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Operative Vaginal Delivery
The Use of Vacuum Extractors and Forceps During Childbirth
By Suzy Feine
The use of forceps is more widespread in the United States than in other parts of the world, such as Northern Europe, the Middle East and Asia, which have predominately used vacuum extractors as their primary instrument choice.
"Change is under way with a near universal observation of an increasing frequency of vacuum extraction operations," says Dr. Pope. However, the instrument of choice is also based on the individual physician's training and experience with a particular delivery instrument. Equally as important, the physician must consider the advantages and disadvantages of each.
The metal-cup vacuum extractor, developed in 1953, has recently been replaced with the bell-shaped silicone rubber vacuum extractor, called the soft-cup vacuum extractor. The soft-cup version causes fewer neonatal injuries compared to its metal counterpart, although the success rate is fewer. In comparison to forceps, soft-cup vacuum extractors result in a quicker delivery with less discomfort, genital trauma and anesthesia for the mother.
The advantages of forceps over vacuum extractors include fewer neonatal injuries and a higher rate of successful vaginal delivery. However, forceps usually result in greater discomfort for the mother, requiring anesthesia.
Much controversy has been made over selecting an operative vaginal delivery instead of an elective Cesarean delivery. "There are less and less operative vaginal deliveries and more elective Cesareans being performed," says Dr. Pope. Long-term medical effects of operative vaginal delivery, such as pelvic relaxation and urinary incontinence, contribute to this decision.
Other factors also come into play. If the instrument operator is inexperienced or cannot achieve proper application of the instrument, a Cesarean delivery is considered. In addition, if the baby's head is not properly positioned or the cervix is not thoroughly dilated, a doctor may decide to perform a Cesarean delivery.
During most non-emergency situations, the mother does have a choice. "A properly conducted, informed consent includes an explanation of the need for the operation, a discussion of risks and benefits and a presentation of alternative modes of treatment," says Dr. Pope. However, during emergency situations, the ultimate decision must be left in the hands of the doctor.
Health Risks for Mom and Baby
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