Ventouse (vacuum extraction)

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This is an alternative to forceps, when the baby requires assistance to be born.

When is it necessary?
The indications for its use are similar to those for forceps, with some differences:

• Vacuum extraction can be performed before the cervix is completely open, as the suction cup takes no additional space around the baby's head. This may enable a very distressed baby to be born quickly.
• It is not usually used for premature or breech births.
• It is impossible to apply strong pressure to the baby's head with the vacuum device, as it will slip off if excessive force is used.
• The small size of the device reduces the risk of damage to the mother's vaginal tissues.

How is it done?

• The mother is placed in the lithotomy position (on her back) with her legs in stirrups.
• A suction cup is applied to the baby's head and held in place while the suction (generated from a portable suction pump or obtained through the hospital's in-built suction system) draws the skin on the scalp firmly into the cup.
• Handles attached to the vacuum extractor can then be used to turn the baby and gently lift it out.
• The mother must assist by pushing.
• Once the head is born, the suction cup is removed and the baby is born normally.
• The chignon or lump on the baby's head caused by the suction usually disappears within hours.

Effects on the mother
Advantages:

	1.	Can be used before the cervix is fully dilated if rapid delivery is indicated by the baby's condition.
	2.	An episiotomy is not usually required.
	3.	Very little, if any, internal bruising of the maternal tissues.
	4.	Mother can still feel the birth and be involved by assisting with pushing.

Disadvantages:

	1.	This technique is not always available, due to lack of experience or professional preferences.
	2.	The technique may fail due to repeated inability of the suction cup to stay in place, and either forceps or a Caesarean may then be necessary.

Effects on the baby
Advantages:

	1.	The baby can be born before the cervix is fully dilated, which could be helpful to a distressed infant in need of being born.
	2.	Less likelihood of displacement of the neck bones as the forces applied by vacuum extraction are not as great as those with forceps.
	3.	Fewer marks on the head and face. The marks left by the suction cap disappear very quickly.

Disadvantages:

	1.	The chignon lump on the baby's head will take time to disappear.
	2.	The baby may be distressed by having suction applied to its head and by traction during the birth.