Expertise

During labour, a pregnant woman may be so focussed on breathing and pushing that she will ignore the crosstalk between doctors and nurses. But if she hears the words “forceps” or “vacuum,” it will probably be cause for concern.

As a general rule, assistive devices such as forceps (a tong-like medical tool) or vacuums (a rigid or soft cup with a handle and vacuum pump) are not used in normal, natural deliveries. The appearance of these tools usually indicates a prolonged labour that is causing concern or signals there is fetal distress. While these tools may help facilitate a vaginal birth, an obstetrician planning to use these devices must also be preparing for an alternative delivery via a C-section.

In capable medical hands, forceps and vacuum deliveries, while posing added risk, generally result in delivery of uninjured newborns. Improper use of these devices, however, can cause serious injury to a baby. If either of these medical tools were part of your delivery and you learn your child has sustained a birth injury, it may be in your interest to investigate whether negligent and improper use of this equipment played a role in the harm.

What are forceps and vacuums?

Forceps and vacuums are types of medical instruments used during assisted vaginal deliveries. Shaped like a pair of long tongs or spoons, forceps are slid on either side of the baby’s head to help guide it out of the birth canal. Typically used while the woman is pushing during a contraction, the doctor will gently direct the baby and assist with movement.

In a vacuum extraction, a properly sized rigid or soft cup attached to a handle is placed on the baby’s head and attached using suction. Once again, as a woman is pushing during a contraction, the doctor would gently guide the baby through the birth canal.

Appropriate conditions for use.

Neither of these tools should be used during the course of a normal delivery. However, there are four common circumstances when it may be appropriate to use them to assist a problematic delivery:

Signs of fetal distress: If a baby is deprived of oxygen during labour, certain symptoms may be an indication it is in distress. These include: an abnormally high (tachycardia) or low (bradycardia) heart rate, decreased or no fetal movement, and abnormal levels of amniotic fluid.

Shortened second labour: When the cervix is fully dilated (10cm), the “pushing” stage of labour begins. Normally lasting about two hours for a first birth and one hour for subsequent births, if the baby is delivered much faster there could be complications, including intracranial haemorrhage from a sudden change in pressure or aspiration of amniotic fluid.

Prolonged second labour: Failure to progress to delivery by the two-hour mark, sometimes combined with abnormal contractions, can increase the risk of fetal distress.

Maternal exhaustion: When labour lasts more than 20 hours or if the pregnant woman has a health condition that prevents extensive exertion, she may become exhausted and require assisted vaginal delivery. Signs of maternal exhaustion include tachycardia, dry mouth, and changes in contractions.

Forceps and vacuum extractions are not recommended:

• for women less than 34 weeks pregnant.
• when the baby has a condition affecting bone strength.
• when the position of the baby’s head is not known.
• when the head had not reached and passed the midpoint of the birth canal.
• when the baby’s arms, feet, shoulders or buttocks are leading the way down the birth canal.

Common birth injuries caused by forceps and vacuums.

When used properly, these tools can help doctors manage at-risk deliveries. However, there are numerous ways misuse of these tools can cause serious damage both to the mother and to the baby.

These tools should only be used to guide a baby through the birth canal. Excessive pulling or force can cause traumatic injuries, including muscle and nerve damage to the neck and shoulders, skull fractures, scalp wounds, bleeding in the skull, facial palsy, or seizures. Problems can also occur with use of a vacuum cup that is the wrong size or type.

Some of the most common types of trauma from forceps and vacuum extraction include:

• brachial plexus injuries (Erb’s palsy, shoulder dystocia): If a baby is pulled through the birth canal when stuck, the action can damage a complex network of nerves around its head, neck and shoulders. Although many babies will completely recover from these injuries, others will have permanent disabilities depending on the severity (stretch/neuropraxia, rupture, or avulsion).
• intracranial haemorrhages/brain bleeds: hemorrhagic strokes, intraventricular haemorrhage, subdural hematomas, caput succedaneum, cephalohematoma, or subgaleal hematoma. Depending on the type of bleed, these birth injuries may cause physical or neurologic disability.
• cerebral palsy: a brain disorder often causing muscle/movement problems and/or cognitive issues.
• jaundice/kernicterus: bruising may lead to a higher concentration of bilirubin.

These medical instruments may also cause injury to the pregnant woman, including:

• vaginal tears.
• chronic pelvic pain.
• incontinence.
• pain during sexual intercourse.
• blood loss/anemia.
• blood clots.

Here to help.

The relief you feel when your baby is delivered can be short lived if you discover (s)he suffered a birth injury. Many birth injuries from forceps and vacuum trauma are evident within hours after birth; however, others may take weeks or months to become apparent.

Whenever you learn of this tragic condition, it is always worth your time to investigate whether it was preventable. A knowledgeable, skilled and experienced birth injury lawyer can help discover if you have an actionable case that will seek the compensation you and/or your loved one rightfully deserve.

When you contact Gluckstein’s birth injury team for a no cost, no obligation initial consultation, we will listen attentively and empathetically to your story. We will ask when you recognized something was wrong and how the injury has affected you and your loved ones.

After explaining your various rights and options, if you choose to make a claim for damages, we will conduct a preliminary investigation into your medical files and consult with experts to determine if standards of care were breached and how the negligent actions or inaction of one or more medical providers caused this harm.

Committed to full-circle care.

Recognized by our legal peers as one of Canada’s top personal injury firms, you can be confident that with us as your advocate and representative your case will be in good hands. But Gluckstein’s birth injury team’s interest in you goes well beyond a legal case. We treat our clients as we would treat our own family, and we genuinely care about your well-being now and your ability to live your best life in the future.

As our client, you will be connected with our renowned client liaisons. These people - some of whom have experienced their own personal injury cases - understand what you may be feeling and know the kind of communication and support that will be important as we work on your case and you begin your healing journey. Our team will connect you with resources that can help you on this journey.

Moreover, we will learn just how much or how little you would like to know about the day to day progress of your case. This ensures we either provide regular updates so you can feel well-informed or limit the depth of our reports so you won’t feel overwhelmed. We always take direction from our clients and tailor our relationship with you in a way that works best for you.

Little risk, great reward.

We believe a client should not need to be independently wealthy to access justice for the harm done to them by another person. That’s why we will never take payment from you unless we are successful in negotiating a fair settlement for you or winning a court award. When we take on your case it’s because we have confidence in the prospect that we can get you the compensation you deserve. Therefore, we take the risk by covering upfront legal costs and disbursements.

With so little to lose and so much to gain, take the first step to a better future by contacting us today. Choose Gluckstein’s forceps and vacuum trauma birth team to be your fierce advocate and trusted supporter at this critical moment in your life.