Delivery may need an assist from vacuum extraction or forceps

The thought of delivery by forceps or vacuum extraction may make you cringe. But when a delivery isn't going well, these devices can save a baby's life. Forceps or vacuum extraction is used in about 1 in 10 deliveries, although forceps aren't used much these days. Vacuum extraction is more common.

There remains some controversy among physicians about the use of these two techniques. Bottom line: In the hands of a skilled practitioner, these devices can save a baby's life by speeding delivery.

In vacuum extraction, a plastic cup is inserted into the vagina and applied to the baby's head. Suction keeps the cup in place and the doctor pulls the baby through the birth canal by pulling on a handle attached to the cup.

In forceps delivery, the doctor inserts the forceps, which look like big spoons, into the mother's vagina. Then the forceps are placed around the baby's cheeks and jaw and the doctor uses them to gently guide the baby's head out of the birth canal.

There used to be three kinds of forceps deliveries: high, mid and low, referring to how high inside the uterus the forceps are used. Forceps horror stories of yesteryear generally refer to high forceps deliveries, which are no longer performed (they've been replaced by C-sections). Mid forceps deliveries have also been replaced by Cesarean and by vacuum extraction. Low forceps delivery, the type used today to assist a baby through the birth canal, can be extremely effective in some difficult deliveries with less risk than surgery. Even so the trend is away from forceps delivery. In many cases a doctor will opt for a C-section instead.

Baby's position, mother's exhaustion are factors

There are a number of situations where your doctor may recommend delivery assisted by these implements.

You may find yourself at the end of labor without enough energy to push the baby out of the birth canal. Pain medications, such as an epidural, may make it more difficult for you to push your baby out on your own.

The baby's position may make delivery difficult, or the baby's heartbeat may slow or become erratic and baby needs to be delivered quickly.

What are the risks?

There has been some controversy recently about the use of these devices, since they could potentially harm a newborn's head. The FDA has stated that the total number of serious complications resulting from these devices has been few. The American Academy of Obstetricians and Gynecologists has also reminded doctors that without vacuum extraction, the use of C-section and forceps deliveries may increase.

Although very rare, vacuum extraction has been known to cause scalp injuries and skull fractures; however, risks of injury and death is extremely low when performed appropriately by an experienced doctor. The American Academy of Family Physicians has said that both forceps and vacuum delivery should be part of modern obstetrical practice.

If you are concerned about vacuum extraction or forceps delivery, discuss your concerns with your doctor at one of your prenatal visits to find out what his or her thinking is regarding the use of these instruments. If you do find yourself undergoing an assisted delivery, remember that many babies have been born with these devices with no problems.

Date last reviewed: October 2002.

Back to top