the safery of using vacuum extraction during delivery

Archived User

the safery of using vacuum extraction during delivery

hi henci:

I was wondering if using a vacuum extractor during childbirth is safe.  I've read horror stories about it leading to brain injuries in newborns. There is just so much misinformation & information out there on the internet today.  I did a google search and found this article on vacuum extraction birth that basically says it increases the chance of a brain injury. Are some vacuum extractors better than others? Are any safe? Do I have any choice in the matter?



Henci Goer

RE: the safery of using vacuum extraction during delivery
(in response to Archived User)

Well, of course attorneys trolling for business are going to portray vacuum extraction in the worst possible light. On the other hand, vacuum extraction is far from harmless. Here is an excerpt from the assisted delivery chapter from the forthcoming new edition of Obstetric Myths Versus Research Realities (in press with University of Michigan Press):

Turning to the neonatal harms of instrumental vaginal delivery, after adjustment for confounding factors, both forceps delivery and vacuum extraction are associated with an intrinsic risk of 1 more neonatal death per 10,000 compared with spontaneous birth. This does not argue for cesarean surgery instead because cesarean surgery imposes an intrinsic risk of 1 more neonatal death per 1000,58 plus it imposes future reproductive risks. Moving on to morbidity, 1 more baby per 1000 will experience intracranial hemorrhage with vacuum or forceps compared with spontaneous birth, and, according to a large Canadian study, 1 more baby per 1000 will experience neonatal seizure, although a large U.S. study reported a much smaller absolute difference. Compared with spontaneous birth, 4-5 more babies per 1000 delivered with forceps will experience facial nerve injury while excesses are smaller with vacuum extraction: 0.5-1 per 1000. Excesses were similar for brachial plexus injury (2 more babies per 1000). Vacuum extraction results in much greater excesses of shoulder dystocia (11 more babies per 1000) than forceps (1 more baby per 1000) compared with spontaneous birth. Finally, a study that routinely X-rayed all infants after vacuum extraction reported a 5% linear (as opposed to depressed) skull fracture rate, although no infant displayed neurologic symptoms or required treatment. Still, while the authors viewed the lack of symptoms as reassuring, we do not. Failure to display overt neurologic symptoms does not rule out subtler adverse effects such as pain, for example, which might interfere with breastfeeding and attachment during the crucial early days of life. Indeed, all instrumental delivery-related nerve compressions, swellings, and bruising hold this potential.88
. . . On the maternal side, instrumental delivery causes markedly more anal sphincter injuries compared with spontaneous birth. In the United States and Canada, where median episiotomy is the norm, 8-18 more women per 100 will experience anal sphincter tears with vacuum extraction than with spontaneous delivery. In primiparous women [first-time mothers], the excess may be as high as 26 per 100. . . . Differences between instrumental delivery and spontaneous birth would undoubtedly be greater were episiotomy, especially median episiotomy, not used at spontaneous birth as well.
Instrumental vaginal delivery is not, however, strongly associated with pelvic floor dysfunction. By six months to a year postpartum, few women with instrumental delivery are anally incontinent, and of those who are, most are incontinent to flatus only. This is understandable when one considers that anal incontinence largely occurs secondary to sphincter injury.67 Most women who have instrumental deliveries will escape sphincter laceration, and even among those who do not, most women with sphincter injury remain continent. This is not, however, reason for complacency. Aging and further childbearing may alter this picture. The sole longitudinal study we have found that women with history of forceps delivery were more likely to report fecal incontinence 12 years after the index birth compared with only spontaneous vaginal births. Likewise, associations with stress urinary incontinence are weak, and what little data we have do not suggest an association with pelvic floor prolapse.
Women having instrumental vaginal delivery are also more likely to be readmitted to hospital within 60 days of discharge than women with spontaneous birth: 2.2% with forceps delivery and 1.8% with vacuum extraction versus 1.5% with spontaneous birth for “pelvic injury/wounds,” “genitourinary complications,” “obstetric surgical complications,” and “major puerperal infection.”
Finally, instrumental delivery may be associated with increased risk of severe hemorrhage. Case-control studies have reported increased risk of transfusion and peripartum hysterectomy, although differences are not always significant.
Instrumental vaginal delivery has adverse psychological impact as well. One study reported that both forceps and vacuum delivery were associated with symptoms of psychological trauma.26 Another reported that vacuum extraction (no data on forceps) at first delivery was an independent risk factor for fear of delivery in second pregnancy.81 A third study that surveyed women’s experience of instrumental vaginal delivery (type not specified) reported that 70% of respondents said instrumental delivery had upset them, increased their fear of childbirth, or both.9 One-quarter of the group would prefer cesarean surgery to a repeat instrumental vaginal delivery. A fourth found that three years after difficult instrumental vaginal delivery, 16% of survey respondents had no further children because they could not go through childbirth again.10

There you have it. Certainly, there are situations where the potential benefits of a timely  vacuum extraction outweigh the potential harms, but for most women and babies,  the safest, healthiest birth will be one without episiotomy where mom pushes out the baby under her own steam. 

~ Henci

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