What Are Forceps or Vacuum Injuries?
Forceps and vacuum devices are sometimes used to help the baby out of the birth canal. Also called operative vaginal delivery, use of forceps or vacuum extraction, which affixes a suction cup to the baby’s head, is applied during a prolonged second stage of labor to facilitate vaginal delivery. These operative vaginal deliveries are done because the baby is delayed in descending down the vaginal canal, the physician suspects fetal compromise, or to shorten the second stage for maternal benefit.
In some situations, birth injuries arise during vacuum-assisted delivery or when using forceps. Major maternal and fetal injuries, including hemorrhage can occur, particularly if the operator is inexperienced or if conditions for operative delivery are not proper. The biggest danger for forceps and vacuum injuries is incorrectly attempting an operative delivery that causes a delay in delivering a baby by cesarean section to prevent irreversible brain injury from bleeding or hypoxia.
Injuries to the mother
Significant perineal trauma to the mother and neonatal bruising are more common with forceps delivery. Prophylactic antibiotics should be considered if there are 3rd– or 4th-degree lacerations before they are repaired to help reduce the risk of infection and wound complications such as fistulas.
Injuries to the baby
- Shoulder dystocia causing brachial plexus injury, cephalohematoma (blood under a newborn’s scalp after a difficult vaginal delivery), jaundice or more serious kernicterus, and retinal bleeding are more common injuries with vacuum-assisted delivery, although the rates remain low. In rare and more severe cases, birth injuries from vacuum delivery include cerebral palsy, intracranial bleeding, Erb’s palsy, blindness, hearing loss, and stroke.
- Birth injuries to the fetus from forceps delivery include jaundice, seizures, skull fractures or bleeding in the skull, bumps or bruises on the baby’s head, small cuts on the baby’s face, cerebral palsy, and temporary facial palsy.
What Are Common Causes of Forceps or Vacuum Injuries?
Common causes of forceps or vacuum injuries stem from incorrect use of these instruments, or when conditions for an operative delivery are not met. The cause may be using too much suction on the baby’s head, or selecting the wrong type of forceps for the extraction.
Before starting an operative vaginal delivery, the clinician should confirm that the cervix is 100% dilated, the fetus is engaged at what is referred to as station +2 or lower, the membranes are ruptured, and the baby’s head is positioned correctly for vaginal delivery. In addition, the clinician must drain the mother’s bladder and assess her pelvic dimensions to determine there is adequate room for the delivery. The clinician must also obtain informed consent before the procedure and alert neonatal care providers to attend the delivery.
Failure by medical staff to assess and meet these conditions and steps before performing operative vaginal delivery are causes of forceps or vacuum injuries.
What Are The Symptoms of Forceps or Vacuum Injuries?
For the mother, symptoms of forceps or vacuum injuries include bladder injuries present as urinary incontinence, fecal incontinence, weakened pelvic muscles or ligaments (called pelvic organ prolapse), pain in the perineum (the area between the vagina and anus), and blood clots in the legs or pelvis.
Symptoms in newborns
Hypoxic injury from lack of oxygen or bleeding can occur. In addition to difficulty feeding look for these symptoms of brain or nerve damage birth injuries following an operative vaginal delivery:
- The baby’s hand is curled into a claw shape
- Muscle looseness or muscle stiffness, poor or absent reflexes
- Low heart rate
- Low oxygen levels
- Excessive drooling
- Light sensitivity
- Facial drooping
- High-pitched crying or grunting
- Arched back when crying
Kernicterus can also occur after birth with jaundice; the skin is very yellow and even orange due to elevated levels of bilirubin. This may be hard to discern in babies with darker color skin. The whites of the baby’s eyes may look yellow as well. Other symptoms of this forceps or vacuum injury are if the baby is hard to wake up or conversely, won’t sleep at all, is fussy, not sucking well from the bottle or breastfeeding well, and is not urinating or defecating frequently enough. The baby’s doctor or nurse can test how much bilirubin is in the baby’s blood.
Some symptoms of forceps delivery or vacuum-assisted delivery may take months to develop and show. These may be:
- Delays in speech or no speech development at all
- Poor motor function and/or coordination – difficulty walking or crawling, cannot sit or stand without assistance
- Ataxia – lack of bodily movements
- Spasticity – lack of muscle control, muscle spasms
- Intellectual disabilities, such as low memory retention
- Poor hand-to-mouth or hand-to-hand coordination
- Involuntary pulling of the neck
- Vision or hearing problems (not responding to visual or aural stimuli)
In toddlers, additional symptoms are demonstrable physical and cognitive disabilities such as inability to dress, eat, talk, or walk; muscle tremors or weakness, and problems with fine motor skills.
Are There Lasting Effects or Complications With Forceps or Vacuum Injuries?
Serious effects from forceps or vacuum-assisted delivery are rare. The most common complications with forceps or vacuum injuries are cerebral palsy and lasting effects related to brachial plexus injuries; the latter include weakness or complete lack of function of the upper limbs. Other lasting effects may also be blindness or deafness, and problems with muscle tone and motor function elsewhere in the child’s body. Facial palsy and seizures are other complications of operative vaginal deliveries.
Contacting an Experienced Birth Injury Attorney
Proving that a neurological birth injury was caused by an improper operative vaginal delivery with either forceps or vacuum requires an analysis of the prenatal care, labor and delivery, and birth records. Other causes such second trimester injuries need to be ruled out, and supportive evidence of a hypoxic injury needs to be found by looking at all the available information. The attorneys at Britcher, Leone & Sergio can analyze the prenatal records, perinatal care, and postnatal care to determine whether neurological birth injury was caused by the improper performance of an operative vaginal delivery. Contact our experienced NJ birth injury attorneys if you feel your child’s birth injuries are the result of medical negligence during a forceps or vacuum delivery.