Vacuum extraction

Vacuum extraction is an assisted delivery type of technique. It has replaced forceps delivery as it is easy to use with less anesthesia. It is done when women are trying normal delivery through the vagina. During the delivery process, when the second stage is relatively stalled but the baby isn’t out despite the mother's try, vacuum extraction is done. Vacuum extractors are used if the baby is in a comfortable position the procedure is adopted. 

Indications:

Vacuum extraction is done to assist a woman in the second stage of delivery. It is done 

• A baby is in distress 
• Second stage of Labor is prolonged 
• There is no progress in the labor 
• Baby’s head is low enough in the birth canal, engaged, and in an appropriate position 
• Fully dilated cervix 
• The pelvis is wide enough for adequate vaginal delivery 
• Anesthesia is adequate 
• Bladder is emptied 
• Patients or the partner has given consent 
• There is a backup plan
• Mother will be benefited 

Contraindications:

• Vacuum delivery is not indicated in: 
• bleeding disorders in the baby 
• demineralizing diseases in the baby
• When the fetus is < 34 weeks of estimated gestational age
• Baby has not progressed enough through the birth canal 
• Baby does not fit in the birth canal 
• Baby is not headfirst but is leg first 
• Baby needs rotation to be done  

Vacuum extraction technique:

Vacuum extraction is also called the ventouse method. This helps the baby to be delivered when it is struck in the second stage. This is a method to be resorted to before going for the surgical method or cesarean section. Vacuum extraction is similar to forceps delivery. 

It is based on the technique of using a vacuum extractor. A vacuum extractor includes a suction cup attached to a mechanical or electric pump. The cup is attached to the visible part of the crown of the fetus and the necessary traction is provided by the pump. The mother should push the baby during the procedure. 

Advantages:

• It is easily done 
• It is safe and effective when applied properly
• It helps in quick delivery
• It causes relatively less injury to the skull 
• Discomfort to the mother is less 
• Trauma to the genital area of the mother is also less 
• Relatively less anesthesia is required 

Vacuum-assisted delivery procedure:

Before undergoing vacuum-assisted delivery an individual should discuss the procedure and know the details before undergoing the procedure. Informed consent should be given. Even before the procedure, one can use other methods like breathing through the oxygen mask as labor can be tiresome. 

Taking fluids through the intravenous line and changing the position of the mother to facilitate faster delivery. Medications to subside pain will be given. The HCP will assess if vacuum-assisted delivery is possible or not. 

Occasionally a small procedure called episiotomy is performed to open the birth canal. This is a small cut that is made between the birth canal and the anus which helps in faster delivery. The water sac may also be broken, and the bladder may be drained. 

Based on the position of the baby, the vacuum cup is placed on the head region of the baby in the correct spot so that no tissues are trapped beneath. A mild pressure of 100-15 mmHg is applied to attach the cup to the baby’s head. Correct placement of the cup is very important. 

The center of the cup is positioned about 6cm away from the front soft spot and 3cm from the back soft spot. The anterior edge of the cup should be at least 3cm away from the front soft spot. This point is called the pivot point of placement. 

The HCP waits for the contraction to come. The traction pressure of 450–600 mm hg is applied during the contraction so that as the mother pushes the baby, the traction force pulls the baby. The direction of the traction pressure changes as the baby travels the pelvic curve. Between the contractions, the vacuum pressure can be either kept the same or reduced. 

The vacuum pressure should be applied quickly to reduce the duration of the procedure. At the same time, the HCP can guide the baby with their hand so that the same and correct angle is maintained during the traction and contraction. Once the head is outside, the vacuum is released, and the cup is removed to facilitate the baby's arrival. 

Instructions:

Care should be taken to apply only appropriate pressure. 

Excessive pressure can injure the baby’s skull and less pressure can detach the cup from the baby’s head. 

Jerky or any side-way movements should be avoided to prevent trauma to the baby

If the baby’s head does not progress up to 3 attempts of traction, then the position should be reassessed. 

Repeated detachment of the cup from the head region of the baby should be an indication of stopping the vacuum-assisted delivery. 

One should continue with the process if it is prolonged for more than 20 minutes 

After the delivery:

After the baby has come out, the baby is assessed for any injuries due to the procedure. The mother is also checked for any tears in the vagina. The baby and the mother are monitored for any complications. 

Side effects, Risks, and complications:

Tears in the vagina, bleeding, and difficulty in urinating are some of the side effects to the mother after the delivery. Swollen skulls, bruising of the scalp, neonatal jaundice, and the collection of blood between the baby’s scalp and skull are some of the side effects on the baby. 

Some complications to the baby include skull fractures leading to immediate surgery, bleeding in the brain of the baby due to trauma, and rupture of the brain blood vessels leading to the accumulation of blood in the fatty tissue. 

Conclusion:

Vacuum-assisted delivery is a type of normal delivery done in women who are struck in the second stage of labor. It is safe, effective, and fast when performed correctly. It can help in progressing the labor and delivering the baby.