Vacuum Extraction. Can vacuum birth have consequences for the child?
The moment the birth bell comes up in discussions about childbirth, expectant mothers take notice and a high dose of skepticism appears. The reason is that there are a lot of negative stories about this birthing method. Even in the 21st century, however, extraction operations are one of the options during childbirth (vacuum or forceps delivery). Just to clarify, birth by bell or forceps takes place in approximately 1 to 3% of births in our country, which is a really low figure even compared to countries with more developed healthcare (Great Britain, Denmark, Scandinavia). Bell birth is also called vacuum birth or birth with the help of a vacuum extractor. This is one of the types of vaginal births, which is used in exclusively specific cases. Is bell birth safe? Can vacuum birth have consequences for the child? When is the birth bell approached?
Author:Victoria Clark
Updated: 06.12.2023
In Slovakia, birth by vacuum extractor has a very bad reputation. At the same time, there are a lot of negative stories based on the standard form of a story, of a mother whose child was born with the "bell" causing some complications and "that's just the way it was". The fact is that there are actually the vast majority of vacuum births that have gone completely fine and without any consequences caused by this extraction method. The operation method using a vacuum extractor is not common at all. It is used only in acute cases, when the indications also allow it. Similar to episiotomy (incision of the perineum, caesarean section and vacuum delivery), it is one of the birth procedures that are performed only in case of necessity, when the situation does not allow for another suitable solution. What is vacuum birth? Under what conditions is vacuum extraction carried out?
Extraction operations during childbirth
During childbirth, complications of various nature, from less serious to life-threatening cases, often occur in practice. In the event that there is a threat of complications during childbirth that may threaten the health or life of the fetus or the mother, the obstetrician himself must consider which method is best for solving the given situation. It is necessary to understand that in some cases seconds are decisive.
Circumstances may also arise during childbirth when it is necessary to act urgently and the possibilities are considerably limited. Obstetric operations are used for these purposes - incision of the perineum, caesarean section or extraction operations to speed up delivery - delivery with forceps or vacuum extractor. It is important to remember that individual obstetric operations usually do not represent mutual alternative solutions. Individual procedures are approached in specific situations. Different circumstances are required to perform a caesarean section, different conditions must be met when cutting the perineum, and sometimes it is appropriate to use delivery forceps or a vacuum extractor (a plastic bell with a certain diameter, a pressure gauge and a manual or electric pump to create a vacuum).
Cesarean section or vacuum extraction?
A caesarean section is not usually a direct alternative to an extraction operation, such as a vacuum extraction. This means that, in case of necessity, when the obstetrician has to decide which procedure to choose during childbirth, there is usually no direct decision between caesarean section and vacuum delivery, because each procedure is carried out under different conditions. Extraction surgery - vacuum birth is an urgent solution to the situation. A caesarean section requires a few minutes of preparation and its implementation also takes additional time, therefore vacuum extraction is sometimes the only suitable solution. Nevertheless, it is still true that the obstetrician must decide at the right time whether it is a suitable case of using an extraction operation or whether to choose a caesarean section.
Certain conditions must be met and specific principles must be followed in order to give birth by vacuum extractor. In obstetrics, it is sometimes enormously difficult to evaluate the situation with one hundred percent certainty. The most important thing when making an acute decision for this method in a specific situation is to determine whether the baby's head is already deep enough in the birth canal. Obstetricians, however, have specified specific indications for delivery by vacuum extraction in their birth plans. Indications represent the circumstances under which it is possible to proceed with the extraction, while at the same time the specified conditions must be observed. If this is not the case, it is advisable to proceed to another extraction-obstetric operation.
Indications for vacuum extraction
Extraction operations are performed in cases where it is necessary to urgently get the child out of the birth canal, while the conditions and circumstances require urgent action by the obstetric staff. It is essential to shorten the birthing phase to the shortest possible time frame. This, in acute circumstances, does not constitute an incision of the perineum or a caesarean section, it is up to the obstetrician to decide whether the procedure is appropriate in the given case or if there is space and time to choose a surgical caesarean section. What indications make it possible to go into labor with a vacuum extractor?
- Hypoxia of the fetus - the obstetrician observes the decreasing responses of the fetus and its weak supply of oxygen - oxygenation (the most common reason for using a vacuum extractor). Lack of oxygen can seriously harm the baby. However, the use of a vacuum extractor is not suitable if the fetus is acutely deoxygenated, because the negative pressure will cause further deterioration of oxygen circulation. For example, the extraction method of forceps birth can be used.
- Weak contractions of the mother - caused by fatigue - exhaustion of the mother, when it is not possible to use the initiated abdominal pressure and contractions to push the baby out of the birth canal and it is at risk of suffocation.
- Uncooperative mother - a mother who cannot push effectively and does not follow the instructions of the obstetric staff, which greatly complicates the procedure during childbirth. The reason may be stress, inability to push, bad mental state or other illnesses of the mother.
- Non-progressive birth in the 2nd stage of labor - the progress stops and the child remains in the birth canal. An indication can also be heart disease in the mother or neurological diagnoses that threaten the health of the mother and the fetus and limit the progress of childbirth in the second stage of labor.
- Heavy bleeding of the mother.
The obstetrician or delivery staff should communicate with the mother. In the event that the birth does not progress as it should and the baby is at risk, the staff should clearly communicate what solution they are approaching and that extraction surgery or caesarean section will be used. Despite the fact that there is no time for explanations and it is necessary to proceed with the necessary, the mother-to-be should always receive basic information.
Conditions for vacuum birth
The conditions themselves, like the indications, limit the use of this extraction operation. Therefore, in order for a vacuum extraction to take place, some conditions must not be met, while others must be met unconditionally.
- The pelvis must not have any pathological changes that could prevent the passage of the fetus through the mother (absence of cephalopelvic disproportion – the head of the fetus is larger than the mother's pelvis),
- the cervix is closed - the uterus is completely open,
- the fetus must be of average maturity (vacuum extraction is not used in pregnancies earlier than the 34th week),
- correctly rotated fetus (head to pelvic floor),
- the amniotic fluid must be drained and the sac membrane ruptured,
- the fetus must be alive,
- the head of the fetus must be located at least in the area of the pelvic width - entered deep into the birth canal,
- birth canals must be reconciled,
- empty bladder.
How does vacuum birth take place?
The vacuum extraction, or VEX birth itself, means that the birth will take place with the help of a special plastic - silicone bell, which is attached to the baby's head. The doctor-obstetrician first evaluates that vacuum extraction represents the best solution at the given moment. There are vacuum extractors with different diameters, while it is ideal to always use a larger diameter that restricts blood circulation the least.
The creation of negative pressure creates desirable conditions for pulling the fetus out of the birth canal. In some cases, the child's head may temporarily have a so-called artificial tumor due to negative pressure. It disappears naturally after childbirth. Sometimes a bruise or slight deformity may develop. In both cases, however, there is a natural correction. The movement of the fetus takes place simultaneously with the contractions and pushing of the mother. This is ideally a matter of cooperation. The doctor must ensure that the soft tissues of the mother are not attached by the bell and that the above indications and conditions are met.
Birth by vacuum extractor or birth by forceps
In terms of professional debates, there are discussions about whether forceps should even be kept in the delivery room in the 21st century, or whether they should be excluded from obstetricians' equipment for good. The fact is that forceps extraction surgery is on the decline. It is interesting that in 2019, 7.3% of births were performed with the help of forceps. In Finland, for a change, up to 9.6% of births were terminated by vacuum extraction. In general, forceps extraction is considered a more effective and reliable method for terminating a pregnancy by delivery.
Both of these methods are extraction obstetric operations, the aim of which is to quickly respond to a risky situation. The result should be a successful completion of childbirth and its significant shortening, because a longer duration could endanger the fetus or the life of the mother. Birth forceps have been known since the 17th century and are used only to a limited extent today. The forceps consist of two parts, and during childbirth they are gradually inserted into the birth canal of the mother. The baby's head is never clamped directly with forceps. Cooperation is important - the woman pushes and the doctor pulls during the contraction. Their significant disadvantage is that they are unsparing towards a woman's birth canal. On the other hand, it is also advisable to use them in case of acute lack of oxygenation of the fetus. Their use is also faster, because there is no need to wait for the creation of a negative pressure.
Vacuum extraction is a newer method that, according to many obstetricians, is gentler on the birth canal and at the same time is technically easier to implement. Compared to ticks, there is no risk of injury to the soft tissues of the birth canal. Research and recommendations in most cases consider vacuum extraction to be the better option (among the two) in the case of acute termination of labor due to risk reasons. In practice, however, there are obstetricians who have experience in using forceps, and it is therefore up to the obstetrician himself which extraction method he chooses and in which he feels more skilled.
Vacuum extraction - experience
Based on the mothers' contributions in the discussions, vacuum extraction delivery was mainly used in cases where the baby descended into the birth canal, but did not progress even after tens of minutes or hours. Due to the position of the baby, a caesarean section was no longer an option. The parents state that the birth by "bell" went well and their children have no complications. Some mothers were advised to visit a neurologist with their child as a precaution. For some women, doctors also used vacuum extraction in case the child was too big. However, the most important thing is that the discussants agree that despite the acute vacuum births, their children are healthy and without consequences.
The most frequent questions - FAQ
Do you also belong to the group of people who are skeptical about birth by vacuum extractor? Have you heard negative stories about vacuum extraction? Do you know what vacuum extraction is? We will answer your questions in our article. In case you have other questions or your own experience of childbirth with the vacuum extractor, we will be happy for your questions, opinions, advice and recommendations. You can contribute to the discussion on this issue. You can comment directly under the article.
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