Forceps or Vacuum Extraction
~ A Message Board Archive
From nellers ~ Are there any studies on which is safer? If it came down to it . . . either forceps or the suction device? I am doing my birth plan up and I want to research these in case they ask me which one I'd rather do if I need help. I don't want to use any mind you but if it came down to it, I'd like to be well informed. Any thoughts on this and can anyone point me into
From miche ~ I think it just comes down to the skills of the doctor. I've read opinions on either side. If the doctor is used to using forceps, I'd rather have that than have them switch to vacuum that they weren't comfortable with.
From Laurisa ~ I agree with Miche it is what the Dr. is most comfortable with.
From midwifetx ~ Definitely, it depends on the skill of the doctor. Best thing for a mom who 'needs' one of these things is to push in a different position, though.
From nellers ~ Okay, it seems everyone agrees it depends on the doctor. Does anyone know of any studies that shows which device has caused more harm to baby and mom?
From hedra ~ You can also check out the online resources at maternitywise.org they're evidence-based medicine, so they're not just research, but reviewed-for-quality research.
From hunter ~ "In a study of 583,340 live, single births in the state of California between 1992 and 1994, UC Davis obstetricians found that the risk of death and injury to newborns were low with all modes of delivery and that abnormal labor rather than mode of delivery may be responsible for poor outcomes.
The study also showed that the incidence of death associated with spontaneous vaginal delivery was 1 per 5,000 births, with vacuum extraction was 1 per 3,333 births and with forceps delivery was 1 per 2,000 births."
A vacuum extractor can't be used in all cases where forceps can be used. The head must be lower, and it's nearly impossible to flex or rotate the head with a vacuum. On the other hand, there are fewer cases of maternal trauma and hemorrhage (of mother or baby) when the vacuum is used, possibly *because* of those limitations. Vacuum is generally considered safer than forceps, but forceps are still safer than a cesarean. Bottom line, if my baby needed help getting out, I would trust that my provider would use whatever tool was most appropriate for the job and/or which tool they were most comfortable with.
From heather ~ In my experience, there are very few doctors who are well trained, or who are experienced in forceps use. They are a very helpful tool, but only by those who are really good at using them. Most newer OBs were never taught to use them. They can be VERY dangerous in the wrong hands. Forceps are definitely the instrument of choice where certain things are "needed" - like rotating the baby from face-up to face-down, to prevent a c-section. Vacuums are easier to use, and more "fool proof".
In general, there is a higher risk for trauma to the baby from vacuums (scalp bruising most commonly), and more risk for severe perineal trauma from forceps. There is NO answer to which is "safer". It really does depend on the situation in birth, and the experience of your attendant. If I have a patient insist on one over the other, we'd need to really sit down and talk about all of the above.
From nellers ~ Thank you for all this information. I would insist that they let me push longer or in different positions first (as long as the baby wasn't in danger) and then I would ask what my doctor was more comfortable with. Although I'm not too comfortable with the thought of forceps, if they were I suppose that would be the best way to go. Hopefully I won't need any of the two options but I want to be prepared in case I do. Thanks again for the advice!
From hedra ~ Just a little story for you on the forceps, something else to discuss at the time if you need them. A friend of mine had a posterior labor, and ended up moving from a birth center to the hospital to handle it. They got the baby to turn, but he kept turning back, and his head was hung up on her pelvic opening. I've seen high forceps attempts be called 'irresponsible' - better to c-section, basically. But this OB was very careful, and did high forceps without an episiotomy (skilled), JUST enough to get his head unstuck. Once they were sure his head was clear, he took the forceps away and let her push him the rest of the way herself. That reduces the amount of risk for baby (less time in contact with the forceps, plus less traction/pulling) and mom (less time with them moving around inside her). She managed to push him out on her own.
Anyway, it might be worth also discussing whether they need to keep the forceps in place/in traction the whole time, or if they are just needed for positioning/adjustment. Each situation will be different, but it is good to know that there are options even once they use them, if they do.
From laumau ~ My last baby was delivered with forceps. He was posterior (face up) and large (9lbs 11oz). He would not turn in the birth canal. My first baby also presented posterior but the nurse actually turned her. With my son, the doctor thought he would turn by himself in the birth canal, but he didn't. He then tried to turn him both ways and he wouldn't budge. He then tried the vacuum, but that didn't work either. He then used the forceps. He didn't pull him all the way out with the forceps because I remember looking down and seeing him come out of me very easily with nothing on his head, I didn't even push. He didn't have any problems from the delivery, or even any marks on his head or under his chin at all. It definitely saved me from a c-section, but was a last resort.
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