In today’s column, our Chicago birth injury attorneys discuss vacuum extraction during childbirth. Vacuum extractors are exactly what they sound like. When vacuum extraction is used in a vaginal childbirth, a soft cup is applied to the top of the baby’s head to create a suction, which creates traction and allows the obstetrician to draw the infant’s head out of the birth canal (and thus deliver the baby). The vaccum seal between the extractors and the infant’s head is, naturally, imperfect. Thus, pressure must be applied continually (at intervals) to the head to keep up the traction and allow for delivery.
Vacuum extractions had been declining in the United States, and now accounts for only ten percent or fewer of vaginal deliveries. But in the past twenty years the number of such deliveries has again begun to rise. This is because forceps delivery has increasingly been acknowledged to be dangerous, leading physicians to select vacuum extraction, instead.
But are vacuum extractions really a better choice? Well, as our experienced birth injury attorneys are only too well aware, vacuum extraction may be the lesser of two evils, but are themselves also quite dangerous, with many infants suffering serious long-term health consequences, or even death, from this controversial technique.
There are certain prerequisites which must be met before vacuum extraction should be considered. First, the amniotic membranes must be ruptures (the “water broken”). Additionally, the mother’s cervix must be fully dilated, and she must be given adequate anesthesia before the procedure is attempted. Moreover, vacuum extraction should never be used without a valid medical indication. Valid medical indications include:
- Prolonged second stage of labor, without cephalopelvic disproportion
- Fetal distress during the second stage of labor
- Interruption of the second stage of labor because of acute bleeding, cardiac or pulmonary disease, pulmonary disease or, in specific circumstances, maternal exhaustion
Maternal exhaustion is often used as the medical indication justifying the use of a vacuum extractor. This indicator, however, is extremely tricky. Exhaustion cannot support the use of vacuum extraction unless the obstetrician has properly determined the cause of the exhaustion. Maternal exhaustion, generally as a result of prolonged labor, is often caused by cephalopelvic disproportion (the circumferance of the infant’s head is larger than the mother’s pelvis) or fetal malposition (the infant is positioned incorrectly and thus cannot move through the birth canal). In either of these cases, delivery will not be accomplished using a vacuum extractor unless the obstetrician applies excessive suction, and the result is often severe birth injuries.
Even if a medical indication is present, there are many contraindications which should prevent the use of vacuum extraction. Because of the likelihood of severe injury to the infant (or mother), vacuum extraction should never be used if any of the following conditions are present:
- Inadequate trial of labor
- Fetal malposition, or unknown fetal position or level of descent (station)
- Any reason to suspect cephalopelvic disproportion
- Fetal coagulation disorder
- Previous attempted use of forceps
- Inexperienced obstetrician
If these requirements are not observed, or if vacuum extraction is performed improperly, there is a greatly increased risk of serious complications for both mother and baby. Although complications for the mother are more infrequent, and less severe, than the complications associated with the use of forceps, they are still considerable. Maternal complications include:
- Lacerations of the vagina or cervix
- Blood loss or hematomas
- Bladder injury
- Anal sphincter injury or fecal incontinence
In addition, the risks to the infant when vacuum extraction is used are great. Vacuum extraction can often cause subgaleal or subaponeurotic hemmorhage (from rupture of the emissary vein), a condition which causes death in one out of every four infants. Subgaleal hemmorhage in newborns does not occur in the absence of either use of forceps or vacuum extraction. Other complications for the infant include:
- Bruising or cuts to the face and head
- Cephalohematomas
- Facial palsy
- Shoulder dystocia
- Intracranial hemorrhage
- Tentorial lacerations
- Cerebral palsy
Talk to your doctor well in advance of your due date to determine whether he favors the use of vaccum extraction in delivery. Depending on what you learn, you may wish to switch doctors, or be prepared to stand firm in the delivery room if your physician attempts to use an unsafe delivery practice.
If, however, vacuum extraction was already used in your delivery, and you or your child were seriously injured, you should consult with an experienced birth injury attorney. A knowledgeable attorney can help you determine whether you might have a legal claim, and help you decide whether you wish to pursue such a claim.
For a free consultation with a top-rated Chicago birth injury lawyer at Passen & Powell, call us at (312) 527-4500 or email us at info@passenlaw.com.
