In recent years, the preferred method of moving along a difficult labor to reduce the risk of birth injury has changed. In the past, doctors would sometimes apply medical forceps to assist in “guiding” an infant through the birth canal. However, while the overall rate of operative-assisted vaginal delivery (meaning birthing tools were used) has remained stable over the last ten years, doctors are now choosing to use vacuums rather than forceps, and the rate of vacuum use has increased relative to forceps application.
These methods of assisting in labor and delivery can be very dangerous, especially because they do not always work. A 2023 Canadian study found that maternal trauma occurs in 25.3% of attempted forceps deliveries and 13.2% of attempted vacuum deliveries. Severe neonatal trauma occurs in approximately 1 in 105 (9.6/1000) infants following attempted forceps or vacuum births. The most common neonatal injury is brachial plexus injury, while the most serious adverse outcome is neonatal death.
One of the biggest issues that stems from vacuum use is the fact that the vacuum pulls on an infant’s head and can cause trauma, including subgaleal hematoma—a pooling of blood and edema between the skull and skin of a newborn’s head. There is a large increase in risk for this injury when there is a “pop-off” or “fall-off” of the vacuum.
But what are these birthing instruments? What do they look like, and how are they used? We would like to provide a basic overview of vacuum and forceps and how they are used to deliver a baby.
Frequently Asked Questions About Birthing Instruments
1. What is a vacuum extractor?
A vacuum extractor is a machine with a small rubber or soft-polymer cup attached to a vacuum engine. The soft cup is attached to a baby’s skull, and suction (“traction”) is applied to help assist in pulling the baby out, with maternal efforts being applied throughout. The original vacuum devices had a hard cup, the most famous of which was called the “Maelstrom.”
2. What are forceps?
Forceps are exactly what they sound like: a metal apparatus used for grasping similar to tongs. Different designs allow the forceps to curve to the shape of a baby’s skull when in the normal birth position, facing down, headfirst (occiput-anterior) and to assist in guiding a baby during birth. Some forceps are curved, while others are straighter. Some allow obstetricians to lock the forceps during contractions and unlock them afterwards.
3. When does a doctor decide to use a vacuum extractor or forceps?
The use of a vacuum extractor or forceps usually occurs when a labor is prolonged, difficult on the mother or baby, when the baby begins to show signs of hypoxia (hypoxic-ischemic injury, HIE, metabolic acidosis), or when maternal pushing efforts fail to deliver a baby.
4. What type of birth injuries are common when a vacuum extractor or forceps are used?
- Shoulder Dystocia/Brachial Plexus Injuries: Damage to the nerve cluster controlling arm and shoulder movement.
- Retinal or Total Eye Hemorrhages: Bleeding in the eyes due to pressure or trauma.
- Scalp or Skull Injuries: Including bruising, edema (swelling caused by trapped fluid), molding, caput (swelling of an infant’s scalp), and skull fractures.
- Diastases of the Sutures of the Skull: Separation of the skull bones.
- Jaundice: Elevated bilirubin levels causing yellowing of the skin.
- Hypoglycemia: Low blood sugar levels.
- Metabolic Acidosis: Acid buildup in the body.
- Brain Injuries: Various forms of trauma to the brain.
5. What is a brachial plexus injury?
While many of the above injuries are explained elsewhere on our site, we wanted to define brachial plexus injury. The brachial plexus is a nerve cluster that is connected to and transmits signals to the spine regarding movement of the hand, arm, and shoulder. When the nerves in this area are impacted during birth, movement of these areas of the body can become partially or totally impaired. When instruments are used, there is an even greater risk of injury to the brachial plexus, since pulling on a baby who is stuck in the birth canal with a vacuum or forceps is an extremely dangerous and risky procedure.
Some of the symptoms of a brachial plexus injury include:
- Poor sensation in the hand, shoulder, or arm
- Absence of muscle control in the hand, shoulder, or arm
- Partial or total paralysis
- Poor muscle tone
A baby might show symptoms of this injury by favoring one arm over the other, or by exhibiting “dead-arm,” where the baby does not support the injured limb and it remains limp.
Brachial plexus injury can cause Erb’s Palsy, a condition that results from partial or total paralysis of the upper brachial plexus. Klumpe’s Palsy is the corresponding injury that occurs on the lower brachial plexus. Both are caused when an infant’s shoulder becomes crushed against the mother’s pelvis during delivery. This is common in large or badly positioned babies.
This can cause the nerves of this cluster to stretch, causing short-term or permanent injury, or even tear, causing permanent, total injury to the following:
- Arm
- Shoulder
- Hand
There are surgeries and physical therapies that can assist with these injuries, but the prognosis is typically better for stretches rather than tears.
Long-term Implications of Birth Injuries
Birth injuries can have lasting effects on both the child and the family. For the child, long-term implications may include physical disabilities, such as limited mobility, chronic pain, or paralysis.
Cognitive impairments and developmental delays are also possible, affecting the child’s ability to learn and perform daily activities. These conditions often require ongoing medical treatments, physical therapy, and special education services.
For the family, the emotional and financial burdens can be significant. Parents may face increased medical expenses, the need for specialized care for their child, and potential loss of income due to caregiving responsibilities. The stress and emotional strain can also impact family dynamics and overall quality of life.
Legal Rights and Steps to Take After a Birth Injury
If your child has suffered a birth injury, it is crucial to understand your legal rights and take appropriate steps. Begin by seeking legal counsel from an experienced birth injury attorney who can evaluate your case and guide you through the process.
Collect and preserve all relevant medical records, including prenatal, delivery, and postnatal documentation. Document any communications with healthcare providers and gather witness statements if possible. Your attorney will help you file a claim, negotiate with insurance companies, and, if necessary, represent you in court to seek compensation for medical expenses, pain and suffering, and other related costs.
Contact Beam Legal Today for a Free Consultation
If you believe you have a birth injury case, do not hesitate to reach out to our firm! We have years of experience helping clients across the U.S. get the compensation they need to move forward after a birth injury.
Originally published August 1, 2015.
