Thu. May 26th, 2022
Instrumental delivery: the use of forceps, vacuum and spatulas to help

We speak of instrumental delivery when the use of external elements is used to extract the baby through the birth canal at the time of delivery. The most commonly used instruments are forceps, suction cups, and spatulas.

The use of instruments in childbirth should not be done systematically, but only when the situation requires it to avoid problems in the baby and/or the mother.

We explain what function each of these instruments has, when its use is indicated and what complications are most frequently associated with instrumental delivery.

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When is the use of instruments used in childbirth?

According to data from the Sant Joan de Deu Hospital (Barcelona), instrumental vaginal deliveries represent around 15-20% of all vaginal deliveries. It is a procedure that, carried out correctly and when the situation so indicates, would help to avoid serious complications for the fetus and the mother .

Forceps, vacuum extractor or Thierry spatulas should be used individually, assessing in each case the risk-benefit for the mother and the baby, and with prior maternal consent.

These are the causes that may require the use of instruments in childbirth:

– Maternal causes : any situation that contraindicates maternal pushing or the presence of certain pathologies could require the use of these instruments. Such is the case of heart disease, high myopia, lung disease or retinal detachment, among others.

– Fetal causes : when there is a risk of loss of fetal well-being , in the event of very prolonged delivery or cases in which the baby does not descend in the ideal position.

– Stagnation of the expulsive

Likewise, a series of requirements must be met before implementation :

– The baby must be placed in the cephalic position and the doctor must have knowledge of the exact characteristics of his head.

– Dilation must be complete .

– The amniotic sac must be broken.

– Prior assessment that there is no pelvic-fetal disproportion.

– Bladder emptying.

– This type of delivery must be performed by a specialist , and have the presence of a neonatologist if there is suspicion of loss of fetal well-being.

– It is advisable to perform an instrumented delivery under epidural anesthesia.

Sucker

The suction cup is a bell-shaped silicone instrument that is placed on the baby’s head performing a vacuum extraction in order to pull it out of the birth canal.

The suction cup is contraindicated in pregnant women under 34 weeks, and a maximum of up to three vacuum losses is considered safe.

Of all the instruments, the suction cup is the one that causes the least vaginal tears. However, as we read in this article from the Spanish Association of Pediatrics, its use is associated with a higher risk in the baby of soft tissue trauma, cephalohematoma, or transient brachial plexus injury. Similarly, after use it is possible to see a bulge in the baby’s head , which tends to disappear within 48 hours.

Spatulas

Spatulas are an instrument in the form of independent metal spoons that are intended to widen the birth canal to help the baby’s head move through it. Unlike the suction cup, the spatulas do not exert traction on the fetal head.

According to this article from the Virgen de las Nieves Hospital (Granada), the most frequent complications of the use of spatulas are maternal perineal tears, brachial plexus paralysis, minimal bruising, jaundice and epidermal erosions.

Forceps

Forceps are an instrument shaped like two large spoons or salad tongs hinged together, inserted through the vagina to grasp the baby’s head and pull or rotate it to help the baby come out through the vagina. birth canal.

According to the Sant Joan de Deu Hospital, its use should be abandoned if there is no progress in the descent of the fetal head after three attempts.

Maternal complications of forceps include perineal and vaginal tears, and urinary or anal dysfunction. For the infant, use of this instrument is associated with an increased risk of facial nerve palsy, facial contusions, and skull fractures.

Consequences of instrumental delivery

Instrumented delivery is necessary when there is danger to the baby and/or the mother, however, as we have been reading in the description of each obstetric instrument, its use is not without risk.

Thus, summarizing everything described above and according to data from the El Parto es Nuestro Association, the most frequent complications of instrumental delivery are:

– In the case of the mother : episiotomies, muscle and anal sphincter tears, associated in turn with incontinence problems , chronic perineal pain and painful sexual intercourse.

In the case of the baby : increases the risk of wounds, bruises, intracranial hemorrhages, facial paralysis and marks and lacerations. All this can negatively influence breastfeeding and increase the risk of hospital admission for hyperbilirubinemia.