Vacuum extraction involves the use of a medical instrument to assist in a vaginal delivery. A vaginal delivery will need the assistance of vacuum extraction when the mother fails to deliver her baby following the appropriate management of the second stage of labor. Or when, there are signs of fetal distress during the second stage of delivery and the baby needs to be delivered immediately because there are signs showing that there is an increasing risk for fetal hypoxia. Other indications for resorting to vacuum extraction are fetal compromise as a result of conditions such oligohydramnios preceding labor, placenta abruption and cord entanglement. In deciding to do vacuum extraction, the following factors must be present:
- the infant’s head is deeply engaged (at least zero station)
- the mother’s cervix is fully dilated
- the position and station of the baby’s head is identified with certainty
- there is adequate maternal analgesia
- facilities are present for neonatal resuscitation
- the mother’s bladder is empty
Vacuum extraction-assisted delivery should never be resorted to if the following conditions are present:
- fetal malpresentation such as the baby is in breech position
- prematurity with gestational age less than 37 weeks
- prior fetal scalp sampling
- mid-pelvic delivery
Vacuum extraction is done using a medical device equipped with a suction cup that is placed on the infant’s head and provides traction that helps pull the baby’s head out of the vaginal canal. Once the baby’s head is out, the suction cup is removed and the mother delivers the baby by herself. However, the pressure provided by the suction cup can lead to birth injuries.
While already doing vacuum extraction, the process and even vaginal delivery should be abandoned if there is still difficulty in delivering the infant. Other means of delivery should be considered if there is no descent with traction, the infant is not delivered after three or four traction, the cup pops off once or twice and vacuum extraction has already been attempted for 30 minutes.
Potential complications associated with vacuum extraction delivery are scalp injuries such as bruising and hematoma; large caput succedaneum; subgaleal hemorrhage; cephalohematoma; intracranial hemorrhage such as subdural, subarachnoid, intraventricular and cerebral; skull fracture; seizure disorder; anemia; metabolic acidosis; hypotension; shock and disseminated intravascular coagulation; hyperbilirubinemia; shoulder dystocia; clavicular fracture; brachial plexus paralysis; subconjunctival hemorrhage; retinal hemorrhage and fetal/neonatal death.
Birth injuries associated with the use of vacuum extraction are often serious, thus the medical practitioner must weigh carefully the risk of having the procedure against the urgent need to deliver the baby. However, the injuries listed above have also been known to be associated with babies born without the assistance of instruments. The fact remains that vacuum extraction should only be attempted by a qualified and experienced medical practitioner to avoid birthing traumas.