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#31 of 41 Old 02-01-2003, 01:17 AM
 
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I've only seen two vacuum extractions, one in which I was the nurse holding the pump. Here is my take on it....

I was a nursing student with the first one. The mom had an epidural and had been pushing for a whole hour. The nurse and the doc asked several times "Are you getting tired?" Finally the mom (who I thought was doing great despite the epidural) said, "Well, I guess." The doc said, "We can help you out if you want." Then told her they could attach this little vacuum to the babe's head and just pull him out. When the mom asked if it was dangerous to the babe, the doc actually said "Oh, no, not at all." I thought I was going to vomit, I am serious. I had never seen one before, and I couldn't believe how much of the scalp gets sucked into the little cup. I seriously had that rush of saliva, that light headedness that you get right before you pass out or you vomit. The babe, whose strip had looked great until the VE, was born with an apgar of 4.

The second one was in an out of hospital situation. Mom had pushed for a couple of hours (competely on her own accord...when we got there she was grunting in a major way), and for the last hour the babe was right there on the perineum. We kept thinking the babe was coming any minute, but she wasn't. Then her heart rate started to drop; it would drop to 30-40 with contractions, and slowly come up to about 90 between. I am certain it was the babe's heart rate, because I was feeling the mom's pulse with one hand and auscultating with the doppler with the other. The mom's heart rate was higher than the babe's! This is scary as all get out; but we also thought, good lord, this babe is almost out, surely she is about to come!

We were far enough from the hospital and close enough to birth that the doc decided to use the VE. I was shocked that she even had one. She used it during two contractions, babe came out screaming, heart rate immediately shot up to 130s, and she hasn't had any problems since (she is almost one year old now). Her apgars were 9, 9, and 10. Yet all indications were of serious distress. For all we know, she was squeezing her cord with her hand....but by what we had to go on, I had the equipment all set to go to do a complete resuscitation.

I asked the doc about the VE later, and she said she liked it better than forceps for several reasons. With VE, you can't pull harder than the pressure setting; it will pop off the babe's head if you are pulling too hard. Also, if the babe rotates, the VE can be held with one hand, so that your hand can rotate easily with the head. With forceps you can pull as hard as you please, and if the babe rotates, you sometimes lose your grip, or the forceps become misplaced, and can do damage to the babe's face and head. She said it is a rare situation that she would prefer forceps over VE; best of course is not to need them at all.

But like any medical procedure, both have their place. It should be judiciously used, of course, NEVER routinely. I think certain aspects of labor and birth can predispose one to need them....birthing lying down, birthing with an epidural or pain medication, not enough change of position during labor. But I was grateful that day that our doc had a VE up her sleeve, because it was just what that babe and mom needed, and it saved them from becoming a transport. The babe was obviously fine once she finally arrived, but you know that in the hospital she would have been whisked away for observation. I am glad we kept them out of the hospital, but boy, I seriously thought I was going to lose my lunch when that heart rate started to drop and then recover so slowly. We watched the video later, and I have this calm look on my very white face, but my hands are visibly shaking when they are in view. I went home and drank three beers after that, then slept for 14 hours, I was so mentally and physically drained!

Edited for typos :
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#32 of 41 Old 02-01-2003, 09:48 PM
 
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I had the vacumn with my dd, and no problems from it what so ever. She was born faceup and was quite simply stuck. My Ob, who I really like tried switching positions giving me oxygen and everything first but couldn't get her too budge and her heartrate was dropping fast. He only used the vacumn enough too get her too move a bit, then told me I had too push with all I had because, the baby needed too come out immediately!! I feel the use was justified, because even though the whole pushing time was only 35 min, she was born a chalky blue, white color. Yes, I had an episiotomy, but was up walking around by that evening with very little pain. She had a bit on a cone head for a few days! LOL But that was it. My son was a very easy delivery and I am hoping this one is too. I would prefer an unmedicated delivery with out interventions. But I trust my OB, I feel he will do what is best. Just my experience.
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#33 of 41 Old 02-01-2003, 10:03 PM
 
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my first had vacumm extraction, but Except for the episiotomy, it was very gentle. They were worried cause ds was showing signs of distress, and they used the vacumn to help me push him out -- that is with each contraction/push he had been slipping backwards when I stopped pushing, so they just sort of held him in place with the vacumn till the next push. I think it was maybe 2-3 pushes with the vacumn thing on till he came out.

Turns out he had a true knot in his umbilical cord so blood supply was being cut off as it streched and tightened.

Rebecca
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#34 of 41 Old 02-02-2003, 12:35 AM
 
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I think someone else might have mentioned this, but I am wondering, how many of these VE/forceps babies were born posterior (ie, face up) or with asynclitic (tilted instead of pointed straight down) heads?

I think blueviolet is on to something with the idea that pushing before you feel the urge can contribute to VE, but I am noticing alot of ladies posting about babies coming sunny side up.

posterior presentation can be assessed, and corrected if necessary by the birth practitioner, even in labor, often before. it's bound to happen normally, in some percentage of moms (sorry, no statistics handy now) but in many others can be linked to too much sitting on soft surfaces and reclining chairs or maladjustments to the pelvis that can be corrected with bodywork and yoga postures.

in other words, I am sad to see so many "stuck" babies described here, and wonder what might be the cause, so we can find a working solution for some of them.

-Lau
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#35 of 41 Old 02-02-2003, 01:34 AM
 
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Interesting....

my ds was born by VE. I pushed for 3.5 hours and his head kept going back up. I don't know why, the whole experience is a haze to me. I was exhausted. I had what the nurses kept calling "minor" tearing, and ds had a hicky on the top of his head. I begged for percocet to bring home, I was in so much pain, I kept going back to my midwife for like 7 months, saying, I still hurt. Not on the outside, but like up, halfway inside the birth canal, if you can picture that. I think it took about a year before I could have sex without actually crying from the pain. The midwives and nurses convinced me that percocet was not necessary (yes it was, but I was really wimpy and let them tell me how I felt) I just remember being in so much pain for so long afterwards_totally different than dd birth 3.5 yrs later that was 100% natural.

In the end, I am grateful that there was no damage to my ds head, neck, brain, etc and that he was perfectly healthy, I am glad that it was not forceps, as those really scared me. And, I am really glad they didn't decide to do a c section after all that I'd already been through, (after 24 hrs of labor and 3.5 hrs of pushing, I can't imagine recovering from surgery also) So, I guess in that situation, it was the best possible outcome. (btw, I did have some sort of shot of something that made me crazy, can't remember the name of it, and an epidural that wore off before the VE was used, it was the worst pain I can imagine and dh said he'd never heard a scream like that before.) I did make numerous position changes, so was not laying on my back the whole time.
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#36 of 41 Old 02-02-2003, 04:04 PM
 
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I've heard stats that 25% of babies are posterior during labor, and 3% are actually born 'sunny side up.'
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#37 of 41 Old 02-02-2003, 05:20 PM
 
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Mine was posterior. The forceps were not used to turn her, just to get her out. The doctor put them on, then pulled once with the next two contractions until the head was crowning, and then she removed them and I pushed dd out the rest of the way. The doula said that most docs won't take them off; they still keep pulling after the head crowns and they cut right down the perineum. She said the reason I was able to keep mine intact was because they were removed so soon.

This is just my belief, but I think that if a baby is posterior or breech or any other position, it has chosen it for a reason and I wouldn't feel right about trying to "correct" it - I would want to honor it instead. Babies can be delivered in just about any position except transverse with no interventions, even at home.

I wouldn't like it if I had found a comfortable position on my couch or something and then someone came along and tried to force me into a different position, one that might not be so comfortable for me.

Of course, I could have taken a lot better care of myself while I was pg. Yoga, stretches, excercise and good diet can benefit everyone! I hardly ever excercised because I was so tired all the time and it hurt so much. Next time, though, I'll be sure to!
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#38 of 41 Old 02-02-2003, 05:50 PM
 
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With ds1 I had an epidural and was told when to push, though after 15 minutes or so felt the urge. Pushed for 45 minutes and the dr said the baby's heart rate was dipping. He attached the ve but I started pushing SO hard to "beat him to it" that I popped the cap off and Ben was born a few pushes later.

With ds2 I had no drugs and BOY IS THE URGE TO PUSH IMMENSE. 20 minutes of pushing, no drugs or interventions other than the damn 20 minute EFM hospital policy bulls**t.

A friend of mine had a baby and they used the ve--he had a HUGE bruise on his head, then developed severe jaundice and was in the NICU for 7 days. She says a nurse told her that the jaundice can be caused by the ve--the bruise, with the blood, needs to be reabsorbed by the body, and the baby's liver isn't mature enough to handle this, and gets overworked, hence the jaundice.

Anyone else ever heard of this?

Thanks,

Mel
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#39 of 41 Old 02-02-2003, 06:27 PM
 
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I've never heard of jaundice being linked to the vacuum.

However, those I know who have had the vacuum were also induced. There IS a relationship between induction (early delivery) and jaundice.
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#40 of 41 Old 02-02-2003, 06:37 PM
 
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My friend just had a baby a few days ago where jaundice was an issue after a VE. She had gone into labor on her own when her water broke spontaneously and was 10cm just 7 hours later with a first baby. She then pushed for three and a half hours before they decided to use the vacuum -- she had had an epidural, so I'm sure that limited the positions she could push in. They actually had assumed the baby was posterior, saying that that was probably why she was "stuck", though it turned out that she was properly positioned. They had also been concerned about size issues, as my friend is a very petite Vietnamese woman with a 6'2" caucasian husband, so thought she might have a really big baby in there (though she ended up being less than 7 lbs at full term).

They told my friend right from the beginning that there was a good chance that jaundice would be an issue since the baby had so much bruising on her head. Her bili level was at 14 the second day, which is not normally high enough to be really worrisome, but they felt that with the bruising they should be pretty agressive with treating the jaundice, so they did phototherapy for 24 hours. Luckily, she was at a fairly breastfeeding-friendly hospital, where they made sure that baby was nursed often, and nobody made any noises about formula, my friend's mature milk came in rapidly, and baby is nursing voraciously, so she has been discharged
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#41 of 41 Old 02-02-2003, 09:26 PM
 
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I'd like to be clear about my use of the word "correct", as in correcting the position of a posterior baby.

I _do not_ believe that forceps or VE should be used in the vast majority of cases where it is used, and I think that in many cases, the hands (a midwife's most valuable tool) can be used in wonderful and surprising ways to facilitate a difficult birth. I was not advocating the use of a VE to correct the position of a posterior baby, and in fact it isn't used as such. it is used to pull the baby down the birth canal by their heads.

posterior presentation can be dealt with in labor by position changes, rebozo techniques, very gentle manipulation of baby's head in the birth canal by the midwife (or dr., though I don't know that they would try that technique) etc.

while I think that some babies need/want to come out that way, sometimes they come out that way because of other reasons that can be helped. I believe good posture and body integration and alignment are absolutely important in pregnancy and birth, something that's hard to achieve in a lay-z-boy recliner. if learned properly, it isn't uncomfortable, it's actually more comfortable to be using your body in a natural way. it's changing the old habits that are uncomfortable. (I know, I am still working through so many of my tendencies to hunch over and pull my chest inward, squashing my now pushed up diapraghm and ribs, sitting flat on my sacrum and leaving less room in my pelvic inlet for the baby, and I've been working on these issues since before I became pregnant in june).

most babies will come out on their own, they aren't truly stuck. but some of the choices that we and others make can contribute greatly to our birth experiences, possibly leading to interventions that otherwise would have been avoided. as a doula, an aspiring midwife, and a soon to be birthing woman, I want to do all I can to help women have good, safe, normal births.

-Lau
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