Many times childbirth progresses naturally and with very few complications. Occasionally, however, an infant’s journey through the birth canal becomes stalled during the second stage of labor. When this happens, a doctor may need to perform a type of assisted delivery (also known as operative vaginal delivery) using vacuum extraction. This procedure uses suction and traction during contractions to gently guide the baby’s head down the birth canal and out into the world.

What Is Delivery By Vacuum Extraction?

Sometimes labor becomes stalled. Despite every effort to push, the baby simply isn’t making its way out. During this process, the doctors and nurses will continually monitor both mother's and baby’s heart rates for signs of distress. If the healthcare team determines that the health of either is in jeopardy from laboring too long, they may try to help in delivering the baby.

Vacuum extraction is one method of doing this. A suction cup (connected to an electric or mechanical pump) is placed on the infant’s head and supplies traction while the mother pushes. If the baby’s head is far enough down in the birth canal and in the proper position, this method may be just enough of a boost to help delivery along. Like forceps delivery, a vacuum extraction delivery is another way to help some laboring patients avoid having to undergo a C-section.

Vacuum extraction birth comprises approximately 2.5% of vaginal births in the United States. In recent decades, though, the rates of operative vaginal delivery have been declining while cesarean deliveries are increasing. The use of both forceps and vacuum extraction is only indicated under certain limited conditions. If those conditions aren’t met, your doctor might advise a cesarean delivery instead.

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What Happens During a Vacuum Extraction?

If your doctor believes you are a good candidate for vacuum extraction, they will advise you about the benefits and risks of the procedure and request your consent before proceeding. You’ll be offered anesthesia if you haven’t already had it. Your doctor may also perform an episiotomy and drain your bladder.

Next, the doctor will gently place the vacuum cup (or venthouse) on the proper spot on the baby’s scalp. During your next contraction, they will use the vacuum to create suction, which will help guide the baby through the birth canal. This also prevents the baby's head from moving back up the birth canal in between contractions. After the baby's head is safely delivered, your doctor will remove the cup and you will push the rest of your baby's body out on your own.

What Are the Benefits of Vacuum Extraction Deliver?

The primary advantage of trying vacuum extraction (or any other type of operative vaginal delivery) is that it may prevent you from having major surgery. A C-section performed after a trial of labor (known as a second-stage C-section) is more complicated and problematic than one performed earlier in the labor process. During labor, the infant’s head may become stuck in the birth canal and need to be pushed up before the baby can be delivered through a uterine incision. Second-stage C-sections also bring an increased risk of bleeding and infection.

Vacuum extraction also may result in a quicker birth for your infant than a C-section. Patients may be able to deliver within minutes with the use of vacuum delivery. With a C-section, however, the patient will need to go to the OR, be positioned for surgery, and receive enough anesthesia prior to undergoing the surgery.

What Are the Possible Complications of Vacuum Extraction Delivery?

There are several possible risks to the mother, though many of these issues are generally comparable to the side effects of an unassisted vaginal delivery as well:

• Perineal pain
• Temporary difficulty with urination
• Temporary (or permanent) incontinence
• Vaginal or perineal tears
• Bleeding

Fortunately, it’s rare for a baby to be severely injured during a vacuum extraction. There are possible risks, however, including the following:

• Caput succedaneum. This is a temporary swelling of the scalp that gives the baby a cone-headed appearance for a few days.
• Bruising / Jaundice. The suction can bruise the infant’s scalp, increasing the chance of neonatal jaundice. This is a common condition that causes a temporary yellowing of the baby’s skin. It typically resolves within a few weeks.
• Cephalohematoma. This is a pooling of blood between the baby’s scalp and skull resulting from broken blood vessels. Because the blood is on the outside of the skull, it doesn’t impact the brain and is regarded as a minor injury. It will heal in one or two weeks.

Severe complications for the baby are rare, but they may include the following:

• Skull fracture. Baby skulls are delicate and easier to break. Most fractures are minute, heal easily, and cause no lasting harm. However, more extreme breaks can cause brain bleeding and damage or need surgery to properly heal. 
• Intracranial hemorrhage. Bleeding in or around the brain is rare but serious. It may lead to apnea, seizures, or brain damage.
• Subgaleal hemorrhage. This extremely rare condition happens when veins in the infant’s head rupture. As a result, blood may begin to accumulate within the connective tissue between the skull and the scalp. If this happens, the baby can experience hemorrhagic shock and death if the condition is not identified and treated quickly enough. A subgaleal hemmorrhage typically develops slowly over the days following birth. 

How Long Does It Take to Recover from a Vacuum-Assisted Delivery?

If all goes smoothly, you’ll recover just as you would with an unassisted delivery. Healing takes about six to eight weeks. Episiotomy stitches will dissolve on their own. You’ll need over-the-counter pain medication and pads for vaginal bleeding. If your newborn experiences any short-term complications during delivery, like jaundice or bruising, those will resolve over the next few weeks as well. Be extra gentle with your little one’s head during those first few weeks at home, and be sure to keep all healthcare appointments for follow-up exams.

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The Takeaway

Childbirth is unpredictable. Most patients hope for a simple straightforward both (and many do experience this), but sometimes complications happen. In those cases, it’s good to know what choices you have. Vacuum extraction is one type of assisted vaginal delivery that your doctor may perform under specific conditions. Talk to your physician about your preferences, as well as their comfort level and experience with the procedure. They’ll help you understand the advantages and possible complications if the situation arises and help you devise a strategy on how to move forward.

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