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Forceps Better Than Vacuum for Baby

Results from a retrospective study suggest that forceps protect the baby, but at the expense of the maternal vagina.

Over the past few decades, obstetricians have increasingly used vacuum extractors in lieu of forceps, without evidence supporting the superiority of either delivery method. In this retrospective cohort study of 4120 term cephalic deliveries, researchers compared outcomes after forceps (n=2075) and vacuum-assisted (n=2045) deliveries. Excluded were deliveries involving multiple gestations, fetal anomalies, use of rotational forceps, or occiput transverse position. Women who underwent forceps delivery were significantly more likely than those who underwent vacuum-assisted delivery to be younger than 35, to have Medicaid insurance, and to have had episiotomy and epidural analgesia.

Compared with vacuum-assisted delivery, forceps delivery was less likely to result in shoulder dystocia (1.5% vs. 3.5%), a 5-minute Apgar score lower than 7 (2.8% vs. 4.1%), neonatal jaundice (10.7% vs. 13.3%), neonatal intensive care admission (3.7% vs. 5.7%), and cephalohematoma (4.5% vs. 14.8%). However, forceps delivery was associated with a higher incidence of vaginal laceration (28.6% vs. 22.2%). These differences remained significant after adjustment for maternal age, ethnicity, BMI, Medicaid insurance, parity, gestational diabetes, labor length, delivering clinician, epidural use, episiotomy, and birth weight.

Comment: Forceps delivery appears to protect the baby, although at the expense of the maternal vagina. What factors account for the increase in vacuum-assisted deliveries? Because today’s delivering clinician quickly hands the baby to the neonatologist and then turns his or her attention to vaginal repair, the significant neonatal morbidity associated with vacuum-assisted delivery is not immediately apparent. Alternatively, perhaps the relatively lower level of skill required to use the vacuum has resulted in its preferential use.

— Sandra Ann Carson, MD

Published in Journal Watch Women's Health December 27, 2005

Citation(s):

Caughey AB et al. Forceps compared with vacuum: Rates of neonatal and maternal morbidity. Obstet Gynecol 2005 Nov; 106:908-12.

• Medline abstract (Free)