Forceps or Vacuum Extraction Birth Injuries: Malpractice Liability?

It's not uncommon to use assisted delivery methods during childbirth, but the fragile condition of a newborn baby's skull means the doctor must use the utmost care to avoid potentially serious injury.

by Mike Becker, Attorney

In some instances of vaginal birth it may become necessary for an assistive method to be used to help guide the baby through the birth canal. There are two main methods used today that involve grasping the baby’s head: vacuum extraction or forceps. Both methods use gentle pulling to help move the baby down the birth canal.

A baby’s skull is very soft for the first few months of life as the plates of bone have not yet completely fused together. Their scalp is also easily susceptible to bruising and disfigurement and is not as closely attached to the skull as an adult’s. Therefore, there is a higher risk of birth injury when vacuum extraction or forceps are used to assist vaginal delivery.

This article discusses the two main types of assited delivery methods, outlines the possible types of injuries, and offers guidance on the possible legal issues.

Injury Resulting From Forceps Delivery

Forceps have been used for hundreds of years in birth assistance. They are a pair of curved metal tongs that are designed to grasp the baby’s head on each side and allow the doctor to gently pull their body down the birth canal.

The most common type of birth injury that occurs with forceps use is bruising or abrasions on the baby’s scalp. These marks are normally cosmetic and disappear within a few days or weeks, but in some severe cases, they can persist and become a permanent disfigurement. If there is too much pressure put on the sides of the skull, indentations may appear on the child’s scalp. These may also clear up within a few weeks.

A particularly rushed delivery with forceps may result in a birth injury known as shoulder dystocia, also commonly referred to as Erb’s Palsy. This is when the brachial plexus (nerves in the shoulder) are damaged and can cause limited mobility or paralysis in the arm and hand. In mild cases, the nerves will repair themselves, but surgery may be necessary to repair the damage from a serious birth injury.

Injury Resulting From Vacuum Extraction

There are two types of vacuum extraction used today, the soft cup method and the metal cup method. Metal cup vacuum extraction is more reliable but causes more potential trauma to the scalp. Soft cup vacuum extraction has a higher detachment risk during extraction but is gentler on the scalp and mother’s body.

The site where the cup attaches to the baby’s scalp during vacuum extraction is susceptible to bruising and disfigurement if the pressure and suction are not carefully monitored. Insertion of the cup can damage the mother’s body if the doctor is not careful and multiple detachments should result in the doctor attempting another extraction method.

Both soft and metal cup vacuum extraction methods pose the risk of a hemorrhage birth injury. Subgaleal hemorrhage is when bleeding occurs between the scalp and skull and results in swelling of the head. If your newborn shows signs of a subgaleal hemorrhage the medical staff should be quick to treat the condition or it may result in anemia, seizures, shock, or even, death.

Retinal birth injuries are also possible during vacuum extraction from the pressure and stress of the birthing process. Your baby’s eyes may have a red ring around them, or small amounts of blood present. This may be mild and clear up without treatment. A more serious birth injury of this nature can result in lasting vision problems.

Proper Prevention of Birth Injury

When you are preparing for a vaginal birth your doctor should explain when forceps or vacuum extraction would become necessary in the labor process. During labor, if the use of an assistive method becomes necessary the doctor should explain the process and make the proper choice in method. Some births necessitate forceps over vacuum extraction and vice-versa.

The doctor should take the utmost care in choosing the safest delivery method for you and your child. If you had a previous high-risk pregnancy that would cause labor complications your doctor should reevaluate to see if vaginal birth is the best option.

Legal Liability for Injury

If a newborn is injured during the childbirth process, it is possible that the delivering doctor or midwife may be held liable. Medical malpractice claims hinge on proving that the medical professional acted in a manner other than prescribed by the medical standard of care. This is a very difficult type of case to prove. For the legal issues at play, see Medical Malpractice During Childbirth.

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