Why learn safe vacuum assisted delivery?
Pressure to avoid non-essential Caesarean sections is mounting as evidence continues to emerge regarding the long-term health risks1. However, rates of prolonged and obstructed labor remain unchanged2. This makes skills in instrumental delivery crucial for safe delivery and litigation avoidance.
While forceps is sometimes adopted as the sole option for instrumental vaginal delivery, it presents different advantages and disadvantages compared with vacuum3. Vacuum-assisted delivery is the less invasive instrument for correcting a paramedian and/or deflexing presentation, is associated with less maternal morbidity, and is considered the first line method4.
Competence in both forceps and vacuum delivery may become increasingly worthwhile for a third reason. News media has the potential to influence public perception very quickly, as shown in the case of a mother’s call for a ban on forceps5 , which made national headlines in 2018.
It makes sense to have the full skill set. But vacuum-assisted delivery is only a safe and effective option in the hands of a well-trained clinician6,7. When best practice is followed, vacuum-assisted delivery is safe and effective and provides the least maternal risk 8, 9.
- 1 Betrán, A., Temmerman, M., Kingdon, C., Mohiddin, A., Opiyo, N., & Torloni, M. et al. (2018). Interventions to reduce unnecessary caesarean sections in healthy women and babies. The Lancet, 392(10155), 1358-1368. https://doi.org/10.1016/s0140-6736(18)31927-5
- 2 Clinical Excellence Commission. Vacuum Assisted Births – Are We Getting it Right? A Focus on subgaleal heamorrhage 2014.
- 3 RANZCOG - Assisted Birth. Ranzcog.edu.au. (2020). Retrieved 8 March 2020, from https://ranzcog.edu.au/womens-health/patient-information-resources/assisted-birth.
- 4 O’Mahony, F., Hofmeyr, G., & Menon, V. (2010). Choice of instruments for assisted vaginal delivery. Cochrane Database Of Systematic Reviews. https://doi.org/10.1002/14651858.cd005455.pub2
- 5 Withey, A. (2018). ‘Ban forceps’ says mother who suffered through traumatic childbirth, AMA disagrees. ABC News. Retrieved 8 March 2020, from https://www.abc.net.au/news/2018-03-16/calls-to-ban-forceps-during-childbirth-after-mothers-injuries/9551336.
- 6 Vacca A. Reducing the Risks of a Vacuum Delivery, Fetal and Maternal Medicine Review. 2006; 17:4 301-315.
- 7 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Prevention Detection and Management of Subgaleal Haemorrhage in the Newborn. 2012; C- Obs 28:1-7.
- 8 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Instrumental Vaginal Birth. 2016; C-Obs 16.
- 9 Clinical Excellence Commission. Vacuum Assisted Births – Are We Getting it Right? A Focus on subgaleal heamorrhage 2014.
There is no doubt that the operator is a major determinant of the success or failure of vacuum delivery and that adverse outcomes associated with the procedure are often caused by the user’s unfamiliarity with either the instrument or the basic rules governing its use.”
Dr Aldo Vacca Handbook of Vacuum Delivery in Obstetric Practice
Why learn the Vacca 5-Steps Technique ?
Vacca Technique™ found to be superior in correct cup placement
A recent study has found the Vacca Technique is easier to learn and results in more accurate placement of the cup on the flexion point (1).
Correct placement of the cup is one of the most important factors in a safe and successful delivery (2,3), allowing for the narrowest circumference of the fetal head to lead through the birth canal and enabling effective auto rotation (4).
Now a study by Marcos Javier Cuerva and colleagues in the Journal of Perinatal Medicine has found “significant difference in the placement of the cup using the Vacca technique vs the Bird technique”.
The researchers found the mean distance from the centre of the cup to the flexion point was 1.78+0.96cm for the Bird technique but just 1.05+0.60cm for the Vacca technique.
They also found that obstetricians who used forceps regularly had better results with the Vacca technique.
References
1. Cuerva MJ, Espinosa JÁ, Barras S, Gonzalez-Cerron S, Ojeda F, Cortés M, et al. Which technique is better to place a manoeuvrable vacuum extractor cup on the flexion point? Vacca vs. Bird technique. J. Perinat. Med. 2020;48(7):694-699.
2. Bird GC. The importance of flexion in vacuum extractor delivery. Br J Obstet Gynaecol 1976;83:194-200.
3. Vacca A. Reducing the risks of a vacuum delivery. Fetal Med Rev 2006;17(4):301-315.
4. Kahrs BH, Usman S, Ghi T, Youssef A, Torkildsen EA, Lindtjørn E, et al. Fetal rotation during vacuum extractions for prolonged labor: a prospective cohort study. Acta Obstet Gynecol Scand 2018;97:998-1005.