Increased Rates of Vaginal Delivery Trauma Linked to Forceps, Vacuum-Extraction in New Study

Following recent pushes to move the medical community away from the overuse of C-sections, new research suggests that more doctors using forceps during vaginal deliveries, which have resulted in more injuries to mothers and newborns, apparently because the skills in using forceps have diminished over the years. 

In a study published in the Canadian Medical Association Journal (CMAJ), researchers from the University of British Columbia found that first-time mothers and women who had previously delivered a child through c-section are experiencing higher rates of physical injuries during child birth, which appears to be specifically due to operative vaginal deliveries, where forceps and vacuum extraction are involved.

Researchers looked at deliveries in four Canadian provinces from 2004 through 2013, involving data on nearly 2 million births. They looked for modes of delivery and obstetric trauma and birth injuries.

According to the findings, vaginal deliveries which involved the use of forceps and vacuum-assisted deliveries were linked to a 44% increased in injury to the mother, and a 53% increased risk of birth trauma among first-time mothers. The researchers noted that while injuries also increased to mothers who had previously given birth, there was not the increase in birth trauma among that group.

The study found that the injuries mostly involved third- and fourth-degree perineal lacerations and anal sphincter injuries, the latter of which can result in anal incontinence. The researchers also noted that deliveries where forceps and vacuums are used have also been linked to increased rates of surgery for pelvic organ prolapse by other researchers.

Researchers noted that within Canada and the U.S., there has been growing concern over the widespread use of Cesarean section deliveries, and doctors have been pressured to reduce those rates. The study notes that as C-section delivery rates went up, vaginal delivery rates went down, and as those numbers begin to reverse themselves, it is being revealed that some doctors may have degraded their skills when faced with an operative vaginal delivery.

“The rates of obstetric trauma and severe birth trauma have increased among operative vaginal deliveries despite an overall decline in the use of operative vaginal delivery,” the researchers noted. “Recommendations to reduce cesarean delivery rates by increasing rates of operative vaginal delivery should be tempered by the understanding that such actions may be associated with higher rates of obstetric trauma.”

The same researchers published a study last year indicating that babies are 80% more likely to suffer severe complications when forceps or vacuum extraction are used, and the mother is also three to five times more likely to suffer trauma from the birth when compared to c-section deliveries.

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.