One page summary: Vacuum extraction injuries

In two sentences

Vacuum extraction means a soft or rigid cup is attached by suction to the baby's head, and the doctor pulls in time with contractions to help the baby out. It is used when the baby needs to be born quickly or when the second stage is not progressing. ¹

Most vacuum births produce nothing worse than a temporary swelling shaped like the cup. The injury that makes the first hours matter is subgaleal hemorrhage, where a baby can bleed into the space under the scalp fast enough to become critically unwell. That is why close observation after a vacuum birth is standard. ²

The numbers, with their sources

• How common operative vaginal birth is. Operative vaginal delivery, meaning vacuum or forceps, accounts for a small percentage of births in the United States, and vacuum is used more often than forceps ³
• What guidance covers. Guidance on operative vaginal birth addresses indications, prerequisites, the number of attempts, duration, and when to abandon the procedure ¹
• The time-critical injury. Subgaleal hemorrhage, in which blood collects in the unbounded space under the scalp and can amount to a large share of a newborn's blood volume ²
• The bedside signs. A boggy swelling that crosses the suture lines and shifts with head movement, together with a rising heart rate, pallor and a falling blood count ²
• Sequential instruments. Using vacuum and then forceps, or the reverse, is associated with higher risk to the baby ¹
• The usual finding. A swelling shaped like the cup, called a chignon, which is not dangerous and resolves over days ²

What to do this week

1. In the first 24 hours, ask whether head circumference is being measured serially and what the numbers are.
2. Ask whether any swelling crosses the suture lines.
3. Ask for the operative note, with the number of pulls, detachments and total duration.
4. Ask whether both vacuum and forceps were used.
5. Ask whether bilirubin is being followed.
6. Ask what the indication for the assisted delivery was.
7. Request the complete records with the records request builder.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the neonatologist

• Does the swelling cross the suture lines, and is it growing?
• What are the serial head circumference measurements?
• What has the blood count done?
• Is bilirubin being followed?
• Has imaging been done, and what did it show?

For the obstetric team

• What was the indication for the vacuum?
• How many pulls, and did the cup detach? How many times?
• How long was the total application time?
• Was any other instrument used before or after?
• Is all of that in the operative note?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Vacuum extraction injuries

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.