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What is vacuum extraction?
Vacuum extraction is a procedure which is sometimes done during a vaginal delivery to assist the delivery of the baby. During this procedure, a soft cup with a handle is applied to the baby’s head. It attaches to the baby’s head with suction and then the healthcare provider gently guides the baby out of the birth canal.
This procedure is largely used to:
- Mother is exhausted due to pushing
- Make the delivery process easy and fast
- Avoid injury to the baby
- Avoid caesarean section
When is vacuum extraction performed?
Vacuum extraction is done during the second stage of normal vaginal delivery:
- when the mother is pushing but the labour has stalled
- if immediate delivery is required due to foetal distress which is indicated by the baby’s heartbeat suggesting that the baby could face a serious health problem
- if the mother suffers from certain health conditions due to which she cannot push for long such as aortic valve stenosis, (narrowing of the heart's aortic valve) blood pressure, aneurysm, glaucoma (if these health condition are serious the doctor may also recommend a caesarean procedure)
How is vacuum extraction performed?
Vacuum extraction is done during the second stage of normal vaginal delivery. During this procedure:
- The doctor gently inserts the vacuum cup into the vagina and positions it on the baby’s head.
- He/she then checks to be sure that no part of the vagina or vaginal tissue comes between the cup and the baby’s head.
- The doctor then uses the pump to create suction so that the cup attaches itself firmly to the baby’s head.
- When the mother experiences the next contraction, the doctor swiftly increases the vacuum suction pressure and clasps the handle of the vacuum cup firmly to guide the baby through the birth canal.
- In between the contractions, the doctor may maintain or decrease the suction pressure.
- Once the baby’s head is delivered the doctor gently releases the suction and removes the cup from the baby’s head.
If:
- the doctor is not able to create enough suction
- after suction is achieved, the cup detaches repeatedly from the baby’s head (the usual rule is that if the cup separates from the baby’s head 3 times or more, or the total duration of the vacuum extraction is more than 30 minutes, then the vacuum extraction operation must be stopped.)
- the baby does not budge along the birth canal whilst the doctor pulls using the vacuum cup handle
and vacuum extraction does not work, the doctor may use forceps to help deliver the baby or may suggest a C-Section.
What are the guidelines to be followed after a vacuum extraction procedure?
If the doctor had made an incision between the vagina and the anus during the delivery (episiotomy), or you had a vaginal tear there are a few things you can do to accelerate your healing:
- Ask the nurse to apply ice packs in the area of the wound right after birth. Once you come back home from the hospital continue using ice packs in the area.
- Use sitz baths a few times in a day once you get home from the hospital. This will provide relief from the pain.
- While urinating keep pouring warm water over the area, this will take away the sting of the urine.
- While passing stool do not put too much pressure. In fact, you can use a clean pad to firmly push against the wound during a bowel movement.
- After urinating or after a bowel movement spray some warm water in the area and pat dry using very soft towels or baby wipes. Do not use toilet paper or rub the area hard.
- While sitting down use a doughnut cushion or a pillow.
What are the guidelines to be followed after a vacuum extraction procedure?
If the doctor had made an incision between the vagina and the anus during the delivery (episiotomy), or you had a vaginal tear there are a few things you can do to accelerate your healing:
- Ask the nurse to apply ice packs in the area of the wound right after birth. Once you come back home from the hospital continue using ice packs in the area.
- Use sitz baths a few times in a day once you get home from the hospital. This will provide relief from the pain.
- While urinating keep pouring warm water over the area, this will take away the sting of the urine.
- While passing stool do not put too much pressure. In fact, you can use a clean pad to firmly push against the wound during a bowel movement.
- After urinating or after a bowel movement spray some warm water in the area and pat dry using very soft towels or baby wipes. Do not use toilet paper or rub the area hard.
- While sitting down use a doughnut cushion or a pillow.
When is a vacuum extraction not advisable?
Vacuum extraction is not advisable if:
- The mother’s pelvis is small and the baby cannot fit through the pelvis
- The mother is 34 weeks pregnant
- The position of the baby’s head is not clear
- The baby is known to have health conditions such as bleeding disorders (such as hemophilia), or conditions that may affect its bones
- The baby is emerging buttocks/feet first (breech position)
- The baby is emerging shoulder first
- The size of the baby is big
- The baby’s head has not moved past the midpoint of the birth canal
- Include plenty of fibrous foods in your diet to avoid constipation. Use stool softeners as well.
- Drink plenty of water.
- Doing Kegel exercises during this period with doctor’s advice will help. It will tone your pelvic muscles and bring strength back to them.
What are the benefits of vacuum extraction delivery?
Vacuum extraction is a minimally invasive method of helping the baby through the birth canal rather than cesarean delivery or forceps. It also lessens the mother’s exertion during labour while pushing out the baby.
What are the risks of vacuum extraction delivery?
Vacuum extraction has its share of risks for both the mother and the baby.
The mother’s risks include:
- Vaginal tears during the delivery
Post the delivery the mother may face the risks of:
- Pain in the perineum
- Difficulty while urinating
- Fecal and/or urinary incontinence
- Anemia
- Weakening of the muscles supporting the pelvic organs
The baby’s risks include:
- Scalp wounds, and bruising on the head along with minor swelling
- Minor cuts and wounds on the scalp (the swelling, cuts, and wounds usually heal in a few days)
- A risk of the baby’s shoulder getting stuck after the head is delivered which can lead to damage in the network of nerves that sends signals from the spine to the shoulder or arms
- Collarbone fracture
- Skull fracture
- Internal bleeding within the skull
What to expect during the postpartum recovery period after a vacuum extraction?
After a vacuum assisted normal vaginal delivery you may face a few issues which will need some care such as:
- Vaginal discharge and bleeding: When bleeding, expect a heavy bright red flow for the first few days after the delivery as it happens during the monthly periods. It then slowly tapers off becoming pink or brown or yellow or white. You need to immediately call your doctor if you have a fever or are bleeding too much and changing the sanitary pads every hour or you are passing big blood clots.
- Vaginal soreness: If you had a vaginal tear during delivery the wound may hurt for upto six weeks, though if the tearing was severe it could take more time than that to heal. While sitting down it can be painful, so you can use a pillow or a donut cushion that helps you to sit down with any pressure on the perineum.
You can place an ice pad between the sanitary napkin and the wound which will provide some relief from the pain.
Make sure you take your painkillers and stool softeners so that as recommended by your doctor.
- Pain while urinating or having bowel movements: As the tissue around your bladder and urethra may be swollen or bruised, you may find it painful to urinate. Doing Kegel exercises during this period with doctor’s advice will help. It will tone your pelvic muscles.
Further, you could also have constipation since you could be taking iron supplements which are prescribed by the doctor to get your blood count up. Make sure you take the stool softeners prescribed by the doctor. Also, drink plenty of water, 8-10 glasses per day to make up for the dehydration breastfeeding may cause, and add high-fiber foods to your regular diet.
If you notice very painful bowel movements you may also have haemorrhoids. To get relief from haemorrhoids you can soak the lower part of your body in a tub of warm water. You may also be prescribed some topical medication by the doctor to apply in the affected area.
- Contractions: Also known as after pains, contractions may occur for a few days immediately after delivery. These contractions are actually good in way as it means your uterus is shrinking back into size and the blood vessels are being compressed preventing excessive bleeding. Contractions can especially occur when you are nursing your baby.
- Hair loss: The rise in hormones during pregnancy keeps you from losing your hair. After childbirth, as the hormones return to normal levels it causes the hair to fall out and return to the normal hair fall and growth cycle. The normal hair loss that was delayed during pregnancy may fall out all at once after delivery.
- Mood changes: After childbirth it is normal for the new mother to undergo frequent mood changes such as irritation, frustration, anxiety etc . Many new moms also undergo what is known as postpartum depression. If the depression deepens the mother may need prompt therapeutic help in the form of psychological counselling.
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References
1. Aviram A, Ashwal E, Hiersch L, Yogev Y. Vacuum extraction in low birth weight (< 2500 g) neonates [Internet]. https://link.springer.com/. 2018 [cited 15 May 2018]. Available from: https://link.springer.com/article/10.1007/s00404-017-4608-1
2. Kabiri D, Lipschuetz M, Cohen S, Yagel O, Levitt L, Herzberg S et al. Vacuum extraction failure is associated with a large head circumference rather than high birthweight [Internet]. https://obgyn.onlinelibrary.wiley.com/. 2017 [cited 15 May 2018]. Available from: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.17875
3. Wen S, Liu S, Kramer M, Marcoux S, Ohlsson A, Sauve R et al. Comparison of Maternal and Infant Outcomes between Vacuum Extraction and Forceps Deliveries [Internet]. https://academic.oup.com/. 2001 [cited 15 May 2018]. Available from: https://academic.oup.com/aje/article/153/2/103/118370
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