Vacuum-assisted delivery augments (speeds up) the process of delivery, reduces the risk of injury to the baby, and helps avoid cesarean delivery in the following cases:
Prolonged labor: There are two stages in normal labor. The first stage of labor is characterized by regular contractions and ends with complete dilation of the cervix. It usually lasts between 12 and 20 hours if it is a woman’s first pregnancy; if not, it lasts only 7-10 hours. The second stage of labor begins with complete dilation of the cervix and ends with the delivery of the baby, which lasts one to two hours. The prolonged second stage of labor may require vacuum-assisted delivery. Prolong the second stage may occur due to
- The use of epidural anesthesia.
- The large size and inappropriate position of the baby.
- A small birth canal.
- Maternal exhaustion.
Maternal exhaustion: When the mother has been continuously pushing for more than an hour, she becomes exhausted. Hence, a vacuum can help deliver the baby.
High dose of epidural anesthesia: Epidural (regional) anesthesia may be administered to relieve pain during labor. Some women may need larger doses of medication to manage pain, inhibiting the ability to push.
Maternal medical conditions: Maternal medical conditions that affect labor and reduce her ability to push include:
- High blood pressure
- Heart conditions such as pulmonary hypertension or Eisenmenger’s syndrome
- History of stroke
- Neuromuscular disorders
Fetal problems: If the heart rate drops, oxygen supply reduces in the fetus, and the fetus can go into distress causing irreversible damage to the baby. Hence, vacuum-assisted delivery can speed up delivery.
Abnormal position of the baby’s head: If the labor is prolonged, your baby’s head may be positioned abnormally. Abnormal positions of the baby’s head include:
- Head tilted to one side
- Head facing to the side
- Head facing the front when the mother is lying on her back
Forceps may turn the baby’s head to a more favorable position and then a vacuum may be used.
Is vacuum-assisted delivery safe?
Vacuum-assisted delivery is usually safe, but the following criteria have to be met to undergo a vacuum-assisted delivery safely:
- The cervix should be completely dilated: If the cervix is not fully dilated and a vacuum is used, there is a high risk of injuring or tearing the cervix, which requires surgical repair and may affect future pregnancies.
- The exact position of your baby’s head should be known: The vacuum should be placed over the midline of the top of the head and never on the baby’s face or brow. Hence, vacuum-assisted delivery is less likely to succeed if the baby is facing straight up.
- The baby’s head must be engaged: The baby’s head should be engaged (fixed), meaning the baby’s head should have entered the pelvic brim or inlet. This is measured in relation to the narrowest point of the birth canal called the ischial spines. The top of the baby’s head should be aligned with the ischial spines and ideally 1-2 cm below the spines to be able to use a vacuum. The success of using a vacuum increases the baby’s head, which is visible at the vaginal opening when the mother is pushing.
- The membranes must be ruptured: The amniotic membranes must be ruptured (also referred to as water breaking) to perform a vacuum-assisted delivery.
- The baby should be able to fit through the birth canal: Sometimes, the baby may be too big for the birth canal; for example, in gestational diabetes, the baby’s head is bigger than average. If a vacuum-assisted delivery is attempted, it would most likely fail and result in serious complications.
- The pregnancy must be term or near term: The risk of fetal complications following a vacuum-assisted delivery is higher in premature infants; hence, it is not to be performed before 34 weeks of pregnancy. Forceps and other techniques may be used to augment the delivery of premature infants.
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