Birth Brain Injury Risk Lower with Forceps than Vacuum Extraction: Study

A new study is challenging the conventional wisdom that vacuum extraction and cesarean delivery are safer means of avoiding a birth brain injury than the use of forceps. 

According to a report published in the latest issue of the journal Obstetrics & Gynecology, researchers at Johns Hopkins School of Medicine have found that using forceps to deliver newborns greatly reduced the risk of a brain injury when compared to vacuum extraction.

Vacuum extraction involves the use of suction on the child’s head to speed up delivery and help remove the infant from the birth canal. The process is primarily used when the baby is in distress.

Vaginal delivery using a vacuum extractor has slowly replaced the use of forceps in many situations, as they are generally considered safer and reduce the risk of facial nerve damage from forceps. However, severe and potentially life threatening birth injury can still occur with the use of vacuum extraction, most commonly involving bleeding in the area between the skull and the scalp or bleeding inside the child’s skull. This can result in brain damage, developmental problems or cerebral palsy.

This new study raises questions about whether the medical community is moving away from the use of forceps too quickly.

Researchers looked at data on live births of children at 34 weeks or greater gestation from 1995 to 2003 in New York City. They found that vaginal deliveries using forceps resulted in fewer seizures and fewer 5-minute Apgar scores of less than 7 when compared to vacuum extraction deliveries or cesarean deliveries.

While cesarean deliveries resulted in fewer instances of some forms of subdural hemorrhaging, overall the researchers found that forceps were associated with the least risk of neurological damage. This is because the incidence of seizures, which are more likely to lead to long-term complications, are more clinically relevant than the subdural hemorrhaging, researchers explained.

The researchers cautioned that with the rise of vacuum extraction and cesarean delivery, there are fewer residents and obstetricians who are experienced enough to perform forceps-assisted vaginal deliveries.