Expert: Catherine Beier MS CBE - 9/23/2008

Question
I just delivered my first baby 3 weeks ago after having a wonderful pregnancy
with no complications.  It was a vaginal delivery that included 2 hours of
pushing and the doctor using a vacuum to assist for the last 3 contractions.  
To make our sad story short, our precious baby girl ended up only living for 2
days.  At first, the doctors had no definite answers for us as to why her body
was failing, but now after some lab tests have come back, it is looking like it
was all due to a head bleed (subgaleal hemmorage), which was most likely
caused by the vacuum.  My husband and I did not know much about the
vacuum before our daughter's delivery and the doctor did not tell us about
any risks before using it.
I wanted to ask you how you feel about vacuum assisted deliveries or what
your experience has been with them?
Also, we would like to try to get pregnant again someday...do you have any
advice as to when would be a good (healthy) time for that?
Finally, if I am able to get pregnant again, I know we will be terrified about
how the delivery will go, do you have any advice?  Would we be better off
scheduling a c-section if possible?

Thanks for your help!

Answer
Jennifer,


I am deeply sorry for your loss.  I cannot begin to imagine what you must be going through and there are simply no words that will offer you the comfort I wish for you.


The first thing I suggest you do is to consult an attorney.  Your doctor is guilty of gross negligence and lack of informed consent if you were not told of the risks and benefits of vacuum extraction before it was used.  Also, if such a hemorrhage occurred, it is almost always due to inappropriate use of the vacuum.  Even if you said it was ok to use it, if you were not informed of the risks, then you couldn't make an informed decision about its use.   I don't recommend a lawsuit for financial gain, but to prevent future families from suffering the same fate as your family, especially if this provider is using the vacuum incorrectly.  It's another death waiting to happen.


As for my thoughts on vacuum extraction - I have serious concerns about its use, in that it can be decidedly deadly in the wrong hands, as you experienced first-hand.  One of the risks of vacuum extraction is hemorrhage- especially if the vacuum is used improperly.


In most all cases, vacuum extraction would not be necessary if the mother used evidence-based birth positions during labor and pushing, so that gravity could help the baby descend and the pelvis could expand to its widest dimensions.


As you indicated that you pushed for 2 hours, this would suggest to me that you had an epidural that blocked all sensation from the waist down, making your pushing ineffective and leaving you flat on your back, the worst possible position to birth in, for both you and your daughter.  When an epidural is used, more pressure has to be put on the baby from the vacuum because the pelvis is up to 30% smaller in diameter and you are effectively pushing uphill against gravity to birth your child.  The baby is also at a much greater risk of going into fetal distress this way due to lack of oxygen and general stress of labor.


Some solutions to this would be to use evidence-based labor and birth positions as well as to choose natural pain relief options before an epidural.  If you do decide to use an epidural, you can turn it down before pushing so that you have better sensation.  Also, you can request that if you are unable to move yourself, that staff move you into a more upright position to push, which should significantly reduce the pushing time and the chance of trauma/tearing to you and lower the risks to your baby.



As for when to start trying for another baby, your body should be ready after you begin ovulating again, usually 3 months or less.  However, your spirit may not be whole for some time.  Only you and your husband can decide when to try again.  Some counseling may be needed to help you work through this difficult time.


As far as scheduling a c-section, I definitely do not advise it.  Having a major abdominal surgery will not guarantee you a better outcome and comes with its own unique risks which are not present with a vaginal birth.


Instead, I would analyze the factors that led to your 2 hours of pushing and seek to remedy those.  Look into effective birth positions (more information is at http://www.givingbirthnaturally.com/birth-positions.html) and natural pain relief options (http://www.givingbirthnaturally.com/labor-pain-management.html) to prevent complications before they begin.  You may also want to investigate other natural childbirth methods that can help you learn proven techniques to help you respond to each stage of your labor (more information at http://www.givingbirthnaturally.com/vaginal-childbirth.html).


Above all, I would search long and hard for a provider who truly understands how to support a woman in labor rather than overusing medical interventions to get her delivered as fast as possible, which only leads to complications that needn't have happened.  Your best match may be with a midwife, as they are specifically trained to intervene only when necessary and have an extensive knowledge of using evidence-based techniques to let labor progress on its own as smoothly as possible.


Best,
Catherine