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Vacuum assisted delivery

[00:00:00] Okay, so another thing that might happen, you're in. . Long time. Short time. It could be a day or two. I know that sounds crazy. It could be a couple hours and you might end up need an operative del vaginal delivery, meaning operative vaginal delivery means not spontaneous vaginal delivery. These are the terms we use. 

We say operative delivery, which is a C-section. We say vaginal delivery, which our vernacular is S V D, spontaneous vaginal delivery. Or operative vaginal delivery, which means vacuum or forceps. I am not gonna discuss forceps here because I don't do forceps. There's nothing wrong with forceps in very capable hands, very skilled hands, which tend to be sometimes the older physicians who used it a lot. 

I think it can actually be amazing. Um, that said, it's not what we were trained to do well, so I personally would never attempt it because it would not be safe, because we're not well trained to do. And in untrained hands or poorly trained hands, it can actually potentially cause concern [00:01:00] for the baby because of the amount of pressure you can exert on the head and on mom's perineum, because it's metal forceps that are put inside, we're gonna talk about vacuum. 

So vacuum assisted vaginal delivery. Our acronym is VA v d. There's a couple different kinds of vacuums. When I was a medical student back in 95 to 99, During our OB rotation in Tel Aviv, they had a metal vacuum. So this cop, which is gonna go on the baby's head, was metal. It had a chain attached to it with a handle attached to a, um, machine. 

It was called the maelstrom, I believe. as in, I think that's a type of, I don't know, storm. And the amount of noise and force it would exert was actually frightening. Now we're more gentle. We have plastic ones. Yes. Landfill, they're disposable. Um, this is one I tend to use. This is a Mighty Vac and this is a Mystic two part of the Mighty Vac. 

And then this is another one that a lot of people in our hospital use [00:02:00] called the. . So, and it's really just personal preference. So because I trained with this one, this is the one I like. It's a little bit more rigid here, but just a different mechanism. So basically the only time you can do a vacuum assisted vaginal delivery is when you think the head is low enough, meaning mom has pushed, or for whatever reason, that baby's head has become low enough that with not too much. 

You can pull and get that baby out. And what I tell patients is I am still not doing the majority of it. You are doing the majority of the work. I say you're doing 95 to 99% of the work and I'm just helping that little bit by pulling it out. Okay. It's not, you know, suctioning in the way people think of it's, it is a vacuum and it does suction just onto the scalp, but it's exerting not too much pressure because what you don't want is to do this in a way that actually. 

Harms the baby's head, or you don't want to do it when the head is not low enough because that is a sign the baby is not ready to come out, and then the effort it takes to pull the baby out is not necessarily good for the baby. So if the baby's head is low enough, [00:03:00] typically either where we can see the head crowning or maybe a centimeter up inside where you can see it, with the labia being kind of stretched out, then the doctor will say, I think we'll do a vacuum. 

And it could be for a couple. , it could either be because mom has just pushed for so long and we call it maternal exhaustion. If she's pushed for a couple hours and she's no longer able to push, but the doctor has assessed the pelvis and understands the position and realizes that with relatively little force she can pull the baby out, she might choose to do that with your consent or if the heart rate drops precipitously and we know that we need to get the baby out quickly, and the amount of time it would take for you to push the baby out would be too long or the amount of time it would take for us to get you back into the operating room for a c-section. 

So if the head is low enough and we need to, we will do a vacuum. So basically the vacuum goes on, ideally the back of the head and the duct will put it on and then squeeze this for suction, just to keep it kind of attached, like a little suction cup here. [00:04:00] And then there's a, there's a kind of a trajectory that you try to pull. 

We call it the J. You kind of go down, And then up. You don't necessarily need an A episiotomy even with a vacuum because often just with the propulsive force of pulling this, we will be able to pull the baby up and without too much laceration to the perineum, we'll be able to get the baby out. That all depends on how taut your perineal muscles are. 

How vagina? And how difficult it is to get the baby out based on the baby's position. Us understanding the baby's position and where the head is, whether it's looking down towards your spine, Oxy put anterior that we talked about, looking up towards the front oxypro posterior that we talked about, or tilted alytic. 

Those are all important things for us to be able to know so that we know where we're. this vacuum. Okay. When the baby does come out by vacuum, we're all very relieved. But when you have a vacuum, you should know that that means there's gonna be extra personnel in the, in the room with the doctor. So the doctor sometimes [00:05:00] an assistant to help her at the perineum, the, the regular nurse. 

Often a second nurse and most likely a pediatrician, so that right when the baby comes out, the pediatrician can assess if everything's okay. That does not mean that you can't do delayed cord clamping or that you can't do skin to skin. Many of you might know that right when the baby comes out. Most hospitals try to do delayed cord clamping where we don't clamp the cord immediately like we used to. 

Our standard at our hospital is about 45 seconds at least. Some patients ask for a little bit more. Most hospitals will probably do the same, and then we delay the bath and we actually put the baby right on your chest as long as the baby is showing us signs that the baby's okay color noise, like crying and toned. 

So we don't want the baby to kind of be floppy, pale, and not crying. We ideally want the baby to be pink, vigorous, and crying, or at least components of that within the first minute that make us feel comfortable if the baby comes out and after a couple of seconds is not crying at all and shows no tone. 

Then we will quickly clamp the cord and have the baby go over to the bassinet, [00:06:00] to the pediatrician to attend to the baby, to sometimes suction the baby and just get the baby to be more vigorous. To get those first couple of breaths into the baby, you also will still be able to bond. And if you want, nurse the baby. 

And if you feel like you don't wanna nurse the baby, That's okay. And if for some reason the baby has to go right over to the bassinet or even go right up to the NICU because of signs of distress, meaning the baby necessarily didn't necessarily wanna come out crying in vigorous, that is okay. You will still bond. 

Even if it's not immediate. You'll bond later that day. The next day, sometimes a couple days into it, it's still your baby. You're still gonna bond, I promise. Okay? Those are some of the other things that can happen. Hope that helped. Bye.