Operative Vaginal Deliveries

unikuelady, RN · Apr 27, 2004

Hey Everyone,
Any of you have physicians use both vacuum and forceps to delivery instead of one or the other and then going for a C-section? What do you all think of that?

I have seen this happen only once. The baby came out very bruised/traumatized. (scalp tears from the vaccume, cheek/head bruising from the forcepts). The mother (thank goodness) had a good epidural during this whole event. She ended up with 3rd degree perineal laceration with repair as well as the C/S incision to care for and heal. As nursery nurse I was called to attend the delivery in L&D and observed all of this happening. This baby and mother ended up with a longer stay in the hospital. 5 days for each. Mother had much difficulty with voiding/stooling. Baby needed phototherapy for 3 days, was a poor feeder, cried when you touched his head, (very large caput along with the skin tears). It made me angry when the OB MD kept trying to vaccume this baby out and having the vaccume pop off, especially after she made a larger episiotomy for the forcepts, of course they didn't work. This baby was not in emergent distress during this time. In fact, after the tocolytics were administered....the C/S was done 3 hours later :uhoh3: Thank goodness this MD doesn't work at my facility anymore.

SmilingBluEyes · Apr 27, 2004

I saw it once, about 6 years ago. VERY BAD DEAL, same as above. Very traumatized baby and mother. I will say no more. The doctors where I work now would NOT do this.

**canoehead, BSN, RN** · Apr 27, 2004

If one doesn't work I don't see how the other will either. I haven't seen anone try both, but don't say that too loud...I know a doc that has probably just not thought of it.

fergus51 · Apr 27, 2004

I have seen it once, mainly at the mother's insistance. (You know, the I need to have a lady partsl birth or I can never be fulfilled as a woman type). Not pretty.

dawngloves, BSN, RN · Apr 27, 2004

I've seen it a couple of times.I think this was because of decels. Scary. I was literally jumping up and down with anxiety. Babies were fine except for big scalp hematomas and a jaw bruise or two. Thank goodness. I know it gave me a few grey hairs.

L&D_RN_OH · Apr 29, 2004

Most of our docs admit to not having used forceps in years. I've only seen them taken out twice. Once they were just at the rady, but never used. The second time was after an unsuccessful vacuum attempt. Mom was unable to push after a seizure and the FHR was in the 60's. If the forceps hadn't worked, I'm sure we would have ran to OR, as someone had already run to open it. But to be honest, I think by the time we made it to OR, we would have lost mom and baby. In this case, Mom died. It was a true obstetric/medical emergency. And one of the scariest things I have ever witnessed in L&D.

I think in general, w/o distress, if the doc is not successful with the vacuum, forceps should not be attempted. A CS would be safer.

BittyBabyGrower, MSN, RN · Apr 29, 2004

We don't do both at my hospital anymore, but there are plenty outlying that do...and when we go pick them up it ain't purty! We have come across skull fractures, brain bleeds complete with seizures, the list goes on...and any doc that does that should be shot in MHO

fergus51 · Apr 29, 2004

In my experience, forceps have been used when the baby is too high for vacuum, and used more to steer, not pull. I don't know any docs who would use them after the vacuum barring some sort of emergency.

dansamy · Apr 29, 2004

Most of our docs admit to not having used forceps in years. I've only seen them taken out twice. Once they were just at the rady, but never used. The second time was after an unsuccessful vacuum attempt. Mom was unable to push after a seizure and the FHR was in the 60's. If the forceps hadn't worked, I'm sure we would have ran to OR, as someone had already run to open it. But to be honest, I think by the time we made it to OR, we would have lost mom and baby. In this case, Mom died. It was a true obstetric/medical emergency. And one of the scariest things I have ever witnessed in L&D.
I think in general, w/o distress, if the doc is not successful with the vacuum, forceps should not be attempted. A CS would be safer.

What caused the mother's death? (I ask because your brief description sounds kinda like eclampsia.)

L&D_RN_OH · May 2, 2004

What caused the mother's death? (I ask because your brief description sounds kinda like eclampsia.)

Amniotic fluid embolism

mother/babyRN, RN · May 2, 2004

The facility I currently work at tries not to use vacuums while another used them a lot. We saw little trauma from most vacuums although I do appreciate not using them if possible. HAVE seen the shoulder dystocia, fourth degree , post partum curette deliveries accompanied by vacs or forceps ( but hardly ever foceps) and just wished they had gone for the csection, especially when the baby had to be resuscitated..Yikes..