Vacuum Extraction Injuries During Delivery

Vacuum extraction can sometimes help complete a vaginal delivery when labor is not progressing or the baby needs to be delivered more quickly. A vacuum device uses a cup placed on the baby’s head to provide traction during contractions and maternal pushing. When appropriately indicated and performed correctly, vacuum-assisted delivery can be an effective obstetrical intervention.

But vacuum extraction is not risk-free. Improper placement of the vacuum cup, excessive traction, repeated attempts, excessive force, or failure to abandon the procedure when it is not working can cause serious injuries to a newborn. Some complications involve the scalp and resolve with treatment, while others can involve bleeding inside the skull, neurological damage, or permanent disability.

At Kalfayan Merjanian, LLP, our California medical malpractice attorneys represent families whose children have suffered birth injuries and investigate whether improper vacuum extraction, delayed intervention, or other negligent medical care contributed to the child’s injuries.

When Is Vacuum Extraction Used During Childbirth?

Vacuum extraction is generally used when a vaginal delivery needs assistance during the pushing stage of labor. Depending on the circumstances, a physician may consider operative vaginal delivery when the mother is exhausted, the second stage of labor is prolonged, or there is a need to expedite delivery because of concerns about the baby’s condition. The decision to use vacuum extraction requires consideration of the mother’s condition, the baby’s position and station, the progress of labor, and whether the prerequisites for a safe operative vaginal delivery have been satisfied. Vacuum extraction is not simply a matter of placing a cup on the baby’s head and pulling. The procedure requires appropriate patient selection, positioning of the device, knowledge of the baby’s location and presentation, controlled traction, and continuous assessment of whether the delivery is progressing safely.

What Can Go Wrong With a Vacuum-Assisted Delivery?

Vacuum extraction can produce a range of injuries. Some are relatively minor and temporary, while others can be severe. A newborn may develop a scalp injury, swelling, bruising, or a collection of blood beneath the scalp. More serious complications can involve bleeding inside the skull or damage to the underlying brain. The risk of injury can depend on factors such as the number of traction attempts, the duration of the procedure, the amount of force used, the location of the vacuum cup, whether the cup repeatedly detaches, and the baby’s underlying condition.

Which Injuries Are Associated With Vacuum Extraction?

One of the more recognizable effects is caput succedaneum, which involves swelling of the baby’s scalp. Vacuum extraction can also cause a cephalohematoma, a collection of blood between the skull and the periosteum. Another, more serious complication is subgaleal hemorrhage, in which blood accumulates in the space beneath the scalp’s connective tissue. Because that space can accommodate a significant amount of blood, a subgaleal hemorrhage can become a life-threatening emergency. Vacuum extraction has also been associated with intracranial hemorrhage and, in severe cases, neurological injury.

Not every injury associated with a vacuum-assisted delivery establishes malpractice. The circumstances and medical evidence must be evaluated to determine whether the procedure was performed within the applicable standard of care.

How Can Excessive Vacuum Traction Injure a Baby?

The baby’s head is subjected to significant forces during an operative vaginal delivery. The vacuum is intended to provide controlled traction that works with the mother’s contractions and pushing. Excessive or improperly directed traction can increase the risk of injury. Repeated attempts can also increase trauma to the scalp and head. A physician who encounters difficulty delivering the baby must recognize when continued vacuum extraction is no longer appropriate. Continuing to apply traction when the procedure is failing can create additional risk without providing a reasonable prospect of safe delivery.

What Happens If the Vacuum Cup Keeps Detaching?

The cup can occasionally detach during vacuum extraction. A detachment does not automatically mean that the physician acted negligently. However, repeated detachments can be an indication that the procedure is not proceeding as intended. The circumstances surrounding each detachment, the number of attempts, the duration of the procedure, and the physician’s response can become important when evaluating whether continued vacuum extraction was appropriate. Medical records can help establish how many attempts were made and whether the healthcare provider recognized that the procedure was unsuccessful.

Can Improper Vacuum Placement Cause a Birth Injury?

Proper placement of the vacuum cup is an important part of operative vaginal delivery. The device must be positioned appropriately on the baby’s head to facilitate delivery while minimizing unnecessary trauma. Improper placement may make traction less effective or increase the risk of scalp or other injury. If the cup is positioned incorrectly and the physician continues applying force, the resulting complications may warrant investigation. An expert review of the delivery records and circumstances can help determine whether the procedure was performed appropriately.

What Is a Subgaleal Hemorrhage?

A subgaleal hemorrhage is bleeding into the potential space between the scalp’s connective tissue and the skull. It is a particularly concerning complication because blood can accumulate over a relatively large area. A newborn with a significant subgaleal hemorrhage may develop increasing scalp swelling, pallor, rapid heart rate, breathing difficulties, low blood pressure, or other signs of blood loss. Prompt recognition and treatment can be critical. A failure to recognize worsening signs of hemorrhage or appropriately monitor a newborn after a difficult vacuum-assisted delivery can create additional questions concerning the standard of care.

Can Vacuum Extraction Cause Brain Damage?

In serious cases, complications associated with vacuum extraction can contribute to neurological injury. For example, significant intracranial bleeding can place pressure on the brain or cause other neurological complications. Severe oxygen deprivation occurring during a difficult delivery may also contribute to brain injury, although the relationship between the vacuum procedure and a child’s neurological condition must be established through medical evidence. A child who develops hypoxic-ischemic encephalopathy (HIE), cerebral palsy, seizures, developmental impairment, or other neurological problems after a difficult delivery may require a detailed evaluation of the entire labor and delivery process. The relevant question is not simply whether a vacuum was used. It is whether the use of the device, the decisions surrounding it, or delays in other interventions contributed to the child’s injury.

When Should a Doctor Abandon Vacuum Extraction?

One of the most important issues in a potential malpractice case may be the decision to continue versus stopping the procedure. If vacuum extraction is not producing appropriate descent or delivery cannot be safely accomplished, continuing to make additional attempts may increase the risk of injury. Depending on the circumstances, the appropriate response may be to abandon the operative vaginal delivery and proceed with a cesarean section. The decision must be evaluated in light of the conditions that existed at the time. What was the baby’s position? How far had the baby descended? How many attempts had already been made? Was the fetal heart rate reassuring? Was delivery becoming an emergency? These questions can be central to determining whether a physician responded appropriately when vacuum extraction was unsuccessful.

What Role Does Fetal Monitoring Play?

Fetal monitoring can be particularly important during a difficult delivery. If the baby’s heart rate indicates that the fetus may not be tolerating labor, the healthcare team may need to expedite delivery. When an operative vaginal delivery is attempted in response to fetal concerns, the timing and effectiveness of the procedure can become especially significant. If vacuum extraction repeatedly fails while fetal distress continues, the medical team may need to consider whether an emergency cesarean delivery is necessary. A subsequent birth injury investigation may therefore examine fetal heart rate tracings alongside the timing of vacuum attempts and other interventions.

Could a Cesarean Section Have Prevented a Vacuum Extraction Injury?

This question sometimes becomes central to a birth injury case. A cesarean section may be appropriate in circumstances where an operative vaginal delivery cannot be safely or successfully accomplished. But determining whether a C-section should have been performed requires consideration of the clinical circumstances at the time, rather than simply looking backward after an injury has occurred. Medical experts can review the fetal monitoring strips, labor progression, baby’s position, maternal condition, and sequence of interventions to determine whether the decision to continue attempting vaginal delivery was consistent with the applicable standard of care. If a physician should have abandoned an unsuccessful vacuum attempt and proceeded with an emergency C-section, the timing of that decision may be important in determining whether the delay contributed to the child’s injury.

How Are Vacuum Extraction Birth Injuries Investigated?

A detailed review of the labor and delivery record can reveal information that may not be apparent from the child’s diagnosis alone. Relevant records can include physician and nursing notes, fetal monitoring strips, delivery records, neonatal examinations, medication records, operative reports, and documentation concerning the vacuum device and delivery attempts. The child’s medical records after birth are equally important. Neonatal intensive care records, imaging studies, neurological evaluations, therapy records, and developmental assessments can help establish the nature and progression of the injury. Medical experts can then evaluate whether the care provided was consistent with accepted obstetrical practices and whether any departure from the applicable standard of care caused or contributed to the child’s injury.

What Long-Term Effects Can a Vacuum Extraction Injury Have?

The prognosis depends heavily on the nature and severity of the injury. Some scalp injuries resolve without lasting consequences. More serious hemorrhages or neurological injuries can result in seizures, developmental delays, cognitive impairment, motor disabilities, cerebral palsy, or other permanent conditions. A child with a permanent disability may require years or decades of medical care, rehabilitation, therapy, specialized equipment, educational support, and assistance with daily activities. For that reason, a birth injury case should consider not only the treatment the child has already received but also reasonably anticipated future needs.

What Compensation May Be Available for a Vacuum Extraction Birth Injury?

When negligent medical care causes a compensable birth injury, damages may include past and future medical expenses, rehabilitation, physical and occupational therapy, speech therapy, medications, assistive equipment, specialized educational services, and other necessary care. For a child with permanent disabilities, a life-care planner may help identify future medical and supportive needs. An economist may then assist in determining the projected financial cost of those needs. Future earning capacity may also be relevant when an injury is expected to prevent the child from working or substantially limit the type of work the child can perform as an adult.

Was the Vacuum Extraction Appropriate in the First Place?

The fact that a physician used a vacuum does not establish negligence. Operative vaginal delivery can be an appropriate medical intervention under the right circumstances. The more important questions are whether there was an appropriate reason to use the device, whether the necessary conditions for its safe use were present, whether it was positioned and operated correctly, whether the physician used appropriate traction, and whether the procedure was stopped when it became unsafe or unsuccessful.

When the answers raise concerns, an obstetrical expert can evaluate the delivery and determine whether the healthcare provider departed from the applicable standard of care.

Contact Kalfayan Merjanian, LLP

Vacuum extraction can sometimes help complete a difficult delivery, but improper use can cause serious injuries ranging from scalp trauma and hemorrhage to neurological damage. When a child suffers a significant injury after vacuum-assisted delivery, understanding what happened requires a careful review of the delivery technique, fetal monitoring, number of attempts, medical decision-making, and the timing of any emergency intervention. Kalfayan Merjanian, LLP represents families throughout California whose children have suffered birth injuries and can investigate whether negligent medical care contributed to the harm. Contact Kalfayan Merjanian, LLP today to discuss your child’s injury and learn about your family’s legal options.