Vacuum and Forcep Assisted Birth (Nursing)

00:01 The next procedure is called a vacuum-assisted birth.

00:05 So during this procedure, a suction cup is actually placed over the vertex of the fetal head and it's used to guide the fetus out during second stage.

00:16 When do we use this? Sometimes the second stage and the labor in general have been so exhausting for the patient.

00:23 They just don't have any gas left.

00:26 And so we'll use the vacuum as a way to help give a little more amp to that pushing power.

00:32 Also, if we have a situation where the fetus is in distress, so again, how would we know that? we know it because we're watching the fetal monitor or we're listening to the doppler right after the contraction.

00:43 If we hear late or variable D cells over time, then we might need to get the baby out sooner, and a vacuum can help to shorten that second stage.

00:53 So what are the risks of a vacuum assisted birth? This is important because this is not the nod.

00:59 So think about the fact that we're putting a suction cup over the baby's head and we're pulling.

01:04 There can be lacerations that occur both on the fetal head, and also on the vaginal walls.

01:12 Skull fractures from the force of pulling, bruising, both on the scalp and also on the vaginal walls.

01:19 We could have an intracranial hemorrhage from the pressure of pulling.

01:23 Facial paralysis.

01:24 If there are any nerve innervations or involvement from something that we've done during the vacuum.

01:29 Or hearing damage.

01:31 And again, this is related to poorly placed vacuums.

01:35 So under normal circumstances, none of these things will happen.

01:38 But we do have to be aware that those risks are there.

01:42 What is the nurse need to do? The nurse is not going to perform the vacuum, but they do need to be prepared to gather the equipment that's needed.

01:49 So that might be what's called a Kiwi.

01:51 So a Kiwi is the most popular type of vacuum that's used.

01:55 So gathering that would be important.

01:58 The next thing is that during the procedure, the nurse is going to need to monitor the fetal heart rate to make sure there are no signs of further distress, and also to assess the fetus.

02:07 So all those things we talked about in terms of intracranial hemorrhage, or bruising, or scalp lacerations, then the nurse when they're doing their newborn exam is going to take extra note of that.

02:18 Another method for helping to deliver the baby during second stage is using forceps.

02:24 Now you might be thinking of forceps, like little tweezers, or maybe you're thinking of salad tongs, that's pretty close to what it is.

02:31 So instead of using the suction cup, we're going to use these metal tongs around the baby's head, or in the case of a breech around their hips to actually help guide them through the pelvis.

02:42 So thinking about maybe the increased risk of using something hard, like a metal tongs to pull the baby out, the significance of what's going on might begin to come into your mind.

02:54 So when do we use it? The indications are the same.

02:57 If we have a patient that's exhausted or we have fetal distress, then forceps will work.

03:01 They can also be used to help maintain the flexion for a baby that maybe has come out of position for delivery.

03:08 They can also be used to help facilitate breech delivery.

03:12 So, when the bottom is coming first.

03:16 So what are the risks? Of course, lacerations.

03:19 Big time.

03:20 If forceps are not placed well, if the person who is doing the forceps, which is not the nurse, so the providers doing the forceps if they are not placed well there absolutely can be damaged both to the fetal scalp, to the head, to the vaginal sidewalls.

03:35 Skull fractures, absolutely.

03:37 Intracranial hemorrhage, facial paralysis.

03:40 Remember, these are metal tongs, hearing damage as we involve the ear, and bruising, okay.

03:47 Big deal if these are not placed well.

03:50 So how does the nurse prepare for forcep birth? Now remember, the nurses not going to perform the forcep delivery at all that is not in our scope of practice, but we will gather the equipment.

04:03 There's several different types of forceps so making sure that you talk with the provider about what their preferences for the type of delivery they're doing is important.

04:11 We also want to monitor the fetal heart rate to make sure that right before the forceps that we've got a good heart rate.

04:17 So we know the baby's ready for this procedure.

04:19 Now we don't have to monitor afterwards because hopefully the baby's out and we can see them.

04:25 We want to assess the fetus after delivery.

04:27 So remember, those are metal tongs on a really soft head.

04:30 So the potential for the dangers and for the complications are high.

04:33 So really want to do a great assessment to make sure that all things are okay.

04:38 And then thinking about the potential for vaginal bleeding.

04:42 So the lacerations that could be caused by the forceps we want to double check and make sure that those lacerations are okay, or hopefully, there won't be any.