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Study Supports Vacuum-Assisted Birth

Finds method is as safe as delivery with forceps

FRIDAY, July 2, 2004 (HealthDayNews) -- Since a federal warning in 1998, some obstetricians have been leery of helping women give birth by using a plunger-like device to pull the baby out of the womb.

Now, new statistics suggest the technique -- used in rare cases when the woman's health is threatened -- is getting a bad rap.

In a study published in the July 3 issue of the British Medical Journal, American researchers report that so-called vacuum-assisted birth is at least as safe as an alternative approach that relies upon the use of forceps. Combined, the two techniques account for an estimated 8 percent of births, and often let women avoid the potentially more dangerous Caesarean section.

The findings should make doctors feel better about using the vacuum-assisted approach, said Dr. Gary Hankins, chief of obstetrics at the University of Texas Medical Branch at Galveston. "This is going to counter any ill effects that the Food and Drug Administration [FDA] inadvertently got with their warning."

Most American babies are born the old-fashioned way: Contractions push them out of the womb. But when there are complications, doctors often must step in to help the baby get out properly.

In some cases, the mother is too tired to push anymore, Harkins said. In others, doctors are worried about stressing the mother because of heart or respiratory conditions. The baby itself may have trouble, too.

Caesarean sections are the most common alternative approach, making up nearly 30 percent of births, Hankins said. But doctors also pull out babies by using forceps to grab the baby's head just below the cheekbones or by using a plunger-like suction cup to grab the baby's skull.

The vacuum approach has grown in popularity over the past 20 years, Hankins said, notwithstanding the FDA warning. Both approaches have pros and cons: The vacuum technique helps doctors gain more pulling power, but it's easier to rotate the forceps and adjust the baby's position as it comes out, he said.

In 1998, the FDA put a chill on the vacuum technique by warning that it could cause deaths. But "nobody looked at the data involving a huge number of deliveries," said study co-author Dr. Kitaw Demissie, an assistant professor of epidemiology at the University of Medicine and Dentistry of New Jersey. "The FDA warning was based on a very small number of reported cases."

In the new study, researchers examined reports of about 12 million live births in the United States from 1989 to 1998 and compared the risks of death and injuries between vacuum extraction and forceps deliveries.

The overall risks of both techniques were similar, according to the study, and researchers concluded that vacuum-assisted deliveries were at least as safe as forceps-assisted ones. One percent of babies removed with forceps suffered birth injuries, while slightly fewer were injured during vacuum-assisted deliveries. Both techniques, however, were riskier than normal delivery.

Potential problems occur when the forceps or suction cups harm the baby's head, Hankins said. Even so, emergency C-sections are even more potentially dangerous, he said, giving doctors plenty of motivation to avoid them if possible by trying the other techniques.

So what now? At the FDA, spokeswoman Kathleen Quinn said the agency supports the study and more research into the safety of delivery methods. "There does need to be more information for people to make an informed decision," she added.

As for obstetricians, Hankins predicts that they'll continue to use the technique they're most comfortable with. In some cases, that will be the forceps, which are easier to use. "There's not a right or wrong," he said. "It's a difference in training."

More information

To read more about different birth methods, visit the National Library of Medicine.

SOURCES: Gary Hankins, M.D., chief, obstetrics, University of Texas Medical Branch, Galveston; Kitaw Demissie, M.D., Ph.D., assistant professor, division of epidemiology, University of Medicine and Dentistry of New Jersey, Piscataway; Kathleen Quinn, spokeswoman, U.S. Food and Drug Administration, Washington D.C.; July 3, 2004, British Medical Journal
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