Vacuum vs. forceps

[USAmma]

Just wondering which I should put in my birth plan should something be needed?? Hopefully neither.

I used to shadow my mom, who's an L&D nurse, when I was a teen and of the 2 vacuum extractions I saw, both were horrible. In the first one the thing kept popping off and they ended up using forceps anyway. In the second one it worked but the baby had a huge amt. of blood under his scalp, it looked terrible.

I have read since that vacuum is better than forceps because it causes less damage to mother and child both. At my hosp. they use forceps with some rubberized padding on the tong parts to protect baby better. At least I feel good about that.

So which is less harmful to mom and baby? I'm terrified that I'm going to have a posterior baby since she prefers that position right now. I do the exercises, she turns easily, then an hour later is back posterior. But first of course I have to wait and see if she's still breech or not.

Darshani

[hunnybumm]

Well I don't know a whole lot about either of these, but my DS had to be vaccummed out. He does have a hematoma (sorry I can't spell) on his head from where the vaccuum was attached, but it isn't that bad at all and I really didn't even notice it untill my DH and mom kept making comments about it. At 18 days he still has it, but it is slowly getting better.

I think it is great that you are thinking about this ahead of time because I never even thought about it. And when it came down to something needed to be done I didn't care what it was as long as it got my DS out. After 3 hours of pushing (I had been in labor for almost 2 days) I was getting too tired to push so they decided to try and vaccumm him out. Honestly I don't even remember being asked if it was ok with me, it was just decided.

[USAmma]

Gena, thanks for sharing your experience. Did you have to get an episiotomy before they use the vacuum extractor? How were you "down there" as a result of the vacuum?

Glad you have him out and home now. :-) I keep trying not to worry so much about the birth because ultimately I just want my baby born safe and sound.

Darshani

[BabyOsMommy]

Had vacuum extraction with ds

And like hunnybumm, I was at the point where I didn't care what they did, I just wanted him out. period. There is so much about his birth that peeves me off, but the vacuum is the least of it. Yes, the vacuum kept popping off his head, and he had a serious ridge in his scalp for a few weeks afterwards, and I blame the fact that he was jaundiced and we had such a rocky start to nursing on the bruising on his head... Yes, actually, that peeves me off quite a bit. But it's what lead to the vacuum that peeves me off more, because I don't believe I would have needed it with better management of my labour.

What peeves me off most about the vacuum was that she did an episiotomy without warning me first, and then got mad when I started swearing. But surprisingly, after delivering a 10lb 10ounce baby with vacuum extraction, I had not too many stitches, and although sore for a couple days, I healed very quickly (the nurses were surprised). It's my understanding that they have to do an episiotomy to use the vacuum, but I could be wrong. It's good that you are trying to think of which one you'd choose, because I went in saying neither, and had no idea which one I'd choose. It would have been moot because my OB doesn't "do" forceps, but I would have at least thought about the after effects. Good luck and I hope you don't need either!

[lorijds]

First of all, posterior does not mean needing forceps or vacuum. I have seen many a babe born posterior without either.

Being able to change positions frequently in labor AND while pushing seems to be key, in my experience.

I also would not put which you prefer in your birth plan....it seems to me almost like giving your doctor permission to do it.

That said, I asked the doctor for whom I worked about this once (I am a nurse at a freestanding birthing center). We don't use either here, but she has used them before in the hospital. She said she prefers the vacuum for several reasons.

Mainly, it has a protective mechanism. It is *supposed* to pop off if the pressure being used is too great. That way not too much pull is applied to the baby's head. With forceps, the doc can pull as hard has he freakin wants, with no indicator, other than his own common sense, to tell him that he is pulling too hard.

Also, positioning is not as important with vacuum. If the forceps are malpositioned, they can do serious damage to the baby's head, specifically the face and eyes.

The vacuum is easier to manipulate. The forceps usually require two hands to hold them. If you are gearing for the baby to turn one way, and then baby turns the opposite, you can be fumbling with them some (and in the meantime, allowing them to be malpositioned). Because of the way the vacuum is held, it is easier to turn to the right or the left, depending upon which way the baby wants to come.

For both vacuum and forceps, an episiotomy is usually performed.

Just for the record, both the vacuum and forceps make me sick. I have seen a couple vacuum extractions. I thought I was going to vomit. I participated in one vacuum extraction as a nurse. I felt ill, but I was also scared to death, as the entire reason for the vacuum was the baby's heart tones dropped to the 60s and lower, and mom and her uterus weren't going to get the baby out in time, and I was glad it was available to us then.

I feel it is of utmost importance to avoid the usage of either of these instruments. Mom being able to move is so key. Also mom being surrounded by people that know she can do it, without help from outside powers, is immensely helpful.

Good luck! Do lots of pelvic rocks. Tell yourself you can birth this baby, whether she is posterior or not. If you tell yourself often enough, perhaps you will begin to believe it, and then you will really DO IT!

Take care. Let us know how it goes. You'll be in my thoughts!!!

[DesireeH]

I agree with the above poster that I would try all other positions/options and such first.

My son was posterior and I didnt get either of those used (did have an episiotomy though.....I only pushed for 5 minutes, dumb dr wasnt patient enough).

In my birth plan I put that I would choose forceps over the vaccum but only cause I once saw a 20/20 about vacuum births and it scared me to death (hemorraging in the brain). My cousin was born via the vacuum and his head was all blue and bruised but he is ok.

[Very Snoofly]

I had the vacuum when my daughter was born (I can't figure out how to word that...my daughter was vacuumed out? ). The doctor used it because her heart rate was dropping; plus she was a big baby (9 lbs). Was it really "necessary"? I dunno...

Anyway, it hurt like the dickens when he was positioning it on her head. I did not have an episiotomy, though, and I didn't tear all that badly. Mallory's head was just slightly "stretched" looking, but it wasn't swollen or bruised. So all in all it wasn't an awful thing, for us.

[Daffodil]

The doctor ended up using the vaccuum extractor to get my dd out, because her heart rate kept dropping every time I pushed, and she thought it was dangerous to let that keep going on too long. She suggested the vaccuum, also suggested we could just do a c-section (since she wasn't sure the vaccuum would work, and a c-section might be necessary anyway), but left it up to me and DP to decide what, if anything, we wanted her to do. I didn't have an episiotomy, and I got a third-degree tear, but it never hurt afterwards, and seems to have healed up just fine. The baby had a bruise on her head that probably contributed to her jaundice in her first week, but it didn't look too bad.

[anothermama]

I'd like to say I agree with Lori...saying that you prefer one over the other is like saying "Yes, please put a time limit on my birth and use ONE". If it were me birthing in a hospital, I'd say no to both, especially if you don't have an epidural or pitocin. There really should be no need.

I really really really hate the notion that "big babies" need help out. I had a 9 1/2 lb baby.....naturally, and on my BACK even!! Women CAN give birth to large babies just fine if they are given the appropriate time and tools to do so.

Now, granted, all this can be out the window if you have an augmented birth. It's the chain reaction thing....one intervention usually leads to another.

I also wanted to add that during my birth, my daughter crowned after a very short time, however she still wasn't positioned correctly...she'd been semi posterior that morning so I assume she was still turning. Anways, I labored like that for nearly four hours.....just because the baby is starting to crown doesn't always mean that it must come out RIGHT NOW.

Another mama mentioned changing positions.....yes yes yes!! IF your worried about posterior, get on all fours.

[Defenestrator]

There are so many factors that weigh in the decision of which to use. They are useful in different situations. Forceps are better for malpositioned heads or babies who are very high, vacuum is better for babies who are very close to being born and just need a little extra help. I think that when you are making the decision to use either the skill of the provider in the individual method is important. If the provider almost always uses vacuum, I would not want him/her using forceps on me.

I have seen a vacuum delivery that I thought was helpful and warranted. The mom had been pushing for a long time after a long labor and did not want pitocin to strengthen her contractions -- the baby was at about +3 station and had puddling meconium. They advised an episiotomy and she declined, then the doctor used what I would describe as medium-strength force and two attempts with the vacuum before the baby was born. When the midwife checked the mom out later she had only first degree tearing. The baby had no ill effects that I could see, apart from a reluctance to nurse in the first 24 hours that I attributed to the deep suctioning that he had to go through for the mec.

I would save the discussion about the choice of surgical tools for the birth itself.

Also, re: the posterior baby -- I would spend lots of time ahead of the birth trying to turn the baby and then also do some work in early labor as well. Search my posts and you can find a regimen that I suggested for someone else.


Good luck!

[HomeBirthMommy]

Darshani,
Lydia was born using a vacuum extration. I am not telling you this to scare you, but to let you know what can happen. First, I was not told they were going to do the vacuum. My doc just called for a "team" and then started going about the vacuum-still without a word to me. She then did an episotomy without telling me. I thought they would put the vacuum thing on when the head was poking out during a push, but no-they still that whole big thing up inside of you and it hurts! When she was pulled out, I literally felt like she was being ripped from me. It was awful. She was then taken immediately to a table to be examined. To this day, I have no idea why the vacuum was done, except for the fact that I had pushed for 2 hours and it was midnight.
Her little head was bruised and so sensitive. We couldn't put little newborn caps on her b/c she would just scream when her head was touched.
I am so angry with myself for letting happen to both of us. I wish that I had known then that I had a voice in the birth of my child. I wish that someone had suggested different positions. I wish that I had asked questions about what was being done to me. I know that you are a smart woman and you are doing your child and yourself so much good by researching before the birth. I know that you will not let anything be done unneccesarily to either of you. Make sure your dh knows to question what and why in case you are unable. I'm wishing you an easy and healthy birth.

[mamallama]

I totally agree about not specifying either in your birth plan. This website has some great information on helping a posterior baby turn:

http://www.spinningbabies.com/index.html

[KayleeZoo]

I'm not a regular poster here, but thought I would add my experience. My second dd was born w/the assistance of the vacuum- the cord was compressed and she was showing signs of severe distress. My OB and I had discussed vacuum at length before the delivery of both my girls (I have a wonderful relationship w/my OB- love her to death!!) and she told me she would never use it unless the baby was in trouble. She let me push for as long as it took with dd#1, but Kaylee showed no signs of distress throughout. With Lexi, my OB was concerned and told me the best thing was to use the vacuum. I consented because I trust her completely- and it went really smoothly. I didn't need an episiotomy, and only had a couple small skid marks (no sutures at all), and Lexi had a bit of cranial swelling, but not bad at all. Her head wasn't sensitive or painful and she recovered just fine. Just wanted to let you know that it doesn't have to be a horrible negative experience. It wasn't my first choice, but like you, a healthy baby was my priority, so I was glad my OB stepped in and did what she needed to do to deliver my little sweetie safely. Good luck and I hope she turns, and stays turned!!

[guestmama9924]

Both are horrible. Both have adverse effects on mom and baby. Both usually require large episiotomy.
Try to avoid either by birthing upright, pushing only with the urge and avoiding purple (breath holding) pushing, avoid medications that may make the baby heart rate go way down and force the staff to extricate the baby ( such as any narcotic, or epidural)

As a long time doula and birth assistant, if it REALLY comes down to using either option, you really must have a baby in trouble and may not really get much say. If you trust your caregiver then this may not be an issue you need to bring up. ( ie trust that the caregiver will only use this step as a the last step before c/section)

[Greaseball]

I had forceps when my dd was born. Those things HURT! You would think they would be designed not to cut you! I managed to do it without an episiotomy, and dd was pulled out face-up with just two pulls. The doctor then took the blades off and started working the skin back while dd was crowning, and then she slid out. We had a doula and she was very impressed with that - she said she had never seen a doctor remove the blades like that; usually the baby was pulled completely out and the blade dragged down the perineum and cut it.

I managed to have an intact perineum when it was all over, but I had two vaginal and labial lacerations that had to be sewed up, and those really hurt. For a week I walked around with ice packs in my underwear. Sometimes they still hurt.

My sister was born via vaccuum and it tore off pieces of her scalp. She still has bald spots. My ob said a vaccuum would not work because of the position of dd's head. I wish she had said I would have to have an epis with the forceps because then there was no way I would have agreed to it. I always felt bad about it because dd had a lot of bruising and some bleeding under the scalp. I bet it hurts, being grabbed by the head and pulled on. It felt like my whole uterus was being pulled out too.

I had been pushing for 4 hours (started when I didn't have the urge to, just because they said I could) and was exhausted and wanted it to be over. I think it could have been avoided if I had not pushed until I was ready, and if I hadn't spent so much time in bed. It was the second-worst part of the whole labor (IV was the worst).

[cottonwood]

Neither should *ever* be necessary if the labor is managed right. Honestly, I would like to know how many uninterfered with, unhindered, instinctive births have to be finished with a mechanical extraction. Just avoid induction, augmentation, drugs, vaginal exams, being flat on your back, and being told when and how to push, and you'll be fine.

[lorijds]

I've been thinking more about this, Darshani. How about, instead of putting which you would prefer in your birth plan, you put something like:

In the event that the baby is malpositioned (ie posterior) please encourage me to change position frequently during labor; to labor on my hands and knees, to perform pelvic rocks in between contractions, to freqently get up to empty my bladder, to use the birth ball, the tub, and other positions to help encourage the baby to turn. If the nurse or doctor have any suggestions for positioning, I welcome all their help and encouragement. During pushing, please remind me to fequently change positions, from side lying to hands and knees, to squatting. Please suggest any and all positions to help the baby turn and help open up my pelvis. I know that some babies remain posterior no matter what, so I welcome and encourage all your help and expertise in my healthy, normal vaginal birth of this baby, whether she decides to come out anterior or sunny side up.

This way, not only are you telling them that you know that your baby might be posterior, but that you know that you might have to work harder. They know this, too, but they don't know how motivated you are unless you communicate it to them. Penny Simkin always talks about wording your birth plan in the positive. When you word it like the example above, you are envisioning yourself doing all these things to help open up your pelvis and get the baby in a good position. When you word it properly, you get your caregivers to envision themselves helping you birth this baby, taking an active, positive role. Also, you are showing them that you have thought this out. You are an educated, strong mama, and you know your options. They are going to recognized this. Finally, you aren't overtly wording it in a way that says "I know you just like to do c-sections because it is the easy thing to do, you lazy bastards." Rather, you are engaging them, asking for them to use their experience and knowledge to help you have a healthy, natural birth. It doesn't hurt to stroke their ego a bit, in the form of "Oh, I know you have so much experience, I know you know lots of tricks to help me have a nice, healthy, vaginal birth." A carefully worded birthplan strokes their ego a bit, while also clearly (though not defensively) conveying your expectations and empowerment in a positive fashion.

Good luck! Think positive thoughts (and remember, a posterior baby isn't necessarily a bad thing! It is the position the baby chose, probably for a good reason. Posterior DOES NOT EQUAL C-SECTION OR VACUUM OR FORCEPS! Where I work, we do not do any of those things, yet we do not have a problem with moms having to transport for posterior babies. It just isn't an issue.). I'm sending lots of empowering and positive thoughts your way!

Lori

[KKmama]

I wish I had a reference for this, but I don't...

When I took my childbirth class when I was pg with ds, we asked our instructor about this. She's a doula, a childbirth instructor, and training to be a midwife. I really liked her, and I have a lot of respect for her. She told us from the reading that she had done, if *she* were given the option, she'd go for a cesarean; she felt like the potential risks to the baby were too great and that a cesarean would give a better outcome. I realize that when seconds count, that may not be an option.

I'll add this to my list of things to discuss with my ob.

edited to correct typo

[Greaseball]

Some people say they would rather have a cesarean to avoid trauma to the baby caused by forceps, but sometimes forceps are used to lift the baby out during a cesarean.