During childbirth, doctors and other care providers should know many ways to assist both mother and child if something starts to go wrong. One of these methods is a vacuum-assisted delivery, or vacuum extraction. This procedure may be recommended to speed up a delivery, but there are risks the parents should know about before making the decision. It’s also essential that best practices for a vacuum extraction be followed to keep mother and child as safe as possible. Here’s what you need to know.
When Do Vacuum Extractions Occur?
A vacuum extraction is often one of the alternatives considered to a Caesarean section (c-section). When the infant’s heartbeat shows they are under stress, or if health concerns like heart problems in the mother mean pushing for an extended period isn’t safe, a vacuum extraction may be preferred over surgery.
According to the Mayo Clinic, there are also certain times a vacuum extraction should not be considered.
- When the baby’s head isn’t halfway down the birth canal, or the position isn’t known
- Breech deliveries or situations where shoulders, arms, buttocks, or feet are leading the way
- The infant is known to have a condition that affects bone strength or a bleeding disorder like hemophilia
- Mother is less than 34 weeks pregnant
- The size of the mother or the baby means the baby might not fit out the mother’s pelvis
In these situations, vacuum extractions are more likely to cause injury or fatal harm to the mother, infant, or both. If a doctor or other caregiver carries out a vacuum extraction in these situations, they would certainly be contributing to any resulting injuries by not following best practices.
What is the Process of a Vacuum-Assisted Delivery?
In a vacuum extraction, a cup made of either soft or hard plastic is inserted into the vagina and placed against the baby’s head. The doctor must check to ensure none of the mother’s tissue is trapped between the head and the cup. Then, as the mother pushes during each contraction the doctor may increase the vacuum suction to try and guide the baby out of the birth canal. This process is extremely delicate and frankly, not easy.
Initially, the cup has to be correctly placed on the baby’s head, in front of the soft spot. If the cup is placed too far forward or back, that could be another instance of medical negligence. Then the doctor must know when and how to lessen the suction, only use an appropriate amount of vacuum, and many other considerations.
Doctors should also know when to abandon the procedure and advise a C-section. Forceps should never be used to compensate for a failed vacuum-assisted delivery. It is up to the care provider to have the training and experience to perform the procedure. If the doctor goes ahead without adequate training, they may not even realize their conduct is not up to the standards of care other doctors would follow. A birth injury attorney will explore these standards of care and other decision making when determining if negligence contributed to a vacuum extraction injury.
Birth Injury Risks from Vacuum-Assisted Delivery
One risk of infant head injury from vacuum extraction is the risk of infant bleeding under the scalp. These are considered some of the most serious risks from vacuum extraction and are very often caused when the doctor is negligent in reducing the suction at the right time.
In some birth injuries from vacuum extraction, the scalp might be partially or fully separated from the baby’s skull by the vacuum. This causes veins and blood vessels to be damaged. Because the space under the scalp is so large, a lot of bleeding can occur. If this goes unnoticed or is just chalked up to bruising, the infant can even bleed to death after a negligent vacuum extraction.
Vacuum extraction can also cause bleeding inside the skull when the doctor is negligent in the amount of suction and how long the forces are applied. This can cause the baby to have loss of memory, speech, or movement, which may not show up for years after the procedure. Or, bleeding inside the skull may even cause wrongful infant death. According to data collected by the FDA and the State of California, infant bleeding inside the skull occurs in approximately 1/860 vacuum extractions. This is opposed to 1/1900 occurrences in natural delivery. In cases where both vacuum extraction and forceps were used, this bleeding occurred in 1/280 cases.
All these types of bleeding could also be accompanied by fractures in the skull. After a vacuum extraction, it is essential the baby is closely examined for these and other injuries and monitored to make sure all is well in the hours and days after the vacuum extraction. Because these are known risks, it would be an act of negligence by the doctor or nurses to overlook these concerns and then find there was an injury. Another risk factor of note is the increased risk of infant shoulder dystocia birth injury when compared to vaginal deliveries as studied by the National Library of Medicine.
Risks to Mother from Vacuum Extraction
As with the infant, mothers also face a risk of severe bleeding during and after a vacuum extraction. If the doctor is negligent in the placement of the cup or uses too much force, the mother can be harmed just as easily as the child.
A negligently-performed vacuum extraction can injure a mother through otherwise unnecessary pain or rips in the perineum or genital tract. The urethra, bladder, and bowels of the mother can also be injured when best practices during vacuum-assisted delivery aren’t followed. This leads to either difficulty urinating or incontinence depending on how the injury to the mother was inflicted. These symptoms and related conditions like fistula can present months to years after the delivery.
A 2009 5-year follow-up with 228 women who delivered by forceps or vacuum extractor found that 47% experienced urinary incontinence, 44% reported more urgent bowel habits, and 20% experienced active loss of bowel control. In cases where the baby’s head is against the mother’s back, the risk of anal sphincter injury to the mother by a vacuum extraction is increased 4-fold.
If a doctor doesn’t take these risks into account and performs a vacuum extraction without following best practices, they may be responsible for the resulting injuries. Caregivers should review these risks and explain additional factors before expecting a woman to consent to a vacuum-assisted delivery.
It is estimated that 5% of deliveries, or 1 out of every 20, will rely on vacuum extraction or forceps. Parents and especially mothers deserve to know these risks of complications for days, months, and years after delivery. They are also entitled to discuss the procedure with the care provider. You have a right to understand the doctor’s vacuum extraction experience and qualifications before giving consent.
In cases where a vacuum-assisted delivery is not the best procedure, or where the caregiver doesn’t have the experience necessary to conduct the operation safely, the impact on the lives of patients can be permanently affected. If you or a loved one suffered a birth injury due to vacuum extraction, the birth injury attorneys at Christie Farrell Lee & Bell want to help you move forward in life with peace of mind. Contact one of our Indianapolis medical negligence lawyers today at 317-488-5500 or send us a message online to share your story.