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Tom Sharon
Severe infant head injury in 0.1 percent of births


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Forceps and Vacuum Extraction

When you sign the consent form for obstetrical services, you are giving the obstetrician permission to use forceps for extraction if he or she believes that the baby is not advancing quickly enough through the birth canal. The use of forceps causes severe infant head injury in 1 in every 664 births, or 0.1 percent of births. Such injury could result in developmental delays and/or cerebral palsy, a generalized spastic paralysis that comes from permanent brain damage. This brain damage occurs when the traumatic use of the forceps causes bleeding on the brain (subdural hematoma) or brain swelling (cerebral edema) and the condition remains unnoticed and untreated for too long a period. Damage to the eyes such as retinal detachment, which results in blindness, can also occur.

If forceps do have to be used, encourage your doctor to check the baby's head and eyes carefully afterward. You can also inspect your child's head yourself or ask the father or another relative to do it for you. If there is any bruising or indentation on the sides of the head where the forceps grabbed, then you need to ask the obstetrician or the pediatrician to order a CAT scan or an MRI (magnetic resonance imaging) to rule out brain injury or internal bleeding. The child would also need an eye examination to check the retinas. If all you get is assurance that everything is okay, then, depending on your comfort level, you will have to decide whether to accept it or demand a second opinion. However, chances are that if the doctors know that you are concerned about the possibility of damage from the use of forceps, they will carefully scrutinize your baby's condition to rule out internal head injury. The bottom line is that if you have any doubts, you must continue voicing them until you get a satisfactory response.
 
Additionally, vacuum extraction is available as an alternative to forceps delivery. The obstetrician accomplishes this by placing a suction cup on the baby's head and using a manual or electric pump to increase the negative pressure. Although there is considerable controversy about this procedure in the medical community, the proponents of vacuum delivery claim that it is less traumatic. However, as with any medical procedure or device, there is a set of risks. It boils down to the skill and luck of the person using the device. If the suction is too strong, it is likely to cause scalp trauma, brain hemorrhage, and/or eye hemorrhage. Although there are guidelines as to the safe amounts of negative pressure, a person can cause injury even while remaining within the accepted range. The same advice applies as with forceps deliveries if there is any hint of trauma.

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