)
• You’re too tired or have a health problem that keeps you from pushing

What can we try first?

Before using a vacuum, your healthcare team may try to:

• Help you change positions
• Give you oxygen through a mask
• Give you fluids through an IV

If these steps don’t help, your healthcare team may recommend an assisted delivery method like vacuum extraction or forceps delivery.

What are the contraindications?

Sometimes, you might need assistance, but vacuum extraction isn’t the right choice. This might be true if your baby:

• Is premature
• Is breech
• Hasn’t moved down low enough in the birth canal
• Might be too big to fit through the birth canal
• Has a bleeding disorder

How does a vacuum extraction work?

Your pregnancy care provider will explain the risks and benefits and ask for your consent before starting. If needed, they’ll give you pain relief. Sometimes, they may also need to cut the area between your vagina and anus (called an episiotomy) or break your water.

Your provider will place the suction cup on your baby’s head. When your next contraction starts, they’ll gently pull while you push. The suction adds extra help to get your baby out. Once your baby’s head is out, they remove the cup. Then, your provider helps guide the rest of your baby’s body out with their hands.

When should attempted vacuum extraction be abandoned?

Your providers will stop using the vacuum extractor if any of the following are true:

• It’s been attempted and was unsuccessful
• The cup has unintentionally detached from your baby’s head three times
• There’s any sign of trauma to your baby’s scalp

What happens after this procedure?

Once your baby has been completely delivered, your healthcare team will check you and your baby for any signs of wounding from the procedure. If you had a tear or an episiotomy, they’ll repair it for you. They’ll continue to monitor your baby for any signs of complications that might arise.

If vacuum extraction is unsuccessful, your healthcare team may recommend a C-section next.

What are the potential benefits and risks of vacuum extraction?

Vacuum extraction can help deliver your baby without putting you through surgery. It’s also faster than surgery, which is sometimes very important.

Risks to the mother from vacuum-assisted delivery are similar to the risks of childbirth, in general. They include:

• Vaginal tears
• Postpartum bleeding
• Difficulty peeing or incontinence

Short-term side effects of vacuum extraction for the baby can include:

• Caput succedaneum. This is when your baby’s scalp swells into a cone-like shape. It gets better in a few days.
• Bruising / jaundice. The vacuum extractor can cause bruising of the scalp, which increases your baby’s risk of jaundice. This condition produces a temporary yellowing of your baby’s skin. It usually goes away in a few weeks.
• Cephalohematoma. This is a collection of blood between your baby’s scalp and skull, caused by damaged blood vessels. It doesn’t affect their brain and typically heals in one or two weeks.

Serious complications for your baby are rare. They can include:

• Skull fracture. Newborn skulls are soft and can easily get injured. Most fractures are small, heal on their own and cause no long-term damage. More severe fractures can cause brain bleeding.
• Intracranial hemorrhage. This is bleeding either in or around the brain. Brain bleeds are rare but can be serious. Less commonly, the bleeding can put pressure on the brain, causing brain damage.
• Subgaleal hemorrhage. This occurs when the emissary veins in your baby’s head are ruptured, and blood accumulates within the connective tissue between their skull and scalp. Typically, it gradually develops during the days after delivery.

How long does it take to recover from a vacuum-assisted delivery?

If there are no complications, you’ll recover in about six weeks (typical recovery time for a vaginal delivery).

If your baby has any of the common short-term side effects of vacuum delivery, such as bruising, jaundice or scalp swelling, these will improve over the next few weeks. Take extra care to protect your baby’s head while it heals, and make sure to bring them in for follow-up checkups with their pediatrician.