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Vaginal Vacuum
Delivery:
Good Use of Your Non-Pulling Hand
During your vaginal
vacuum deliveries, how do you utilize your non-pulling hand?
The following recommendations have been compiled from the seminar “Reducing
the Risks of Vacuum Delivery” presented by Aldo Vacca M.D., and from his
publications on the subject1,2.
The thumb of the non-pulling hand is placed
on the center of the OmniCup to help prevent detachment (pop off) of the cup
as you pull on the vacuum device.
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The forefinger of the same hand should be placed
upon the fetal scalp away from the thickness of the caput if possible so
as to feel bone under the scalp. In this way the user is able to
monitor descent of the head and at the same time can tell that the woman
is pushing effectively. She may tell you she is pushing, but
due to epidural effects or exhaustion, you need to realize how effective
or ineffective her pushes have become.
When the thumb and forefinger are in proper
position on the cup and fetal scalp, the non-pulling hand can assist in
gaining axis traction by gently pushing the head backwards toward the
sacrum slightly. "The extent to which axis traction is possible will depend on how
far the perineum will stretch in that direction.”1
However, it is rarely, if ever, necessary to perform episiotomy to
“straighten out” the lower birth canal.
“With descent and correction of
deflexion and asynclitism, the cup becomes visible within the vagina. The
operator must resist the tendency to change direction of traction too soon
because the long axis of the fetal head pivots around its midpoint and
requires that traction should be directed slightly downwards or
horizontally until the midpoint has emerged from under the pubic arch1.
The thumb and forefinger of the non-pulling hand can thus assist in
maintaining this proper axis traction.
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The thumb, placed on the center of the cup, will also allow for control of
the traction force that is transmitted to the fetal scalp. The thumb of
the non-pulling hand, by counter pressure will reduce the amount of
traction from the pulling hand and thus modulate the total force acting on
the scalp. In addition, users of the Kiwi OmniCup with Traction Force
Indicator can determine exactly how much force is applied with each pull2.
Many clinicians have commented that the numeric value system of the
Traction Indicator serves as a useful guide to help prevent excess
traction on the scalp. Thus the non-pulling thumb can aid in keeping
higher levels of traction in check at the cup-scalp site.
Thumb placement on the center of the cup will
also control descent of the fetal head. Occasionally, |
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References:
1 Handbook of Vacuum Extraction in
Obstetric Practice, Aldo Vacca M.D. pg. 26-27
2 Vacca A. Operative vaginal delivery: clinical appraisal of a new
vacuum extraction device. Australian and New Zealand Journal of
Obstetrics and Gynaecology 2001;42:156-160.
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unexpected rapid descent can occur once the head is properly flexed. Sometimes the
mother’s expulsive forces may be underestimated. Keeping the thumb
on the cup can prevent tears of the perineal tissue as well by controlling
the head descent.
Simple feeling of the cranial scalp with the
forefinger is also helpful in determining proper vacuum cup attachment. A
large caput may reduce the grip of the cup on the scalp but it is not
always possible to avoid placing the cup over the caput. If there is a
slight hissing sound related to a vacuum leak, the forefinger and thumb
can adjust the counter pressure on the cup to prevent complete detachment
when it becomes necessary to rapidly reapply more vacuum to prevent such a leak and
"pop-off."
Dr. Vacca is a practicing
obstetrician who has published widely on the subject and is recognized
internationally. He has a major interest in coaching physicians on
the correct technique of vacuum assisted delivery and its positive
outcomes. Dr Vacca is co-designer of the Kiwi OmniCup that incorporates
Bird’s posterior cup principle (i.e. the body of the cup and the suction
‘stem’ are in the same plane) which, together with its low profile,
enables the user to position the cup correctly over the “flexion
point” safely in virtually any fetal position2.
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This Month's Winners
**Please respond to this email with your correct
mailing address to send the prize.
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| Susan Dorenbusch, Columbus, IN |
| Patrick Ramsey, Birmingham, AL |
| Cesarea Belden-Johnson, Flint, MI |
Handbook of Vacuum Extraction in Obstetric
Practice. By Aldo Vacca |
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