A ventouse delivery, also known as vacuum extraction, is a form of assisted vaginal delivery. The procedure involves attaching a soft or rigid cup to the baby’s head using a vacuum seal. A healthcare provider then gently pulls on a handle during a contraction, providing traction to guide the baby through the birth canal. This assistance is only used when the mother is fully dilated and the baby is already positioned low in the pelvis. It is a common intervention, utilized in approximately one out of every eight vaginal deliveries to safely expedite the birth.
The Need for Assistance
The decision to use a ventouse is made when the second stage of labor is not progressing adequately or when there is an immediate concern for the health of the mother or the baby. One common indication is maternal exhaustion, where a person has been pushing for a prolonged period and is physically unable to continue with effective expulsive efforts.
The procedure is also initiated when a non-reassuring fetal heart rate pattern suggests the baby is experiencing stress and needs to be delivered quickly. Changes in fetal heart monitoring indicate the baby is not tolerating labor well, making the vacuum device a fast way to complete delivery. A prolonged second stage of labor, defined by a lack of descent after a certain amount of time pushing, is another frequent reason for intervention.
Certain maternal health conditions also necessitate the use of a ventouse to shorten the second stage of labor. For example, a person with a severe cardiac condition or a high-risk neurological disorder may be advised to limit the amount of strenuous pushing to avoid placing excessive strain on their body.
How the Procedure Works
Before beginning the procedure, several prerequisites must be met to ensure safety and success. The cervix must be fully dilated, the fetal head must be engaged in the birth canal, and the exact position of the baby’s head needs to be confirmed by the clinician. The patient is usually positioned on their back with legs in stirrups, and the bladder is emptied with a catheter if necessary.
The cup, which may be a soft, silicone device or a more rigid, metal cup, is carefully inserted into the vagina and placed onto the baby’s scalp. Correct placement is paramount, as the cup must be centered over the flexion point, a specific area on the top of the baby’s head. The vacuum is then gradually created, attaching the cup firmly to the scalp through negative pressure.
Once the seal is established, the provider waits for a contraction and asks the mother to push simultaneously. Traction is applied only during the contraction, following the natural curve of the birth canal. This synchronized effort ensures the force is applied most effectively and minimizes the risk of the cup detaching, which is often referred to as a “pop-off.” The vacuum is released and the cup is removed as soon as the baby’s head is delivered, allowing the rest of the body to be born naturally.
Maternal and Fetal Considerations
Ventouse delivery carries specific, short-term risks for both the mother and the infant. For the baby, the most common effect is a temporary swelling on the scalp called a chignon, which is the area of the skin pulled into the cup by the vacuum. This swelling is harmless and resolves within a few hours to a day.
A more significant finding is a cephalohematoma, a collection of blood between the skull bone and its outer covering. This occurs in approximately 1 to 12 out of every 100 ventouse deliveries and, while usually harmless, can take several weeks to months to disappear. In rare instances, the intense pressure can lead to more serious complications, such as a subgaleal hemorrhage or intracranial hemorrhage, which involve bleeding in or under the scalp or brain.
The procedure also increases the risk of maternal trauma, specifically to the vaginal tissues and perineum. Ventouse delivery is associated with a higher likelihood of requiring an episiotomy or sustaining a perineal tear, particularly a third or fourth-degree tear that extends to the anal sphincter. The rate of severe tears is estimated to be about four times higher with ventouse assistance compared to an unassisted vaginal delivery.
These severe lacerations can lead to short-term or long-term issues, including temporary discomfort, pelvic floor dysfunction, and a slight increase in the risk of urinary or anal incontinence. The patient also has a slightly elevated chance of developing a postpartum hemorrhage due to trauma or uterine atony. Despite these potential complications, the procedure is performed only when the benefits of a swift delivery outweigh the risks, often preventing a more complicated outcome, such as an emergency cesarean section.