Question for expericed NICU nurses

[HeartsOpenWide, RN]

I am an RNC-OB on a rural unit with LDRP and a level one nursery. We do not have a NICU so we have to stabilize and ship our sick babies out. I have been a nurse for 4 years and have only seen forceps used twice, most of the time the Kiwi is used; and even then, not very much in the very natural birth center in which I work. I have seen some pretty scary case studies in CEU courses where the Kiwi was used, but not much is mentioned about forceps and my experience personally is limited. I am wondering, from the experience of some NICU nurses that have been around: what are some of your personal experience with forceps and vacuums? Which have the worst birth injuries in the one vs. another sense?

[babyktchr, BSN, RN]

Not a NICU nurse, but in my experience....lets face it, forceps are a scary piece of equipment. If you have a SKILLED provider, a forceps assisted delivery can be amazing. I don't think their use is being taught so much anymore, so you find that the "more mature" provider use them, and then it isn't as routine as it once was. Vacuum is much more popular and I fear is being taught as a process to "speed things along" when dinner plans or sleep time is involved (yes, I used my outdoor voice there).

I have seen all kinds of outcomes from each. Use of both are reported to risk in my facility (a small level 1 LDRP) so I answer my share of risk evals, and honestly and thankfully we don't use either a lot. On the whole, I have seen more nerve damage and 'cosmetic' damage from forceps use, and more neurologic damage from vacuum. I am sure that those coming from higher level facilities can add a great deal to this discussion. It would be interesting to see what others experience, especially in those places with residents (as far as technique/skill level/frequency of use)

[Jolie, BSN]

Properly and judiciously used by skilled practitioners, forceps and the vacuum extractor can be of use in safely assisting lady partsl delivery, sparing surgical risks to mother and baby. The (fortunately rare) serious complications I've seen stem not from the devices themselves, but from their improper use.

Improperly applied forceps can cause facial and head trauma, including injury to eyes and ears. Improper use of vacuum extractors, including excessive length of attempts, excessive numbers of attempts and excessive pressures can cause significant head trauma, including intra-cranial hemorrhage. Perhaps the greatest potential risk is the loss (waste) of precious time in delivering an oxygen deprived infant if the practitioner fails to recognize the need to move on to a C-section rather than make repeated attempts to deliver with one of these assistive devices .

Neither is inherently good or bad. Both require substantial skill, expertise and judgement to be used safely and effectively. In the wrong hands, they are a curse. In the right hands, they are a Godsend.

[klone, MSN, RN]

I work for a teaching hospital, and all our residents are highly skilled in forceps deliveries. The kiwi is RARELY used (really, the only time I see it used is during a C/S). I believe research has found that properly used, there is far less damage caused with a forceps than with a vacuum. When vacuum is used, it greatly increases the risk of subgaleal hemorrhage.

At the small community hospital where I used to work, that had only private practice docs, there was only ONE doc who was skilled and comfortable in the use of forceps. At that hospital, I had only seen it used a couple times, whereas the Kiwi (or with one doc, the purple mushroom shaped one where the RN had to pump it up with the hand pump) was used almost exclusively. We saw a lot of mushy headed babies, especially with one particular doc.