Vacuum-assisted birth is a medical procedure employed to help guide the baby through the birth canal when labor progress slows or the baby needs assistance. This method involves applying a soft cup, connected to a vacuum pump, to the baby’s head. While generally considered a safe intervention, it carries potential risks and complications for both the newborn and the birthing parent.
Potential Complications for the Baby
Infants delivered with vacuum assistance can experience scalp injuries. Minor issues include lacerations (small cuts) and abrasions (scrapes), which often heal within days or weeks. A more significant, but generally benign, injury is a cephalohematoma, a collection of blood between the skull bone and its outer membrane. This localized swelling does not cross suture lines and usually resolves over several weeks to months, sometimes leading to jaundice as the blood breaks down.
A more serious, though less common, bleeding complication is a subgaleal hemorrhage, where blood collects between the scalp and the fibrous layer of the skull. This hemorrhage can be extensive because the subgaleal space is large and extends across suture lines, potentially leading to significant blood loss and hypovolemic shock. Infants with a subgaleal hemorrhage require close monitoring for signs of increasing head circumference, pallor, and changes in vital signs.
Rarely, vacuum extraction can be associated with intracranial hemorrhage, or bleeding inside the skull. This can range from subdural hematomas, bleeding between the brain and its outer protective membrane, to intraventricular hemorrhages within the brain’s fluid-filled ventricles. Such severe head injuries are uncommon but can have serious neurological consequences, including seizures or long-term developmental issues, depending on the location and extent of the bleeding.
Another potential injury is facial nerve palsy, a temporary weakness or paralysis of the facial muscles. This occurs if pressure from the vacuum cup or the birth canal compresses the facial nerve. The condition typically resolves spontaneously within days to weeks, and permanent damage is infrequent.
Retinal hemorrhages, small bleeds in the eye, are also observed in some newborns after vacuum-assisted delivery. These usually clear on their own within a few days or weeks and generally do not affect long-term vision.
Potential Complications for the Mother
Birthing parents undergoing vacuum-assisted delivery face an increased risk of trauma to the vaginal and perineal tissues. This includes vaginal lacerations and cervical tears. The perineum, the area between the vagina and anus, is also susceptible to tears, ranging from first-degree (skin deep) to more severe third and fourth-degree tears that involve the anal sphincter muscles or even the rectal lining. These deeper tears often require extensive repair and can lead to prolonged discomfort or complications.
Postpartum hemorrhage, defined as excessive bleeding after childbirth, is another heightened risk for mothers following a vacuum-assisted birth. The increased trauma to the birth canal and uterus can interfere with the uterus’s ability to contract effectively after delivery, a natural mechanism to stop bleeding. This can lead to significant blood loss, sometimes requiring medical intervention like medications to stimulate uterine contractions, blood transfusions, or, in rare cases, surgical procedures.
Some mothers may experience temporary or, less commonly, persistent urinary or fecal incontinence after a vacuum-assisted delivery. This can result from damage to the nerves or muscles of the pelvic floor and anal sphincter, particularly with more severe perineal tears. While many cases improve with time and pelvic floor exercises, some individuals may require further medical evaluation and treatment to manage these symptoms.
Pelvic organ prolapse, where one or more pelvic organs (like the bladder, uterus, or rectum) descend into the vagina, is also a potential long-term complication. The forces exerted during vacuum-assisted delivery, especially when combined with other risk factors, can weaken the pelvic floor support structures. The symptoms and severity of prolapse vary, and management can range from conservative measures to surgical correction, depending on the individual’s condition.
When to Seek Medical Attention
Following a vacuum-assisted birth, parents should monitor their newborn for signs indicating a need for medical attention. For the baby, these include:
Unusual lethargy (difficulty waking or unusual sleepiness).
Difficulty feeding, a weak suck, or a refusal to feed.
A high-pitched cry, excessive or rapidly worsening head swelling or bruising.
Rapidly developing jaundice (yellowing of skin or eyes).
Mothers should also be vigilant for signs of complications. A fever could indicate an infection. Foul-smelling vaginal discharge, or discharge that changes in color or consistency, is another potential sign of infection. Excessive or worsening bleeding after leaving the hospital, particularly if soaking more than one maxi pad per hour, requires prompt medical assessment.
Persistent or increasing pain not managed by prescribed pain relief, especially if localized to the perineum or abdomen, should be reported. Difficulty urinating or defecating also warrants medical consultation. Any other concerning symptoms should lead to a discussion with a healthcare provider.
References
American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 8th ed. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American College of Obstetricians and Gynecologists; 2017.
O’Grady JP, Pope CS, Patrick JD. Forceps and vacuum delivery. In: Gabbe SG, Niebyl JR, Simpson JL, et al., eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 26.
Royal College of Obstetricians and Gynaecologists. Operative Vaginal Delivery. RCOG Green-top Guideline No. 26. London, UK: RCOG; 2011.
Aasheim ET, Nilsen ABV, Lukasse M, Reinar LM. Perineal tears and episiotomy at vaginal deliveries: a systematic review. BJOG. 2017;124(3):399-410.
American College of Obstetricians and Gynecologists. Postpartum Hemorrhage. Practice Bulletin No. 183. Obstet Gynecol. 2017;130(4):e168-e186.