Birth Injury: Improper Use of Forceps and Vacuum Extractors

 Both forceps and vacuum extractors are obstetric instruments designed to assist in a vaginal delivery when a mother is having difficulty pushing the baby out. Forceps are surgical instruments that resemble large salad tongs. They are carefully placed around the baby’s head to gently guide it through the birth canal. A forceps delivery is typically considered when the mother is exhausted, labor is not progressing, or there is a need to expedite delivery due to fetal distress. Alternatively, vacuum extractors use a soft or hard suction cup attached to the baby’s scalp. A vacuum pump creates suction, which allows the doctor to pull the baby’s head during contractions. This method is often preferred over forceps as it is considered to be less invasive. While these tools are valuable in certain situations, their use carries significant risks if proper medical protocol is not followed.

Risk Factors for a Forceps or Vacuum-Assisted Delivery

While the use of these tools can be unpredictable, certain factors can increase the likelihood that a doctor may need to use them. These include:

• Prolonged Second Stage of Labor: If the mother has been pushing for an extended period without progress, the doctor may opt for an assisted delivery.
• Maternal Health Conditions: Certain health issues, such as heart disease or high blood pressure, may make it unsafe for the mother to continue pushing.
• Fetal Distress: When the baby’s heart rate or other vital signs indicate distress, a rapid delivery may be necessary.
• Abnormal Fetal Position: If the baby is not positioned correctly for delivery, forceps or a vacuum extractor may be used to rotate the baby’s head to facilitate delivery.

What Constitutes Improper Use?

Medical negligence occurs when a healthcare professional’s actions fall below the accepted standard of care, resulting in an injury to the patient. In the context of assisted deliveries, improper use of forceps or vacuum extractor complications can include several types of errors. These include applying excessive force with either the forceps or vacuum extractor, or using an incorrect application by placing the tool on the wrong part of the baby’s head, which can lead to skull fractures or brain injury. 

Another form of negligence is making too many attempts with a vacuum extractor, as repeated efforts can significantly increase the risk of a cephalohematoma or other scalp injuries. A physician’s failure to recognize when to stop and perform a C-section is a critical error. In many cases, continuing with an assisted vaginal delivery is more dangerous than performing a timely cesarean section, and a doctor’s failure to perform a C-section can be a key point in a medical malpractice case. 

Furthermore, a doctor may be considered negligent if they fail to adequately explain the risks and benefits of an assisted delivery to the parents, obtain proper consent, or use the incorrect tool for the specific circumstances of the birth.

Common Injuries Caused by Birth Trauma

The birth trauma from delivery can lead to a wide range of injuries, some of which may not be immediately apparent. These can include:

Cephalohematoma: A collection of blood that pools between the baby’s skull and its scalp. This is a type of subperiosteal hemorrhage, meaning the blood is contained by the cranial sutures, and it usually appears as a raised lump on the baby’s head. While it often resolves on its own, it can lead to complications such as jaundice if the red blood cells break down.

Facial Nerve Palsy: This injury occurs when the facial nerve is damaged by pressure from forceps or by a vacuum extractor. The baby may be unable to move one side of their face, which is most noticeable when they cry. The mouth will not move symmetrically, and they may not be able to fully close one eye. While often temporary, permanent paralysis can occur in severe cases.

Brachial Plexus Injuries: The brachial plexus is a network of nerves in the baby’s neck and shoulder that controls the arm and hand. Excessive force during delivery, such as pulling on the baby’s head or shoulders, can stretch or tear these nerves. The most common form of this is Erb’s Palsy, and Erb’s Palsy symptoms can include a lack of feeling or a limp appearance in the arm. In severe cases, the baby may have no movement in the affected arm.

Cerebral Palsy: In the most severe cases, improper use can cause a lack of oxygen to the baby’s brain (hypoxia) or intracranial hemorrhage (bleeding in the brain), which can lead to irreversible brain damage. This brain damage is the root cause of cerebral palsy from birth injury, a lifelong condition that affects a person’s ability to control their muscles and movements. The severity of the condition varies widely, but it can significantly impact a child’s quality of life.

Recognizing Signs of a Birth Injury

Parents should be vigilant for signs of a birth injury in the days and weeks following delivery. These can manifest as:

• Physical signs: Swelling, bruising, or lumps on the head, an asymmetrical face, or an arm that hangs limply or doesn’t move.
• Behavioral signs: Persistent, high-pitched crying, extreme fussiness, difficulty feeding or swallowing, or seizures and tremors.
• Developmental delays: As the child grows, they may experience delays in reaching motor milestones like sitting up, crawling, or walking.

Taking Action: From Diagnosis to Legal Recourse

If you suspect your child has suffered a birth injury, it is essential to act quickly. The first step is to get a formal diagnosis from a qualified medical professional, which will provide the necessary documentation to understand the extent of the injury and the required treatment. After seeking a diagnosis, you should meticulously document everything, including all medical appointments, diagnoses, prescriptions, and out-of-pocket expenses. This documentation is crucial for building a strong case. It is also important to take photographs of any visible injuries, such as bruising or swelling, as soon as you notice them. Finally, you should consult with a birth injury attorney who can review your medical records and the circumstances of the delivery to determine if there is a valid medical malpractice case and explain the legal process.

The Statute of Limitations: A Crucial Deadline

It is critically important to be aware of the statute of limitations. This is a state-specific law that sets a deadline for filing a lawsuit. If you do not file your claim within this time frame, you may lose your right to pursue compensation, regardless of the merits of your case. For this reason, contacting a birth injury attorney as soon as you suspect an injury is essential.

Conclusion

The improper use of forceps and vacuum extractors is a serious issue that can have devastating consequences for children and their families. While nothing can undo the harm caused by a preventable birth injury, understanding your rights and options is the first step toward securing the care and compensation your child deserves. By being informed and proactive, you can advocate for your child’s well-being and hold medical providers accountable for their actions.

The Powless Law Firm is an Indiana law firm that represents victims and families statewide in serious cases involving medical negligence, nursing home neglect, birth injury, personal injury, and wrongful death. If you have concerns about medical negligence, please contact us at (877) 769-5377. Together, we can make a difference.