19.6: Interventions During Birth
By the end of this section, you will be able to:
- Explain the obstetric indications for the use of forceps during birth
- Explain the obstetric indications for the use of the vacuum extractor during birth
- Discuss the nursing care of the person in labor requiring an operative vaginal birth
The use of forceps or vacuum to assist with the birth is considered operative delivery . These deliveries can be difficult for both the laboring person and the fetus. However, in certain situations, the use of these instruments can protect the person or the fetus by expediting delivery.
Obstetric Forceps
The metal instruments placed on the fetal head to rotate the head or assist in delivery of the fetus are called obstetric forceps . The use of forceps during labor is indicated for maternal exhaustion and when the birth must urgently occur, such as when fetal heart rate decelerations are noted. This can be an alternative to cesarean birth . Obstetric forceps are designed to fit the fetal head. They cradle the fetal skull to apply traction, rotation, flexion, and extension, as seen in Figure 19.12 (Shabib & Black, 2022). Indications for forceps birth include nonreassuring fetal heart rate , prolonged second stage of labor , and delivery of the head after a breech presentation . Forceps birth can be attempted only if the cervix is completely dilated, the membranes are ruptured, the fetal head is low in the pelvis, and the provider does not suspect cephalopelvic disproportion (Shabib & Black, 2022). Complications to the birthing person when obstetric forceps are used include lacerations of the vagina and cervix, pelvic hematomas , urethral and bladder injury, rupture of the uterus, and posttraumatic stress disorder (PTSD). Fetal complications include facial lacerations and nerve damage, cephalohematoma s, skull fractures, intracranial hemorrhage , and seizures (Shabib & Black, 2022).
When the health-care provider makes the decision and obtains consent from the birthing person to use forceps to deliver the fetus, the nurse performs several actions. The nurse assists the person into the lithotomy position and ensures that the bladder is emptied. If the person has an epidural, the nurse can call the anesthesia provider to ensure the person has adequate pain relief. The neonatal team should be in the room in case of newborn complications.
Consent for Operative Delivery
Upon admission, the laboring person signs consent forms for birth. Because an operative delivery is a deviation from normal, informed consent should be requested and given by the laboring person for use of forceps or vacuum. The health-care provider should explain why the operative delivery is necessary, the risks and benefits of the procedure, and how the procedure will be performed. The provider should allow time for questions and ensure shared decision making. The health-care provider is responsible for providing this information in a nonbiased way. For consent, the person must have the mental capacity to understand and make that decision.
Vacuum Extractor
A vacuum extractor is a device used to help deliver the fetal head during the second stage of labor. The vacuum device usually features a soft, silicone cup that fits onto the fetal head. A pump and gauge attach to the cup to apply the proper amount of suction. Once the vacuum is applied to the fetal head, traction is placed to assist the birth while the birthing person is pushing. Indications for a vacuum-assisted delivery are the same as for forceps-assisted delivery. Contraindications to the use of the vacuum include face or breech presentation, cephalopelvic disproportion, fetal head anomaly, preterm fetus, or fetal bleeding risk (Shabib & Black, 2022). Complications include neonatal injury, including superficial scalp markings, retinal hemorrhage, cephalohematoma, subgaleal hematoma, and intracranial hemorrhage (Shabib & Black, 2022). The vacuum can cause perineal and vaginal lacerations to the laboring person.
When the provider has indicated a need to deliver the fetus using the vacuum extractor and consent has been obtained, the nurse assists the person into stirrups. The vacuum system is checked for leaks. The cup is placed on the fetal head, and the vacuum pressure is increased during the contraction. The pressure is decreased between contractions. The nurse ensures the pediatric team is available for newborn complications. Figure 19.13 demonstrates the application of the vacuum.