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Vacuum Delivery Complications

Vacuum extraction is a procedure used by doctors during vaginal delivery to help the baby exit the birth canal. The attending physician places the cup of the vacuum on the baby’s scalp during contractions while the mother pushes. Some doctors routinely use vacuum extraction when the mother is making little progress during the pushing stage of labor. Fetal distress is another common reason that doctors use vacuum extraction during labor.

About 5% of deliveries are operative vaginal deliveries. Expectant mothers should understand that vacuum extraction comes with a risk of complications for themselves and their babies. However, most negative outcomes are avoidable.

Pregnant woman in labor with two doctors

How does a vacuum extractor work?

Doctors commonly refer to this procedure as vacuum-assisted delivery. In a vacuum-assisted delivery, the doctor places the vacuum cup on top of the baby’s head as it nears the end of the birth canal. The medical professionals placing the suction cup should ensure that no vaginal tissues become trapped between the baby’s head and the cup.

When the mother pushes during a contraction, the doctor increases the suction power on the cup and simultaneously grabs the handle on the top of the suction cup. Doctors should reduce the suction power between contractions. Once the baby’s head emerges from the birth canal, the doctor should release all suctioning power and remove the cup from the newborn’s scalp.

When is vacuum extraction necessary?

Doctors must ensure that the labor and delivery meet several criteria before preparing for a vacuum-assisted delivery. This includes the mother being fully dilated and her membranes having ruptured. Common situations that might call for a vacuum-assisted delivery include:

  • The baby’s head has descended into the birth canal, but the mother is making little to no progress pushing it out.
  • The baby’s heartbeat indicates a potential emergency.
  • The mother has a health condition, such as aortic valve stenosis, that could worsen with prolonged pushing.

Health care providers should never attempt a vacuum-assisted delivery unless a doctor is available to perform a cesarean delivery if labor fails to progress with the vacuum intervention. Doctors may need to make a professional judgment to skip vacuum extraction and transition the mother to a cesarean delivery if there is an increased risk posed by the labor and delivery scenario. Possible risks include:

  • The mother is six or more weeks from full term.
  • It is possible that the baby won’t fit through the birth canal.
  • A medical professional diagnosed the baby with a bleeding disorder or any condition that affects prenatal bone strength.
  • The baby does not descend headfirst into the birth canal; instead, the arms, shoulders, feet, or buttocks come first.
  • The doctor cannot determine the location of the baby’s head or is certain that it has not moved past the midpoint of the mother’s birth canal.

Despite the common knowledge that performing a vacuum-extracted delivery in these situations causes an increased risk of complications, some doctors try it anyway. The result can be devastating for the mother and baby.

Complications and Injuries from Vacuum-Assisted Births

Laboring mothers and newborn babies each face unique risks during a vacuum-assisted delivery. Risks to mothers include:

  • Severe perineal injury that causes pain in the tissues between the vagina and rectum
  • Perineal tear
  • Tears in the lower genital tract
  • Short-term difficulty urinating or fully emptying the bladder
  • Short-term urinary incontinence or fecal incontinence
  • Postpartum hemorrhage

A small number of women require an episiotomy before the doctor can place the vacuum and suction cup into the vagina. An episiotomy is a small incision that provides additional room for the vacuum.

The unique risks to newborn babies during a vacuum-assisted birth include:

  • Bleeding in the brain, such as intracranial hemorrhage or subgaleal hematoma
  • Skull fracture
  • Brain damage due to pressure from the vacuum device or forceps delivery
  • Cerebral palsy
  • Erb’s palsy
  • Brachial plexus injuries that cause weakness in an arm, shoulder, or hand, or complete lack of movement in an arm
  • Scalp lacerations

Some doctors also use forceps with a vacuum delivery to pull the baby’s head from the birth canal. This increases the risk of serious injury to the baby. Please note that the above is not an all-inclusive list of potential complications from vacuum-assisted childbirth.

What to Expect After a Vacuum-Assisted Delivery

If all goes well, your doctor will examine you for any injuries and repair tears, including those from an episiotomy if one was performed.

The medical staff will monitor your baby for complications. If none are found, the vacuum-assisted delivery is deemed successful. 

It is normal for a vaginal tear or episiotomy to hurt for a few weeks. But if you notice any of the following, you should contact your doctor immediately.

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Worsening pain

Vacuum delivery complications icon

Worsening pain


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Signs of an infection

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Signs of an infection

Inability to control bowel movements

Some vacuum delivery complications won’t develop for days, or even weeks, after birth, so be sure to seek medical assistance promptly if you believe that something is wrong with you or your baby.

Written by:
Birth Injury Center Team

The Birth Injury Center aims to create informational web content and guides to help women and their families seeking support and guidance for birth injuries caused by medical negligence. All of the content published across The Birth Injury Center website has been thoroughly investigated and approved by medical expert Natalie Speer, RNC-OB, Attorney Ryan Mahoney, and Attorney Rick Meadows.