Anxiety rises over birth delivery tools

March 7, 2000
Web posted at: 10:22 AM EST (1522 GMT)

In this story: Increased anxiety over delivery tools Research deflects concern Easing parents fears RELATEDS

(WebMD) -- While the majority of births don't call for extreme measures, some can turn problematic at the last moment. Just ask Peg Rosen.

The Montclair, New Jersey, mother of two underwent a labor with her first child that began typically. However, by the time her cervix had dilated to 10 centimeters and she was ready to push, she had developed a fever and the baby's heart rate was dropping. In addition, the baby passed meconium -- the first bowel movement -- and the medical staff, worried that he would inhale it and run the risk of pneumonia, wanted to get him out as quickly as possible. As a result, Ben was delivered with the aid of forceps. His birthday souvenir: two red marks that stretched from his hairline to his cheeks.

Ben's marks eventually faded, but doctors and patients alike are becoming more vigilant about the effects of operative vaginal delivery that includes the use of instruments -- namely, forceps and, increasingly, vacuum extraction -- to hasten delivery and preserve the health of the mother and infant.

Doctors use both forceps and vacuum devices when the baby's progress out of the birth canal has halted, explains Dr. Lynn Simpson, an obstetrician-gynecologist in maternal-fetal medicine at Columbia Presbyterian Hospital in New York City. These tools help pull the baby's head out of the birth canal while the mother pushes. Forceps are fixed around the head lengthwise, closing around the jawline; vacuum devices attach with a suction cup to the top of the head. When used properly, both are safe.

"Most obstetricians are trained in both [forceps and vacuum extraction]," says Simpson.. For the most part, doctors generally choose the tool they are most familiar with, she explains. If neither is helping with delivery of the baby, a cesarean is then performed.

Increased anxiety over delivery tools

But recent controversy -- about vacuum extraction in particular -- has caused heightened anxiety.

In May 1998, the Food and Drug Administration, spurred by 12 infant deaths and nine injuries over four years, issued an advisory on the vacuum method, urging doctors to use caution. In August 1998, the American College of Obstetricians and Gynecologists came out with its own, less alarmist opinion, recommending that ob-gyns continue to use the extractors when appropriate and with proper training. But more recently, a January 29, 2000, segment of the TV show "20/20" stirred up new fears with a report on head injuries caused by vacuum devices.

With vacuum extraction, problems arise when the suction pulls the scalp from the underlying tissue, creating a space into which the baby may bleed. Doctors must be careful not to twist the baby's head with the device or leave the device on for more than 20 minutes, says Dr. Dena Towner, an ob-gyn at the University of California at Davis Medical Center.

Dangers of forceps include injuring the soft tissue of the head, face and neck -- anywhere they clamp down on the baby -- which may in turn cause nerve damage, says Simpson.

Research deflects concern

Many doctors, however, believe that not only are these tools necessary in some situations but they are also relatively safe.

A study published in the December 2, 1999 New England Journal of Medicine suggests that the real danger may lie not in the tools but in the labor itself. Researchers from the University of California Davis in Sacramento, California, and Harvard Medical School and Massachusetts General Hospital in Boston, studied 583,340 infants born to first-time mothers. "In essence, we found that the risk of intracranial bleeding was relatively the same regardless of whether the baby was delivered with forceps, vacuum extraction or a Cesarean during labor," explains Towner, who participated in the study. (The risk ranged roughly from 1-in-664 to 1-in-900.)

For Cesarean deliveries performed with no attempt at allowing labor to occur, the incidence of intracranial hemorrhage was extremely low (1-in-2,750). It was surprisingly higher (1-in-1,900) for unassisted vaginal deliveries -- where the baby passed through the birth canal but didn't need the assistance of instruments. Statistically, there was enough variation between unassisted vaginal deliveries and Cesarean deliveries without an attempt at labor to lead researchers to suppose that instruments or method of delivery are not increasing a baby's risk of a head injury; instead, "the actual trauma of a problematic birth may be causing some of the injuries," says Towner.

Easing parents fears

While doctors can't predict which women may have a difficult labor, parents can help prepare themselves by fully knowing the possibilities and how a doctor might react when a labor becomes prolonged.

"Tell your doctor what you're expecting out of delivery, and ask what will happen if it doesn't go that way, preferably in the office beforehand," recommends Simpson. Ask questions: How much experience has the doctor had with problem deliveries? How has the doctor reacted in such cases? What is the doctor's track record of injuries with assisted deliveries?

But "at a certain point you have to put your baby and your life in their hands," Ben's mom, Rosen, advises. All the more reason to make sure you have a good relationship with your physician -- and confidence in his or her abilities.

© 2000 Healtheon/WebMD. All rights reserved.

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