During vacuum-assisted vaginal delivery, your doctor uses a vacuum device to help guide your baby out of the birth canal. The vacuum device, known as a vacuum extractor, uses a soft cup that attaches to your baby’s head with suction.
As with any other procedure, there are risks associated with vacuum-assisted delivery. Even normal vaginal deliveries can result in complications in both the mother and the baby. In most cases, the vacuum extractor is used to avoid a cesarean delivery or to prevent fetal distress. When performed properly, vacuum-assisted delivery poses far fewer risks than cesarean delivery or prolonged fetal distress. This means the mother and the baby may be less likely to have complications.
The vacuum extractor has been used extensively in recent years, and the risks of vacuum-assisted delivery have been well-documented. They range from minor scalp injuries to more serious problems, such as bleeding in the skull or skull fracture.
Superficial scalp wounds
Superficial scalp wounds commonly occur as a result of vacuum-assisted deliveries. Even after a normal vaginal delivery, it’s not unusual to see swelling in a small area of the scalp. During delivery, the cervix and birth canal put a lot of pressure on the part of your baby's head that moves through the birth canal first. This results in swelling that can give your baby’s head a cone-shaped appearance. The swelling may be located on the side of your baby’s head if their head is tilted to one side during birth. This swelling typically goes away within one to two days after delivery.
The original vacuum extractor, which has a metal cup, may produce cone-shaped swelling on the top of your baby’s head. This is called a chignon. The chignon formation is essential to the success of the delivery. The swelling usually goes away within two to three days.
Occasionally, the placement of the cup causes a slight discoloration with the appearance of bruising. This is also resolved with no long-term consequences. Some vacuum extractors still use rigid suction cups, but this is rare. Today, most vacuum extractors have newer plastic or Silastic suction cups. These cups don’t require the formation of a chignon and are less likely to cause swelling.
Vacuum-assisted deliveries may also cause small breaks in the skin or cuts on the scalp. These injuries are more likely to occur during difficult deliveries that are prolonged or that involve multiple detachments of the suction cup. In most cases, the wounds are superficial and heal quickly without leaving any lasting marks.
A hematoma is the formation of blood under the skin. It usually happens when a vein or artery becomes injured, causing blood to seep out of the blood vessel and into the surrounding tissues. The two types of hematoma that can occur as a result of vacuum-assisted deliveries are a cephalohematoma and a subgaleal hematoma.
Cephalohematoma refers to bleeding that’s confined to the space under the fibrous covering of the skull bone. This type of hematoma rarely leads to complications, but it typically takes one to two weeks for the collection of blood to go away. A child with cephalohematoma usually doesn’t need extensive treatment or surgery.
Subgaleal hematoma, however, is a more serious form of bleeding. It occurs when blood accumulates just under the scalp. Since the subgaleal space is large, a significant amount of blood can be lost in this area of the skull. This is why subgaleal hematoma is considered to be the most dangerous complication of vacuum-assisted delivery.
When the suction isn’t strong enough to move your baby’s head through the birth canal, it pulls the scalp and the layer of tissue just under the scalp away from the skull. This causes major damage to the underlying veins. The use of the soft plastic suction cup has decreased the incidence of these injuries. Although subgaleal hematoma is fairly rare, it’s a life-threatening condition.
Intracranial hemorrhage, or bleeding inside the skull, is a very rare yet serious complication of vacuum-assisted delivery. The suction applied to your baby’s head may damage or injure the veins, causing bleeding in your baby’s skull. Although intracranial hemorrhage is rare, when it does occur, it can lead to loss of memory, speech, or movement in the affected area.
Retinal hemorrhage, or bleeding in the back of the eyes, is relatively common in newborns. The condition usually isn’t serious and goes away quickly without causing complications. The exact cause of retinal bleeding isn’t known. However, it might be a result of the pressure placed on your baby’s head as it passes through the birth canal.
Skull fracture | Skull fracture
Bleeding around the brain may be accompanied by a skull fracture, though there may be no outward signs of intracranial hemorrhage or hematoma. There are several classifications of skull fractures. These include:
- linear skull fractures: thin hairline fractures that do not deform the head
- depressed skull fractures: fractures that involve an actual depression of the skull bone
- occipital osteodiastasis: a rare type of fracture that involves tears to the tissue on the head
Neonatal jaundice, or newborn jaundice, may be more likely to develop in babies that are delivered by vacuum extraction. Jaundice, or the yellowing of the skin and eyes, is a common condition in newborns. It occurs when babies have a high level of bilirubin in their blood. Bilirubin is a yellow pigment produced during the breakdown of red blood cells.
When vacuum extractors are used to deliver your baby, a very large bruise may form over their scalp or head. Bruising occurs when there’s damage to the blood vessels, causing blood to leak out and form a black-and-blue mark. The body eventually absorbs the blood from the bruise. This blood breaks down and produces more bilirubin, which is normally removed from the blood by the liver. However, your baby’s liver may be underdeveloped and unable to remove bilirubin efficiently. When there’s excess bilirubin in the blood, it can settle in the skin. This causes a yellowish discoloration of the skin and eyes.
Although jaundice usually goes away on its own within two to three weeks, some babies with the condition may require phototherapy. During phototherapy, your baby is kept under a high-intensity light for one to two days. The light changes bilirubin into a less toxic form and helps the body get rid of it more quickly. Your baby wears protective glasses throughout phototherapy to prevent eye damage. Your baby may need blood transfusions to decrease the levels of bilirubin in the bloodstream if they have a severe case of jaundice.