Forceps vs Vacuume Extraction

[jmmsunshine]

Hi! I'm hoping someone can help with some research here. I'm pg, due 9/1 and having a hospital birth with a midwife and doula. My doula asked me to research Forceps and Vacuume Extractions and determine which I would prefer if given the alternative between an assisted vaginal delivery or c-section. I've googled and looked around and all I can find are pretty clinical descriptions of indications and contraindications as well as potential maternal and fetal complications. All are more standard ACOG type documents and I'm looking for a less "traditional" viewpoint as well to provide a well rounded comparison.

It's kind of like when you look at vaccinations and all you find is pro vac, but you want to look at the anti vac or limited vac arguments as well so you can consider all angles.

Does anyone have any websites they know of that they can send me?
Thanks!!

[mamallama]

Honestly, once the decision for assisted delivery is made, the question of which tool to use is one I would suggest leaving to the care provider.

My rationale is that I'd rather have the ob using whichever tool they're most familiar and comfortable with, rather than one they find clumsy or awkward or ineffective.

[happymammaof3]

Originally Posted by mamallama

Honestly, once the decision for assisted delivery is made, the question of which tool to use is one I would suggest leaving to the care provider.

My rationale is that I'd rather have the ob using whichever tool they're most familiar and comfortable with, rather than one they find clumsy or awkward or ineffective.

I totally agree with this. My doctor was inexperienced using the vacuume extractor and it was awful. It broke off once so he had to do it again and when my son was finally born he had a very nasty sore on his head. He had to stay an extra day at the hospital to be monitored by the neonatologist because they feared swelling by the brain which could have caused brain damage. I thank GOD that He had His hand on him because he came through it just fine. That was 14 years ago.

[Emma's_Mommy]

personally i know moms who have had both, and from a recovery standpoint it seems like a vacume assisted delivery is less tramadic to the mom....b/c both moms i know who had forcepts ended up being cut from one end to the other to make room for the forcepts and had a rough recovery from it.....

[alegna]

I can not imagine allowing either.

If it was the most dire situation I agree that I would want the practitioner to use what they felt comfortable with.

I birth at home so that no one comes at me with either.

-Angela

[Robinna]

There's not a bad section in The Thinking Woman's Guide to a Better Birth by Henci Goer, pp 114 -118, in part of the chapter on slow labour. That chapter is published online at http://www.hencigoer.com/betterbirth/sample/

Myself, ITA that it would pretty much be the practitioner's call because in that situation, which would be my "last-ditch-effort-to-avoid-surgery", I would want them using whichever tool they were most skilled with.

xo Robin

[stacey2061]

i agree with the PPs that i would opt for whatever the doc was most skilled/comfortable using...but if all things were equal, i'd opt for the vaccuum (although i've BTDT and hope it never happens again...)

[megjo]

This is a really tough call. I've seen both used on babies during deliveries and sometimes it just depends on how low the baby is in the birth canal. If it's too high, forceps seem better. If it's low, then vacuum is used more often. Some injuries I have seen on babies are terrible; especially with the vacuum if it is reapplied. Vacuum also tends to not want to suck well on babies with lots of hair. Forceps, on the other hand, make bruises on the sides of the baby's head or cheeks and at the absolute worst case scenario, over the babies face itself. I've taken a vacuum extractor and put it up on my calf muscle to see how it feels and it feels HORRIBLE! I barely even got it to the "green" mark before I had to get it off. Of course, I can't tell you what forceps feel like...lol.

I do think that having the doctors do what they are most comfortable is a wise choice. Where I used to work, both vacuum and forceps were used for three contractions only. The vacuum could only be reapplied three times. That's alot of pulling. Ask to see what your doctor or hospital normally does.

I would suggest you do everything in your power to change positions so that you can help the baby along. Lay on your side, with people helping lift your leg, or try to get up on all fours, or try sitting up in a semi squat. Also, if you have a heavy duty epidural, ask them to turn it down or quit pushing the button! Your baby could move much faster if you know where and how to push when it comes naturally to you. I hope that helps.

[DoomaYula]

Yowch to both. Personally, I'd skip the vac/forceps info and do research on laboring "down" til you feel the urge to push, and avoiding directed pushing. Because if it comes down to it, the provider will choose whatever he or she wants.

I'm with Angela; I'll be at home, no birth assistance, thanks.

[HarperRose]

When I was born I was pulled out w/ forceps. My mother says I was horribly bruised and banged up.

Then 22 years later my son was pulled out w/ a vacuum. He had a bump on his skull for 2 YEARS from where the vacuum was attached to his head.

My mother was cut/torn from stem to stern as was I. We both suffered PTSD from our births (and ultimately both ended up w/ homebirths for future kids).

Neither is an option I would choose and if I was even given the option I would seriously question whether I was in the care of the right person.

[jmmsunshine]

Thanks for your posts & the referral to the book! My first response was, "I want neither - my body's not broken!" But I had a c/s with #1 and will do anything to avoid it with #2 - so if it means a choice between surgery or assisted delivery... it's a no brainer. But of course, you can't try one and then switch to the other - it's an either or situation...

Everything I've found so far says there is little difference in success rates between the use of either method, but with forceps there is much greater injury to Mom. I hadn't considered the amount of hair with VE - and my son was born with a headfull. My practice has a lot of younger OBs and I've read that many colleges are finding it difficult to appropriately teach forceps as the older OBs retire, so that's something to consider too...

My gut was to simply defer to the OB and ask what they were more skilled/familiar with, but I think it's great that she made me do a little research, as now I know what I could be in for depending on which would be used.

Thanks again!!

[Robinna]

Sunshine it's moot anyway cause you're going to just hunker down in whatever position feels right to you and push that baby out.

The best part of that chapter in Henci's book is actually about how to *avoid* an instrumental delivery.

xo Robin

[wannabe]

Alegna, I hope you never have the need for one, then. I'd prefer a living baby to a dead or brain damaged one, myself.

To the OP, I understand that forceps usually needs an episiotomy, but as the others have said, it's going to have to be judgement call on the OB's part. I don't think midwives are allowed to do vacuum or forceps? I got the impression that they try to use vacuum if appropriate because it'll come off and not damage the baby, whereas forceps needs skill to tell when you might be forcing too hard and doing damage IYKWIM.

Where I used to work, both vacuum and forceps were used for three contractions only. The vacuum could only be reapplied three times. That's alot of pulling. Ask to see what your doctor or hospital normally does.

I was told they'll try twice, and if she wouldn't budge it'd be c-section. It worked first time and was apparently quite easy (didn't feel easy pushing for the four hours beforehand)

This is one of those things where care provider choice is vital, because you have to trust them.

but I think it's great that she made me do a little research, as now I know what I could be in for depending on which would be used.

I know, that's fantastic that she's really empowering you. Good doctoring!

[alegna]

Originally Posted by wannabe

Alegna, I hope you never have the need for one, then. I'd prefer a living baby to a dead or brain damaged one, myself.

To the OP, I understand that forceps usually needs an episiotomy, but as the others have said, it's going to have to be judgement call on the OB's part. I don't think midwives are allowed to do vacuum or forceps? I got the impression that they try to use vacuum if appropriate because it'll come off and not damage the baby, whereas forceps needs skill to tell when you might be forcing too hard and doing damage IYKWIM.

This is one of those things where care provider choice is vital, because you have to trust them.



I know, that's fantastic that she's really empowering you. Good doctoring!

Well, the vac and forceps can both CAUSE brain damage or death.....

And it was her DOULA who had her research, not an MD.

-Angela

[lula]

I put down that I wanted a c-section if possible. (if my decision was forceps/vacuum vs c-section.)

Now I do NOT want a c-section but the injury/brain damage rates with forceps and/or vacuum freak me out more than a c-section. I have talked to tons of people with c-sections. (my mother who had 4 one of which was a giant emergency etc) I also witnessed a forceps delivery and my friend had a forceps used yesterday at her delivery. Yikes!

I am, as are all women , adverse to the idea of a 4th degree tear or huge episitomy so for me forceps are my last resort option. (even after c-section) Since I am not planning on getting pg again I am less concerned with potential damage to my uterus or potentially complicating further pregnancies with a c-section.

I am basing my decision primarily on risk of injury to my child's brain since I have handled drugs, etc very well in prior medical procedures. Is my logic off here? I have also specified that if the baby is really far down and would likely be more damaged by pushing him back up for a c-section to try the vacuum. Yes, I have a long list and much discussion! I have actually also been researching this since I am due with my second in September.

ETA: I also don't anticipate needing one but I am on the side of thinking about all possible outcomes.

[bryonyvaughn]

I haven't participated in this whole thread but think it would be interesting to get the perspective of chiropractors and osteopaths who treat children born with forceps and vacuum extraction.

When I lived up north my chiropractor participated in a study of chiropractic adjustments for the treatment of asthmatic children delivered with forceps. I think the study was in the late 80s to very early 90s so the kids were born in the 70s and early 80s before they had vacuum extractors in these parts. The kids all had atlas issues and showed amazing improvements. No one got worse, most were on reduced meds, and a good chunk got off meds entirely.

~BV

[mwherbs]

first off- get up- even if what you do is squat on the bed or lunge on the bed get your tail bone off the bed!!!!!! Now I am not saying push in these positions necessarily just to get up and move around if the urge hits you pushing will happen- if you can't stand because of an epidural get that turned down completely and worn off enough to move before either forceps or vacuum is done--if it comes down to one or the other - basically what is your provider skilled with? the the doc is skilled at both then I would still leave the decision up to the doc because they would know through experience what might work best in a given situaiton--
but first and foremost get up --- or try MCRoberts if you just can't move!

[jmmsunshine]

Originally Posted by bryonyvaughn

I haven't participated in this whole thread but think it would be interesting to get the perspective of chiropractors and osteopaths who treat children born with forceps and vacuum extraction.~BV

THANKS!! That's a great suggestion and I'll mention it to my chiro when I go in for my next adjustment.

I have no intention of using drugs or an epidural during labor - in fact I intend to arrive at the hospital in transition or ready to push. And because of my good relationship with my midwives and my doula, I'm confident that I won't need any assistance. Robbina's exactly right - I plan to just hunker down and do whatever my body tells me to do!

That having been said, I was confident I'd have a natural, non-medicated birth with #1 and that didn't happen. And worse than that, I didn't have the information that I have today that might have changed that outcome, or at least added to my support. So my view today is plan for the best, prepare for the worst. I'd rather have at least reviewed and thought about my options here and never need them, than find myself in an emergent situation completely unprepared.

[AuntG]

I talked to my dad today and he told me I was pulled out with forceps after they cut my mom.

"Go look at your baby pictures," he said, "up until you got hair, you could still see the scar from where they cut your head."

It's neither here nor there, but I thought it was interesting.

Mom passed away a while back and I never thought to ask about my own birth!

[Momma Aimee]

Honestly, once the decision for assisted delivery is made, the question of which tool to use is one I would suggest leaving to the care provider.

My rationale is that I'd rather have the ob using whichever tool they're most familiar and comfortable with, rather than one they find clumsy or awkward or ineffective.

my thoughts.

I think by the time we all agree it is necessary -- ie an assited birth -- it is best to let the OB choose what they feel best useing, or best using in that situation.

we were a forcept delievey -- and the OB chose the forcepts over the vacume that the CNM requested because of the position of the baby's head the OB felt the vacume would not "work as well" and he "had more control to guide the baby with the pushing" with the forcepts.... which he did, i kinda sorta birthed him.... a little I was pushing and he was "working him out" and never actually pulled on him at all.

and not all forcept babies have marks, though i gues smost do. DS looked perfect, head not even wapred or anything -- evey care provider in adn out fo the room for 2 days commented they never would have known. OB says that is cuz he didn't have to pull, he just guided and steered while i pushed (liek shoe horn kinda) and kept DS from back sliding inbetween.

I did have a 4th degree tear, and am still GLAD to have recovered from THAT and not majior abdonimal sugery .. and having a buddy who has recovered from both... she votes with me....the C was a lot more, and effected nurseing a lot more, than the 4th degree tear.

Note -- I think most OBs like you to get a epdural for either -- i did for my forcepts, but i know a mom who birthing i think is CA who had forcepts without pain medication.