Rotation and Extraction of the Baby During Labor
Forceps and the vacuum extractor are two obstetrical tools that are used to rotate a baby to a more advantageous position for birth and to help a baby move down the birth canal. They are used when the baby’s head resists rotating from a posterior or transverse position, when a woman’s pushing ability is diminished because of anesthesia or fatigue, or when a baby is in fetal distress. Before employing either of these instruments, many doctors administer a regional anesthetic and/or perform an episiotomy.
Forceps are large, curved metal tongs whose two blades are inserted into toe vagina and placed on either side of the baby’s head. The blades are then locked into place and used to manipulate or extract the baby. Forceps can bruise a baby’s soft head and facial tissue, but they can be an alternative to cesarean section if birth is imminent.
The dangerous high forceps procedure, in which the forceps are applied before the baby’s head is engaged in the pelvis, is not used today, replaced by cesarean delivery, which is safer for both the woman and the baby.
The midforceps procedure, in which the forceps are used at zero to above plus-two station, presents some risk to both the maternal tissue and toe baby, and should be performed only by an experienced doctor.
Low forceps are used when the head is felt at plus-two or more station and the head is not rotated more than 45 degrees past the midline. Outlet forceps, the most common procedure, are applied when the scalp is visible between contractions. They are used to aid in toe final expulsion of the baby, and they carry the least risk to the woman and baby.
A vacuum extractor is a caplike device that is attached to the baby’s head using suction. The suction cup fits over the top portion of the baby’s head and helps ease the infant out through the contours of the birth canal. The doctor can adjust toe amount of suction that he uses. As a safety factor, the suction is released from the baby’s head if the doctor applies too much tension. The use of a vacuum extractor could result in caput succedaneum, a cephalhematoma, lacerations, or abrasions of the scalp.
The advantages of the vacuum extractor over forceps include less trauma to the bladder and vaginal tissues, and lowered risk of extending an episiotomy. The use of anesthesia is not always necessary with the vacuum extractor. In rare cases, the vacuum extractor can be applied before the cervix is completely dilated to avoid a cesarean section if fetal distress indicates the need for immediate delivery.