Maternal Trauma During Forceps and Vacuum Delivery: A Concern Not Accounted For in Existing Data

It is the hope of every parent that their child experiences a safe and complication-free delivery as they enter the world.  Unfortunately, some deliveries do encounter complications—how healthcare providers respond to complications is incredibly important in minimizing risk to both the baby and the birthing parent.

In the second stage of labor, if the descent of the baby’s head has stopped, there are imminent risks to the baby, or there are conditions that contraindicate pushing, the use of forceps, and vacuum-assisted deliveries are recommended as safe, acceptable alternatives to cesarean delivery.  This is because existing maternal and neonatal mortality and morbidity data show no clear advantage of the use of forceps and vacuum-assisted deliveries (known as operative vaginal delivery) over cesarean delivery.  Nevertheless, said data fails to account for the impact of maternal trauma, which is the most common injury associated with operative vaginal delivery.  A recent study published in the British Medical Journal revealed that this is particularly problematic in North America.  Canada presently has the highest rate of maternal trauma after operative vaginal deliveries among high-income countries, followed closely by Denmark and the United States.

The study authors explain that the initiatives to decrease cesarean deliveries in North America that include scaling up training and use of operative vaginal deliveries are not acknowledging the serious safety concerns related to operative vaginal deliveries.  The authors recommend that emphasis be placed on ensuring that birthing parents are adequately informed of the risk of forceps, vacuum, and second-stage cesarean delivery, instead of on reducing cesarean delivery rates.  This would mean a shift in focus towards transparent, evidence-based, patient-centered care and safe, positive birth experiences.  Indeed, “[t]he benefits and risks associated with all delivery alternatives need to be carefully communicated to pregnant women, ideally in the antenatal period, with current, empirically derived measures that reflect the risks women encounter in routine obstetric practice.”  This kind of communication is key in allowing the birthing parent to make an informed decision as to their chosen method of delivery.

What Causes Birth Injuries to Occur?

Stanford Medicine Children’s Health explains that the following conditions may be linked to a difficult birth:

• Babies born at more than 8 pounds, 13 ounces
• Babies born before 37 weeks
• The size and shape of the birthing parent’s pelvis not being adequate for the baby to be born vaginally (known as cephalopelvic disproportion)
• A difficult labor or childbirth (known as dystocia)
• A prolonged labor
• An abnormal birthing presentation, such a breech delivery
• Maternal obesity

What Types of Birth Injuries Are Common?

Stanford Medicine Children’s Health identifies the following as common birth injuries affecting babies:

• Brachial palsy: a condition where the group of nerves that supplies the baby’s arms and hands becomes injured, and can occur when there is trouble delivering the baby’s shoulder
• Bruising or forceps marks: bruising may occur from the trauma of passing through the birth canal and contact with the mother’s pelvic bones and tissues, forceps can leave temporary marks or bruises on the baby’s face and head, and babies delivered by vacuum extraction may have bruising or cuts on their scalp
• Caput succedaneum: a condition where the baby’s scalp experiences a significant swelling of soft tissues when the baby travels through the birth canal
• Cephalohematoma: bleeding between the skull bone and its fibrous covering
• Facial paralysis: a condition caused by pressure on the baby’s face during labor or birth that injures the facial nerve and may occur when forceps are used for delivery

Although birth injuries to the birthing parent can be devastating, these injuries are at times inadequately discussed and/or improperly addressed, leaving those who have suffered such an injury feeling isolated.  These injuries can include:

• Tears to the perineum
• Pelvic floor muscle damage
• Pelvic organ prolapse
• Pelvic fractures to the pubic bone, coccyx, or sacrum
• Caesarean wounds
• Emotional or psychological distress from a physical birth injury

What Can You Do if You or Your Loved One Suffered from A Birth Injury?

If you or a loved one suffered an injury during the birthing process that you believe to be the result of medical malpractice, you should reach out to an attorney right away.  Contact the experienced attorneys at Berkowitz and Hanna, LLC if you have any questions about your legal rights regarding this concern.  To schedule a free, no-obligation consultation, call 203-324-7909 or contact us online today.