Ventouse delivery, commonly referred to as vacuum extraction, is an assisted method of vaginal childbirth. The procedure uses a specialized instrument, the ventouse or vacuum extractor, to guide the baby through the birth canal. This device consists of a soft silicone or rigid cup attached to the baby’s head using negative pressure (suction) generated by a pump. Assisted delivery is only employed when a continued vaginal birth is deemed the safest option for the mother and baby.
When is Vacuum Extraction Necessary
The decision to use a vacuum extractor is made when a swift delivery is necessary for the well-being of the mother or the baby, typically during the second stage of labor. A common indication is a prolonged second stage of labor, where the mother has been pushing for an extended period without adequate descent, often due to maternal exhaustion.
Fetal distress is another significant reason for intervention, indicated by a non-reassuring heart rate tracing that suggests the baby may not be receiving enough oxygen. The baby needs to be delivered quickly in these cases to prevent further complications. Additionally, certain maternal health conditions, such as severe heart disease or neurological disorders, make prolonged pushing risky for the mother, necessitating assisted delivery to shorten labor. For the procedure to be considered, the cervix must be fully dilated and the baby’s head must be engaged low in the pelvis.
Step-by-Step How the Procedure Works
Before the procedure begins, the healthcare provider ensures all prerequisites are met, including full cervical dilation and knowing the baby’s head position. The mother is positioned with her legs in stirrups and may receive a local anesthetic or have an existing epidural managed for pain relief. A urinary catheter may be inserted to empty the bladder, and sometimes an episiotomy is performed to enlarge the vaginal opening.
The ventouse cup is carefully inserted into the vagina and placed onto the baby’s head. Proper placement is crucial for success, with the cup centered over the flexion point, slightly in front of the posterior fontanelle. The provider checks the cup’s edge to ensure no maternal tissue is trapped before slowly applying the vacuum pressure.
Traction (gentle pulling) on the cup is applied only during a uterine contraction and simultaneously with the mother’s pushing efforts. This synchronized action guides the baby through the birth canal. The provider monitors the descent and may apply counter-pressure to prevent the cup from detaching. Once the baby’s head is delivered, the vacuum pressure is released, and the cup is immediately removed, allowing the rest of the body to be delivered naturally.
Potential Risks for Mother and Baby
Vacuum extraction carries potential risks for both the mother and the infant, though these are generally weighed against the greater risk of a prolonged labor or emergency Cesarean section. For the newborn, common short-term effects occur on the scalp where the cup was applied. These include a temporary, cone-shaped swelling known as a chignon, which usually resolves within a few days.
A more specific complication is a cephalhematoma, a collection of blood between the baby’s skull bone and the outer membrane, occurring in about 1-12 out of every 100 vacuum-assisted deliveries. This bruising typically heals in a few weeks but can slightly increase the risk of neonatal jaundice. Serious, though rare, complications include intracranial hemorrhage (bleeding inside the skull), which occurs if suction damages blood vessels, though the risk is significantly lower than with a combined use of both vacuum and forceps.
Maternal risks are primarily related to trauma to the birth canal and surrounding tissues. The likelihood of severe perineal tears, specifically third- or fourth-degree lacerations involving the anal sphincter, is higher with assisted delivery than with a spontaneous vaginal birth. These severe tears increase the risk of long-term issues such as urinary or anal incontinence.
Post-Delivery Care and Alternatives
Following a successful vacuum-assisted delivery, immediate care focuses on assessing and managing any trauma sustained. The mother’s perineum and vagina are inspected for tears, and any lacerations or the episiotomy are repaired with stitches. Monitoring for excessive blood loss is a standard part of the immediate recovery period.
For the infant, the scalp area where the cup was placed is examined for bruising or swelling. While temporary swelling resolves quickly, any signs of a larger blood collection are monitored closely. Parents are advised on what to watch for at home, as most common side effects fade within a few days to weeks.
If the vacuum extraction attempt is unsuccessful, a change in the delivery plan is necessary. Failure is defined if the cup detaches multiple times, or if the baby does not descend after a maximum number of pulls (often limited to three) or a specific time limit. The next step may be delivery using forceps or proceeding directly to an emergency Cesarean section.