The Food and Drug Administration warned in May 1998 of a tiny but growing number of head injuries and deaths among infants delivered with vacuum extractors and advised doctors to exercise caution when using the devices. However, a study in today's New England Journal of Medicine suggests that difficult labor itself, as much as the method of delivery, may lead to brain injuries and deaths in babies. In addition, vacuum extraction is generally safer for the mother than the use of forceps or Caesarean section, said Dena Towner of the University of California at Davis, the study's lead author. Caesarean sections typically are performed when labor stalls in the early stages or if the baby is in an awkward position. Vacuum extractors have a soft plastic cup that is placed on top of the baby's head and used to pull when the mother has a contraction.
Doctors use rounded forceps to grasp the baby's head on either side, then pull.
Some injuries and deaths occur because forceps or the extractor are applied to the wrong part of the baby's head, or used when labor is not far enough along, Towner said. The study looked at 583,340 live births to first-time mothers in California from 1992 through 1994. Brain injuries occurred in 1 of 1,900 infants delivered normally and 1 of 2,750 delivered by Caesarean section before labor began. In difficult labors, brain injuries occurred two to three times as often as during normal, vaginal birth. The differences in risk among the three methods were not statistically significant.