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Jennifer Goodpaster

Vacuum Extraction and

Forceps Delivery
Defined: Vacuum extraction and forceps are used Forceps-assisted birth is the use of a steel
to decrease the length of the second stage of
labor when indicated.

instrument with two curved blades applied to

opposite sides of the fetal head to facilitate
birth. (Ward & Hisley, 2009)
Vacuum-assisted birth, vacuum
extraction, or vacuum-assisted vaginal
delivery (VAVD) is the use of a soft plastic
cup attached to a suction device that uses
negative pressure which is applied over the
posterior fontanel of the fetal head to facilitate
birth. (Ward & Hisley, 2009)

Indications / Risk Factors for Use of Forceps or Vacuum Extraction:

Maternal age (35 and
Maternal height < 411
Pregnancy weight gain >
Gestation > 41 weeks

Epidural anesthesia
Maternal exhaustion
Prolonged 2nd stage of labor
Infant presentation other

than occipitoanterior
Presence of dystocia
Midline episiotomy

Abnormal fetal heart

rate (FHR) tracing
Neonatal and Maternal
(Davidson, London, &
Ladewig, 2012)

Complications from Vacuum Extraction and Forceps:

Perineal trauma
Hemorrhage from cervical
lacerations and vaginal tearing
Fecal incontinence
Long-term pelvic floor disorders
(Ward & Hisley, 2009)

Superficial scalp and facial markings
Facial nerve injury
Retinal hemorrhage or ocular trauma
Intracranial hemorrhage

The Nurses Role:

Providing reassurance and support to the patient and her family
Empowering the patient to take control as much as possible
Educating the patient about the use of forceps/VAVD and of expected caput swelling or
facial marks
Assisting the patient to a lithotomy position to allow sufficient traction
Documenting time and amount of the first postbirth voiding, to rule out maternal bladder
(Ward & Hisley, 2009)
Management of care during a VAVD, including control of the vacuum gun and the pressure
Recording of all required documentation, including the sequence of events during the
vacuum assistance along with the maternalfetal response
Following protocols and advocating for cesarean birth if maternal exhaustion or failure of
Utilizing evidence-based guidelines for management of the second stage of labor, to
reduce the incidence of instrument-assisted deliveries
(Mahlmeister, 2005)
Assisting clinicians in maintaining situational awareness by tracking important time and
device parameters during the VAVD

Postoperative maternal assessment to identify trauma to perineal tissue, birth canal, or

anal sphincter. Observe for postpartum bleeding or hemorrhage.
Performing neonatal assessment for signs of cephalhematoma, bruising, bleeding, or
lacerations. Performing serial assessments for signs of intracranial bleeding or subgaleal
hematoma for 48 hours.
(Lacker, 2012)


Davidson, M. R., London, M. L., & Ladewig, P. A. (2012). Olds maternal-newborn nursing &
womens health across the lifespan (9th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

Lacker, C. (2012). Safety Monitor: Preventing maternal and neonatal harm during vacuumassisted vaginal delivery. American Journal of Nursing, 112(2), 65-69.

Mahlmeister, L. R. (2005). Best practices in perinatal and neonatal nursing: Vacuum-assisted

vaginal delivery. Journal of Perinatal & Neonatal Nursing, 19(1), 9-11.

Ward, S. L., & Hisley, S. M. (2009). Chapter 14: Caring for the woman experiencing
complications during labor and birth. Maternal-child nursing care: Optimizing outcomes for
mothers, children & families (pp. 437-439). Philadelphia, PA: F.A. Davis Company/Publishers.