Forceps or vacuum devices are used to assist delivery when labor is not progressing or when there are signs of fetal distress. For nulliparous mothers without epidural anesthesia, no progress over two hours can serve as an indication (3 hours with epidural). If operative vaginal delivery fails, Cesarean section is often a backup plan for assisted delivery.
Mechanism of Action
Forceps and vacuum devices both help to manually extract the infant from the uterus. Forceps consist of two interlocking sides with smooth blades that fit around the fetus’s head. Vacuum devices employ a cup that is placed on the infant’s head. Using either a manual or electric pump to apply suction, the cup adheres to the head, and the attendant can help extract the infant. The higher up n the birth canal lies the babies head, the more difficult is extraction with either instrument and the greater the risk to the baby and mother. The maximum force required to deliver rarely exceeds 22 lbs, and higher forces can present risks. A Cochrane review of forceps vs. vacuum suggests that neither technology is clearly superior. Each has risks, but vacuum is more widely used.
Current use in High-Resource Settings
Approximately 4.5% of US vaginal births are “operative vaginal deliveries”, wherein forceps (0.8%) or vacuum devices (3.7%) are used to assist birth. The popularity of vacuum devices may be partially driven by their tendency to cause less trauma and discomfort for the mother, and the relative simplicity of placement. Although there is no conclusive, data-driven consensus on when to abandon vacuum, many clinicians will discontinue use after 2-3 cup detachments, 3 sets of pulls, or total vacuum of more than 15-30 minutes. The most common recourse is cesarean section.
Application in Low-Resource Settings
Forceps and/or vacuum-extraction are commonly available in hospital settings. Re-usable devices that can be autoclaved are favored in more remote settings. The experimental “Odon Device” which is a plastic bag that fits over the baby’s head, may offer an alternative, especially where attendants may not have the requisite skill for forceps or vacuum.
Associated techs in development