Vacuum Delivery

What is Vacuum delivery?

Assisted vaginal delivery, where a small suction cup is placed on the babies head and the doctor applies gentle traction, while the mother pushes on during her contractions. Suction helps the baby to pass through the birth canal.
It is only performed to facilitate birth if a medical reason exists, and is safe.

When can Vacuum delivery be safely performed?

• The cervix is completely dilated.
• The baby’s head has dropped down into the pelvis.
• It is clearly understood where the baby is located.
• The membranes get damaged completely.
• Usually at or after 34 weeks of pregnancy, when the baby gets mature enough.

What is the procedure performed for Vacuum delivery?

A procedure that is performed to deliver a baby through the birth canal when labour is not progressing or the baby needs a quick delivery. A soft or hard suction cup is placed on the babies head, and slight traction is offered during the contractions, while the mother still pushes.

Step-by-step procedure:

Pre-procedure assessment

Healthcare provider verifies before vacuum delivery that: –

• Cervix is completely dilated.
• The membranes have ruptured.
• The baby’s head is positioned in the pelvis.
• The position of the baby is known (head down).
• It is not suspected that the baby is too big for the mother’s pelvis (cephalopelvic disproportion).
• It does not have any contraindications, including an unengaged fetal head or some fetal bleeding disorders.
• The mother is informed about the benefits, risks and alternatives and informed consent is obtained.

Preparations

• The mother is sitting on her back in the lithotomy position.
• Fetal heart rate monitoring is done continuously.
• If needed, the bladder is emptied through the use of a catheter.
• Good pain management is provided (epidural or local anaesthesia).
• Sterile precautions are followed.
• Newborn resuscitation equipment is available if the baby needs resuscitation at birth.

The arrangement of the Vacuum Cup.

• The right vacuum cup (soft silicone or hard metal cup) is chosen.
• The cup is slowly pushed down the vagina.
• It rests on the flexion area of the baby’s head (some 3 cm ahead of the posterior fontanelle on the sagittal suture of the head).
• Proper positioning allows the head to remain flexed and prevents trauma.

Creation of Vacuum

• The provider inspects thoroughly to make sure no part of the mother’s vaginal or cervical tissue is caught under the cup.
• The required negative pressure is created before the onset of traction.

Assisted Delivery

• Only gentle, controlled traction is used when there are uterine contractions.
• As the mother pushes, she is encouraged to push at the same time with each contraction.
• Traction is along the natural curve of the birth canal.
• Between contractions, the vacuum is maintained, and the traction is turned off.
• The provider re-evaluates progress after every pull.
• Involve the Head in the delivery.
• Head traction decreases as the baby’s head crowns.
• After the head is delivered, the vacuum is turned off, and the cup is pulled out.
• The shoulders are then delivered, and the remainder of the body is delivered by regular vaginal birth.

Safety of the mother and the baby

• At 1 minute and 5 minutes, the Apgar score is used to determine the newborn condition.
• Scalp bruising, scalp lacerations, cephalohematoma or other injuries are checked on the baby scalp.

The mother is checked for:

• Perineal tears
• Rupture of the vagina or cervix. Rupture of cervical or vaginal tissues.
• Postpartum haemorrhage.
• The placenta is delivered, and any tears are mended if necessary.

What are the benefits of Vacuum delivery?

Some advantages include:

• Prevents some women from undergoing an emergency caesarean section.
• Shortens the pushing phase of labor.
• Can alleviate fatigue in mothers.
• If the baby shows signs of distress, it allows for faster delivery.
• Generally, leads to a faster recovery than caesarean delivery.
• Fewer days in hospital than surgery.
• Reduced risk of surgical complications in suitable cases when compared to caesarean delivery.
• Vacuum delivery can then be an option for a safe birth when needed, and can be an important choice to make.

What are the possible risks of Vacuum delivery for the Mother?

Possible maternal complications are:

• Tears to the vagina or perineum.
• Pain and swelling around the birth canal.
• Excessive bleeding during childbirth (postpartum bleeding).
• Pelvic Infection (rare).
• Urethral difficulty (UDU) is a temporary condition.
• Weakness of the pelvic floor muscles.
• Sitting causes pain for several days.

What are the possible risks for the baby?

The vast majority of babies who are born with vacuum assistance will be healthy and make a rapid recovery. But there are some temporary conditions that might arise.

Typical minor issues are:

• A soft swelling on the scalp (caput).
• Mild bruising.
• Small skin abrasions.
• A swelling that goes away within 24–48 hours.

The rare and serious complications are:

• Haemorrhages under the scalp (subgaleal haemorrhages).
• Bleeding inside the skull (intracranial haemorrhage).
• Fracture of the skull (very uncommon).
• Jaundice due to bruising.
• Small bleeding in the eyes (usually self-resolving, called retinal haemorrhage).

What are the modern innovations in Vacuum-Assisted Delivery?

The last two decades, however, have seen technological advancements, education and evidence-based obstetric practices that have helped make vacuum-assisted delivery safer.

Flexible Silicone Vacuum Cups

Typically, today’s vacuum equipment uses flexible silicone or plastic cups rather than the traditional metal variety. These cups are used to minimize injuries and trauma to the scalp and to the mother’s birth canal, and will have success rates when used in appropriate cases.

Digital Measurement of Vacuum Pressure

There are some of the newest vacuum systems that have digital displays, which provide pressure readings. This assists healthcare providers in maintaining the proper suction throughout the process. It reduces the chances of over-sliding and ensures patient safety.

Ultrasound Before Assisted Delivery

Handheld ultrasound for the assessment of fetal head position before using the vacuum is increasingly being used in the Delivery Room. This specific assessment reduces the risk of failure and will boost the opportunities for success.

Continuous Electronic Fetal Monitoring

In modern labour continuous foetal heart monitoring is used to detect fetal distress in the early stages. This can aid the medical professional in determining the ideal timing for vacuum delivery before complications get out of hand.

Simulation-Based Training

High-fidelity simulation training is now used by many obstetricians in many hospitals. Simulated practice in emergencies enhances technical practice, teamwork, and decision-making, resulting in a safer outcome for the mother and baby.

Standardized Clinical Guidelines

There are evidence-based recommendations from international organisations on:

• Proper patient selection
• Safe traction techniques
• The total number of pulls you can perform before you get tired.
• Cup placement
• Determine when to discontinue the procedure

Vacuum delivery is a safe and effective method of assisted vaginal birth when delivered to appropriately selected patients in a safe, trained-hands environment. It can shorten the second stage of labor, can be used when medically necessary to deliver a baby quickly in many women, and can minimize the need for an emergency caesarean section.

While there may be maternal and fetal dangers, they are rare if the recommended clinical guidelines are followed. New developments like vacuum extraction, ultrasound, fetal monitoring and simulation training continue to make the procedure safer.