Healthy Habits: C-Sections May be Safer than Forceps of Vacuum Assisted Delivery

In normal vaginal delivery, contractions of the uterus slowly push the baby down and
through the mother’s birth canal. This type of natural delivery occurs with no real
intervention or manipulation from the doctor or nurses. In some situations, however, the
mother is not able to safely push the baby out on her own. This can occur for a number
of different reasons. Sometimes the baby may be too large (fetal macrosomia) for safe
vaginal delivery or the baby’s shoulder may become stuck behind the mother’s pelvic
bone (a condition called shoulder dystocia). In other cases the labor may simply drag on
too long or fail to progress.
When these situations occur doctors and hospital staff must take action and intervene to
facilitate delivery of the baby. If they wait too long the baby could suffer oxygen
deprivation and die or be left with permanent brain injury. When medical intervention or
assistance is required during delivery doctors have 3 basic options:

1. Emergency C-Section: in a modern hospital, doctors can perform an emergency C-section delivery within a matter of minutes.
2. Forceps Delivery: obstetric forceps are like salad tongs which a doctor can insert into the birth canal to grip the baby’s head and pull it down and out.
3. Vacuum Extraction: a vacuum pump extractor uses a small suction cup with a pump to attach to the baby’s head and enable the doctor to guide them out.

The latter 2 options, forceps delivery and vacuum extraction, are collectively referred to
as assisted or “operative” vaginal delivery.

How Forceps and Vacuum Extractors Work
Obstetric forceps and vacuum pump extractors are different tools but they both function
in the same basic way. They are design to grip the baby’s head inside the birth canal so
that the doctor to carefully maneuver the baby and guide them out.
Obstetric forceps have actually been around for 500 years and their basic design is
pretty much the same today as it was in the 16 th century. Forceps are best described as
jumbo salad tossing tongs. The specially shaped cups at the ends of the handles are
designed to fit around the baby’s head inside the birth canal. One cup goes over the
back of the baby’s head while the other cup is supposed to gently cradle the baby’s
face. Once firmly grasped around the baby’s head the doctor will apply pulling and
lateral traction in conjunction with contractions to guide the baby out.

The vacuum pump extractor (also known as a ventouse extractor) is more modern birth
assistance tool. The vacuum extractor has specially contoured suction cup made of
silicone which is attached to a pump and has a handle on the back. The suction cup is
place on the top of the baby’s head in the birth canal and then the pump is employed to
create a vacuum seal. Once the cup is firmly suctioned onto the head the doctor then
uses the leverage handle to maneuverer the baby inside the birth canal and safely
guide them out into the world.

Safety of C-Sections vs. Operative Vaginal Delivery
Operative vaginal delivery methods were traditionally preferred by doctors and continue
to be endorsed by the American College of Gynecology (ACOG). However, a major
study released in 2017 found that emergency C-sections are actually much safer for
mother and baby compared to a forceps or vacuum assisted delivery. The study was
published in the Canadian Medical Association Journal and it compared the risks of
operative vaginal delivery techniques in comparison to C-sections in the “mid-pelvic”
delivery stage (baby’s head is halfway down the birth canal).

The findings of the study were fairly dramatic. Major birth injuries or trauma to the baby
were 10 times more likely to occur with the use of forceps or vacuum extraction as
opposed to an emergency C-section. Vacuum extraction and forceps delivery caused a
range of adverse outcomes and injuries including brain bleeds (which can cause
cerebral palsy) and nerve damage or other physical injuries. Adverse outcomes
resulting from emergency C-sections were minimal and uncommon.

Operative delivery with forceps or vacuum extraction also posed a much greater risk of
maternal injury when compared to a C-section. In fact, the study found that mid-pelvic
forceps or vacuum deliveries presented a very high risk of physical injury to the mother.
Nearly 20% of mid-pelvic forceps deliveries resulted in 3 rd or 4 th degree perineal
maternal tearing. Vacuum extraction deliveries presented a 12% risk of serious tearing.
This type of severe tearing during delivery can have major long-term consequences for
mothers including sexual dysfunction and pelvic floor prolapse. In addition to tearing,
postpartum hemorrhages are also more likely to result from forceps and vacuum
deliveries compared to C-sections.

Emergency C-section deliveries do present some increased risks in comparison to
operative delivery techniques. For instance, the rate of postpartum maternal infection
was significantly higher after a C-section as compared to forceps or vacuum extraction.
C-sections also result in longer recovery periods and make future vaginal deliveries
(VBAC) high risk. But the overall results of the study indicate that an emergency C-
section is a much safety option for a mother and her baby, at least during the mid-pelvic
stage.