How is a vacuum assisted delivery performed?

Obstetric suction cups, spatulas, spoons, tweezers: what are they?

In France, 12% of deliveries require the use of extraction tools. In addition to suction cups, there are: pliers and the spatulasalso called spoons.

The suction cup is an instrument that grabs the baby’s head suction power.

Marie-Elise Launay, Midwife: “The suction cup consists of a small cap, called a cup, which looks like a cap, which is placed on top of the baby’s skull. It will adhere to the toddler’s skull and help him to to come out.”

The pliers are a metal instrument in the form of tongs topped with spatulaswhich we on the . will put babies temples to aid the extraction.

“Finally, the spatulas or spoonsas the name suggests, resemble large metal spoons that are not connected this time,” describes the obstetrician. They make space by removing the soft part of the mother’s vagina.

Of the 12% deliveries that required extraction instruments, half done with suction cups1/4 with tweezers and 1/4 with spatulas.

In which cases are suction cups or tweezers used during labour?

When a vaginal delivery is physiologically smooth, it is called “euticConversely, when complications arise and the use of extraction instruments is indicated, we speak of a delivery. “dystocian”.

“The use of instruments at birth is justified in three main scenarios,” the obstetrician describes:

  • when the baby is not progressing in the pelvis, but he’s okay. This may be the case when mom is too exhausted to keep pushing, eg.
  • the baby is in a position that does not facilitate the exit : the instrument used will allow him to reposition himself in an axis more favorable for birth,
  • the baby is in fetal distress : episodes of bradycardia registered with monitoring, prolonged delays, presence of meconium fluid… it is therefore urgent that it be born.

“The suction cup allows rotation and traction : it is therefore often used when the head is bowed or asynclitated,” explains Marie-Elise Launay.

The tweezers allow the baby’s tractionand the spatulas allow toopen space by pressing on the vaginal walls to facilitate the descent of the baby.

“During each delivery, if an instrumental extraction is deemed necessary, the doctor decides which instrument is best to use depending on the situation he encounters, the instruments at his disposal and his experience,” explains the obstetrician.

Nevertheless, according to the 2020 Guidelines for Instrumental Extraction by the Royal College of Obstetricians and Gynecologists, the idea of ​​the woman’s consent is essential. The document states that “women should be provided with information about instrumental extraction during pregnancy. If they place any restrictions or limitations on this intervention, they should be able to discuss it with a senior midwife, ideally before going into labor”. delivery room, a the wife’s oral consent must be obtainedand are transcribed in his file.

The use of extraction instruments is done during the last stage of labor. “The full dilation phase has already taken place during labour, the cervix is ​​open until 10 cm dilated – ie when fully dilated – and the baby is in the pelvis, which triggers the urge to push,” says Marie-Elise Launay. The pushing has already started and the mother-to-be is then assisted by the obstetrician who, if necessary, can suggest a more suitable position or a more effective way of pushing for her patient.

“In case of complications, the obstetrician calls the obstetrician, who alone is authorized to perform an instrumental extraction,” the obstetrician insists.

The decision to act is made extremely quickly in the event of fetal distress, and if the pushing is less urgent, it adapts to the situation depending on the baby’s height in the pelvis, the effectiveness of the pushing efforts.

“Once the decision is made to use the suction cup: The doctor places the cup on top of the baby’s skull, suctions so that the device is sucked onto the child’s head, and can then perform slow movements on the sides to turn the head of the baby a little, and put it back in an easier axis for the exit’, summarizes the midwife.

The suction cup also allows traction between each push from the mother, which prevents the baby from going “up” due to the yo-yo effect.

Episiotomy, tear, hematoma: are there any risks or dangers of using cupping during labor?

The fact that the exit happens faster thanks to the traction can unfortunately expose the perineum to a brutal and important tension, with a increased risk of tearing, andepisiotomythe latter must always be performed with the patient’s consent.
“The mother who gives birth through cupping also has a greater risk of developing vulvar edema, and more rarely a thrombus – namely, a vulvovaginal haemorrhage after a clot that forms in the walls of the vagina after a vascular rupture,” explains Marie-Elise Launay at .

Vacuum Delivery: Is a Cesarean Section Necessary?

The suction cup is used when the baby is in the pelvisa stage where it is usually no longer possible to cesarean section because the baby is too low in the pelvis.

“However, it happens that cupping is attempted on a baby who is still a little high in the pelvis at the beginning of the engagement. If the cupping fails the delivery, Caesarean section must be performed urgently and obstetrical maneuvers must be performed to open the baby’s head,” explains the obstetrician.

But as a general rule, if, despite all the techniques used, the baby has difficulty moving spontaneously in the pelvis, the doctor first chooses to proceed with a fully dilated cesarean section, especially in the case of fetal macrosomia.

Is it possible to give birth with vacuum cups without an epidural?

“If a baby has been blocked for 30 to 45 minutes with no progress or if there is an emergency, the indication to perform a sucker remains the same, with or without epidural“says Marie-Elise Launay.

If the woman is not under anesthesia and the child is not in pain, she has a little more time to try to push her baby unaided. “Conversely, if the baby is poorly positioned or if there is an emergency, it will be necessary to perform the delivery with a suction cup without waiting,” adds the midwife.

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