Have you heard about vacuum-assisted birth? As the labor progresses, near the end of the pushing stage, sometimes mother and baby require additional support. This is called assisted birth.
As the mother pushes, the doctor or nurse who attends to the delivery will carefully help the baby’s head out through the birth canal. Approximately one in eight women have to undergo assisted birth. This can be either vacuum-assisted or forceps-assisted.
What Is A Vacuum Assisted Birth?
The vacuum-assisted birth is a procedure in which the doctor uses Ventouse (vacuum extractor) to help the baby out of the birth canal. The doctor attaches this instrument to the baby’s head through suction. This instrument is Ventouse. A cup that is usually of soft plastic or metal and connects by a tube to the suction device.
The cup firmly fits the baby’s head. As the mother pushes through the next contraction, the doctor will gently apply a small amount of suction to the baby’s head and assist the baby’s head through the birth canal. Vacuum-assisted delivery is not performed in case of preterm delivery specifically if the delivery happens before the 34th week, as the baby’s head will be too soft during that time.
When Does One Need A Vacuum Assisted Birth?
The doctors choose vacuum-assisted delivery if:
- The mother is physically exhausted after pushing for a long time as in the case of prolonged labor.
- The baby is in a difficult position to deliver naturally. This often happens if the mother has received an epidural.
- Epidural not only makes the mother deliver painlessly, but it also makes the mother feel fewer contractions than usual thus making pushing ineffective.
- It also affects the action of the pelvic muscle that helps to turn the head and shoulder of the baby into the preferred position during delivery.
- The mother has some health issues that require her to stress less and therefore has to limit the time of pushing
- The baby is distressed. The baby may not be receiving enough oxygen, which can increase the risk of brain damage
The team plans a vacuum-assisted birth only if the hospital has the facility to carry a C-section. This is because if the vacuum assistance fails, C-section might be the only option.
Types Of Ventouse Cup Or Vacuum Extractors
There are different types of ventouse that vary in size and material which is used for the ‘cup’ portion of the instrument. The selection of the size and type of the cup depends on several factors like:
- The size of the baby’s head
- The position of the baby’s head
- How far has the baby’s head come down the birth canal?
The most common type of vacuum extractors are:
Metal cup
As the name implies, the cup is metal. It also has the shape of a mushroom. The diameter of this cup varies from 40 to 60 mm. The doctor choose metal cup when the baby’s head is higher in the birth canal. This type of vacuum extractor helps with more difficult delivery like brow presentation or in occiput posterior (OP) position (back of baby’s head facing mother’s back) or in case of a distressed baby.
Also, the doctor may choose the metal cup if the full dilation (7cm dilation is enough) fails to happen. The benefit of using this type of ventouse is its higher success rate over the semi-rigid cup and a soft cup. The disadvantage is that it increases the chances of fetal scalp injury
Semi-rigid Cup
This type of suction cup is of flexible plastic. This is softer than the metal cup and more rigid than the soft cup. Doctors opt for a semi-rigid cup in similar conditions as a metal cup. The benefit of using this cup is that it lowers the chances of fetal scalp injury than the metal cup. The disadvantage of this type of suction cup is that it is less successful than the metal cup.
Soft Cup
Made of hard, but flexible, rubber or silicone. The medical team uses this cup only if the baby’s head is relatively low in the birth canal. The main disadvantage is its lower success rate. As said earlier, it can only be successful if the baby is very low and needs only little assistance to pull the baby’s head through the birth canal.
However, this cup is very difficult to correctly fit a baby’s crown if the baby is higher in the birth canal, or the baby is in an OP position
When Is A Vacuum Assisted Birth Possible?
There are certain prerequisites for the possibility of vacuum-assisted birth. Some of them are:
- The water breaking happens
- The cervix must dilate at least 7cm
- The baby must be in a head-down position only
- The crown of the baby’s head must reachable
- The head should be favorably down in the birth canal
When Is A Vacuum Assisted Birth Not Recommended?
The doctor will not choose vacuum-assisted birth:
- If pregnancy has not crossed the 34th-week mark.
- If the baby has undergone fetal scalp sampling (a procedure used to affirm whether fetal oxygenation is adequate).
- Once the baby’s head has not descended halfway through the birth canal.
- If the baby has some health condition with a bleeding disorder like hemophilia.
- If the pelvis of the mother is small for the baby to come through.
- The baby is not in a head-down position.
- If the baby has a health condition affecting the skeletal strength.
What Are The Risks Of Vacuum Assisted Birth To The Mother?
Most of the risks associated with vacuum-assisted delivery to the mother can happen during the normal vaginal birth too. Here are some common risks comes with vacuum-assisted delivery to the mother:
Pelvic Organ Prolapse
This happens when the vacuum birth weakens the ligaments and muscle that holds up the pelvic organs
Urinary Incontinence
Unintentional urine leakage can happen as a result of vacuum delivery. This can be rectified by physiotherapy
Anal Incontinence
If a third or fourth-degree tear occurs during vacuum-assisted delivery, anal incontinence (involuntary defecation) can happen
Pain in Perineum
Pain in the perineum after delivery is common in vacuum-assisted delivery
What Are The Risks Of Vacuum Assisted Birth To The Baby?
The baby born through vacuum-assisted birth can have both significant and minor issues. Some of the commonly found risks are:
Chignon
The swelling that happens in the shape of a cone to the area where the suction cup attaches is chignon. The swelling will resolve within two to three days. Besides, it is an indication of successful vacuum delivery.
Cephalohematoma
It refers to the accumulation of blood in the space under the fibrous covering of skull bone. It is a relatively harmless condition and will resolve within a couple of weeks when the baby’s body reabsorbs the blood.
Subgaleal Hematoma
This is one of the most dangerous complications of vacuum-assisted delivery. This potentially life-threatening condition happens as a result of the accumulation of blood in a relativity larger area of the skull just beneath the scalp.
A lot of blood loss can happen this way. This happens due to significant damage that occurs in the veins under the scalp. This takes place when the suction is not strong enough to pull the baby’s head and instead it pulls the scalp.
Neonatal Jaundice
Neonatal jaundice occurs when the level of bilirubin increases as a result of the breakdown of RBC. This risk is due to its increased chances of blood vessel damage during vacuum suction. Thoughbaby’s body reabsorbs most of the blood, the breakdown of blood results in increased production of bilirubin.
As the baby’s liver (which removes bilirubin from the body) is still developing, it may not be able to deal with the increased bilirubin, and as a result, the baby suffers from neonatal jaundice.
Intracranial Hemorrhage
It is a very rare condition that comes with vacuum-assisted birth. However, it can lead to harmful long-term side effects like speech loss, memory loss, etc. Depending on the part of the brain that gets affected. It is basically the hemorrhage that happens inside the skull.
Retinal Hemorrhage
Due to the pressure placed on the baby’s head, retinal hemorrhage, which is bleeding behind the eyes, can happen after vacuum-assisted birth. It usually resolves without further complications.
Clavicle Fracture and Injury to Brachial Plexus
This happens when the collarbones and brachial plexus get stuck or are wrongly placed in the birth canal. In this case, there will be excess pressure as the vacuum pulls out the baby’s head through the birth canal.
