Running head: PREVENTION OF TRAUMA IN CHILDBIRTH

Prevention of Trauma in Childbirth

April K. Greene
Ferris State University

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Prevention of Trauma in Childbirth
Preventing Maternal and Neonatal Harm during Vacuum-Assisted Vaginal Delivery, by
Cynthia Lacker, discusses the avoidable trauma in mothers and neonates during childbirth.
Statistics acquired by the Agency for Healthcare Research and Quality found that in 2006,
approximately 157,700 injuries occurred. Vaginal births assisted by mechanical instruments
were seen to have the highest related obstetric trauma, with 160.5 per 10,000 deliveries causing
injury. One specific type of instrument-assisted delivery has known risk factors and
complications. Vacuum-assisted vaginal delivery, or VAVD, is used in the second stage of labor
under certain circumstances. Maternal perineal injury and fetal cranial hemorrhage caused by
the use of vacuum devices both can be found to be fatal, although VAVD is seen as a safe
alternative to forceps deliveries. It is important for nurses to recognize the indications,
contraindications, and risks in order to minimize complications and maximize the success of
vacuum-extraction.
A prolonged second stage of labor, possible fetal compromise, medical contraindications
of the mother that require expulsive effort, or necessary shortening of labor for maternal benefits
are all indications for the use of VAVD. When fetal compromise is identified, clinicians must
determine if VAVD, forceps, or C-section is the best option. Failure of VAVD requires an
immediate backup plan. One contraindication to vacuum extraction is a gestational age below 34
weeks. Other contraindications include a bleeding disorder of the fetus, a fetal predisposition to
fracture, incomplete cervical dilation, a breeched fetus, the fetal head not engaged in the pelvis,
or suspected cephalopelvic disproportion. Assessment of the mothers pelvis preoperatively
should be done; if none of these things can be determined, vacuum extraction should be avoided.

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Professional nursing staff during labor and delivery is essential in the detection of
complications when using VAVD. Cervical lacerations, vaginal hematomas, hemorrhage,
perineal tears, anal sphincter injury, postoperative bleeding, hypovolemic shock, and unplanned
hysterectomy are all maternal complications that can arise. Cephalhematoma, neonatal jaundice,
retinal hemorrhage, and subgaleal hematomas are all associated neonatal injuries.
In order to prevent trauma, it is important to ensure that VAVD is only performed when
the indications for it are clear and when the likelihood of success is high. There are many other
interventions to facilitate the birthing process such as one-on-one maternal support during labor,
adopting an upright or lateral position to facilitate fetal descent, the use of analgesia, and
administration of oxytocin, as well as the delay of pushing for 2-3 hours during labor. These
interventions can reduce the need for vacuum-assisted procedures and thereby reducing the risk
for injury. A thorough assessment of both the mother and baby preoperatively and
postoperatively and being active in the delivery process by the nursing staff can reduce morbidity
rates.
Preoperative assessment of the mother includes informed consent by the mother and
physical assessment. The mother must be willing and able to participate in VAVD. Less force is
required by the VAVD is if the mother is able to contribute during the contractions. Fetal
assessment requires general fetal condition, size, head engagement and station, and fetal position.
Fetal heart rate and size must be determined; a severely compromised fetus will most likely
benefit more from a quick C-section.
Increased safety in both mother and baby is found to be associated with greater VAVD
expertise. Credentialing and training programs in the use of VAVD and familiarity with
manufacturer guidelines can make obstetric units safer. During the procedure, if failure

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presumes, the doctor must decide whether or not to continue with assisted delivery or to go on
with a C-section. This is known as sequential device use. If the use of the VAVD is not
successful, the procedure may need to be abandoned.
Just as preoperative assessment is important, postoperative assessment is crucial as well.
Any trauma or injury that occurred during the procedure will need to be identified, and
depending on the severity, may require surgical repair or increased monitoring. Urinary, stress,
bowel incontinence, perineal tissue injury, and anal sphincter disruption will also need to be
assessed on the mother. Scalp injuries of the neonate occur often after VAVD extraction, so
again depending on the severity, they will need to be assessed and monitored for edema and
cranial bleeding.
Facility strategies and policies can help reduce risk in the hospital setting; they should
specify parameters of time frames and indications and contraindications. Advanced
documentation strategies of VAVD should also be standardized. Preoperative strategies include
discussion of the risks and benefits with the mother, ruling out contraindications to VAVD, and
verifying an exit strategy before proceeding with VAVD. During the procedure, being an active
nursing partner during VAVD is important. Postoperative strategies include ensuring that all
members of the care team are aware that VAVD occurred, performing thorough postoperative
assessments on the both the mother and child, and preparing for immediate intervention if
complications arise (Lacker, 2012).

References

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Cynthia, L. (2012, February). Preventing maternal and neonatal harm during vacuum-assisted
vaginal delivery. Pennsylvania Safety Reporting System, 112(2), 65-69.