Just after delivery: forceps vs. vacuum in vaginal assisted deliveryShare on Pinterest
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For 9 months (give or take), your little one has been growing in the cozy warmth of your body. So, when it’s time to bring them into the world, sometimes they don’t want to come out without a few challenges.

This is true when your baby is in your birth canal, yet needs some assistance to make it out the rest of the way. At this time, you may hear your care provider ask for special tools, such as a vacuum or forceps.

Honestly? Forceps look like long and large metal spoons that you may not totally believe are a real medical instrument — but they have a specific structure and purpose.

They’re a metal instrument that your care provider may use to guide your baby’s head through the birth canal during a difficult delivery. Medical professionals specifically designed forceps to cradle baby’s head while also applying traction.

Ideally, this helps baby continue to move through your birth canal and into your arms.

When doctors use forceps (or a vacuum), they call this an “assisted” or “operative” delivery because they needed a little extra help to make the delivery happen.

A doctor must be specially trained in using these tools because they require skill and careful techniques.

During the pushing stage, a doctor may use forceps timed with your contractions to help your baby make their world debut.

A vacuum used during delivery isn’t the same as a household vacuum, but it does involve applying a soft suction device to a baby’s head.

The vacuum has a handle that allows your doctor to gently guide your baby’s head through the birth canal. The combination of the suction and traction help move the baby’s head.

Both assisted delivery methods aren’t used during a routine delivery. However, either may help you to have a vaginal birth if your labor isn’t progressing as your doctor would hope.

If your baby can’t pass through, your doctor may need to perform a cesarean delivery.

There are many considerations and risk factors that go into a doctor’s decision to introduce the idea of a vaginal assisted delivery.

Here are a few factors surrounding either the pregnant parent, the baby, or both.

What’s required for an assisted delivery?

Certain situations need to be present during delivery to consider an assisted delivery. The use of forceps or vacuum should only be used to help with labor when it can be done safely. Otherwise, a cesarean delivery is likely the better option.

Here are some considerations for a vaginal assisted delivery:

  • The birthing parent must be fully dilated.
  • The presentation of the baby must be known (the position baby is facing) and the baby’s head should be engaged (meaning baby’s head has dropped down into the pelvis). Baby’s head must be low enough in the pelvis for the forceps or /vacuum to be used.
  • The membranes must be ruptured, either spontaneously or by a healthcare provider.
  • The pregnant parent’s bladder must be empty.
  • Consent from the birthing parent is required. You’ll always get to decide if the proposed procedure is right for you.

Special circumstances

An assisted delivery may be considered in special circumstances such as when the birthing parent has a medical condition where it is not safe to push, such as with heart disease.

What could prevent an assisted delivery?

Here are some reasons why a doctor may avoid an assisted delivery:

  • If baby is estimated to be larger, the doctor could consider not using a vacuum or forceps. In this instance, the tools may increase the likelihood that baby could get wedged in the birth canal and have a shoulder dystocia.
  • If baby has any health conditions such as bleeding disorders or bone disorders, applying suction to baby’s head with a vacuum would not be recommended.
  • A vacuum would not be applied to a baby who was in breech or transverse positions.
  • Forceps may be used for breech position, but vaginal delivery of breech babies are becoming more and more uncommon due to the risk of birth injury.

A doctor won’t typically use a vacuum if your baby is less than 34 weeks’ gestation. This is because there are increased risks for side effects, especially bleeding, when using a vacuum before this time.

They also won’t usually use a vacuum if your baby has a “face” presentation, which means your baby’s head and neck is extended too far back as it tries to pass through your birth canal.

The use of a vacuum during delivery has become more common than forceps. That’s because a vacuum generally requires less anesthesia and pain-relieving medications than forceps.

A vacuum is associated with less risk for a needing a cesarean delivery when compared to forceps.

It’s also associated with less risk to the person giving birth.

Like any procedure, there are possible side effects of using either a vacuum or forceps.

Vacuum extraction has higher failure rates than using forceps. When a vacuum extraction isn’t effective, a Cesarean delivery may be needed.

Also, vacuum-assisted delivery can increase the risks for certain complications. These complications include:

  • retinal hemorrhage: when there is bleeding in the blood vessels of the baby’s retina.
  • cephalohematoma: a collection of blood between the skull bones and tissue of a baby’s head.
  • scalp wounds: swelling or cuts on the baby’s head and scalp.
  • jaundice: yellowing of the skin and eyes.
  • intracranial hemorrhage (bleeding in the skull): although it’s rare, this bleeding can affect speech and memory.

Doctors who are classically trained or who’ve been practicing for many years are more likely to use forceps than vacuum extraction as an approach to delivery.

Because vacuum use is much more common, some doctors don’t get the same training on forceps and, as a result, may not use forceps.

When trained on them, doctors can also usually use forceps faster than attaching a vacuum, which is good when quick action is needed.

Use of forceps has less risk of cephalhematoma than the use of a vacuum.

Forceps aren’t a perfect tool either.

Just as vacuum-assisted delivery can cause complications, so can forceps. Forceps deliveries are associated with greater risk of facial nerve damage when compared to vacuum assisted deliveries.

Forceps also carry a risk of retinal hemorrhage and cephalhematoma.

In a 2020 study more women encountered pelvic floor trauma when they had a delivery assisted with forceps versus a vacuum. Similarly, a 2009 journal article noted that vacuum-assisted deliveries were associated with fewer perineal injuries than the use of forceps were.

If perineal tearing happens, it can be repaired. However, this can extend your recovery time.

When it comes to labor, there are only so many things you can control. It’s hard to predict if you’ll need forceps or a vacuum for delivery, but if you do, it’s often in a situation when your baby is in distress and fast, effective action is needed.

One of the best ways to ease your concerns is to talk to your doctor at one of your appointments before your delivery. Getting all the info in a lower-stress situation can help if a higher-stress one occurs on delivery day.

Here’s a few questions you can ask your doctor about vacuum or forceps:

  • At what point might you use a device like forceps or vacuum in delivery?
  • Do you typically use forceps over vacuum or vice-versa?
  • What are some of the ways we can reduce the need for forceps or vacuum?
  • What are some of the risks to me and my baby with either delivery approach?
  • If an assisted delivery is chosen, what can I expect after?

It’s important to remember that while each option has risks and side effects, your doctor is using them to prevent other complications, which can include significant distress and health problems with your baby.