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Operative Vaginal Delivery

By Julie S. Moldenhauer, MD, Associate Professor of Clinical Obstetrics and Gynecology in Surgery, The Garbose Family Special Delivery Unit, The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia; Attending Physician, The University of Pennsylvania Perelman School of Medicine

Operative vaginal delivery is delivery using a vacuum extractor or forceps.

A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. It is inserted into the vagina and uses suction to attach to the fetus’s head. If vacuum extraction delivery is tried and is unsuccessful, cesarean delivery is done. Rarely, a vacuum extractor bruises the baby’s scalp or causes bleeding in the baby’s eyes (retinal hemorrhage). The risk of shoulder dystocia and jaundice is also increased.

Forceps are metal surgical instruments with rounded edges that fit around the fetus’s head. Rarely, using forceps bruises the baby or tears the area between the opening of the woman’s vagina and anus (called the perineum).

Vacuum extraction or forceps delivery may be required in the following situations:

  • When the fetus is in distress

  • When the woman is having difficulty pushing

  • When labor is prolonged

  • When the woman has a disorder (such as some brain or heart disorders) that make vigorous pushing inadvisable

Using Forceps or a Vacuum Extractor

Forceps or a vacuum extractor may be used to help with delivery. Forceps are placed around the baby’s head. A vacuum extractor uses suction to adhere to the baby’s head. With either device, the baby is gently pulled out as the woman pushes.

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