Researchers are calling for a reassessment to the safety practises of using forceps or vacuum deliveries in Canada, citing a new study that suggests rates of trauma among mothers and babies who need the interventions are higher than previously reported, and higher than some other countries.
The study, published Monday in the Canadian Medical Association Journal, says one-in-four deliveries that require forceps and 13.2 per cent of those using a vacuum resulted in physical trauma to the mother, while just under one per cent of babies delivered with either intervention experienced trauma.
Maternal trauma included severe perineal tears, impaired sexual health, urinary or fecal incontinence, and other pelvic disorders while severe neonatal trauma could include long-term nerve damage and brain injury.
Giulia Muraca, a perinatal epidemiologist at McMaster University who helped lead the study, says pregnant people need to be made more aware of the risks of forceps and vacuum deliveries.
The techniques, which fall under the term operative vaginal delivery (OVD), may be used during the second stage of labour if labour is stalled, if there is a risk to the fetus, or to avoid pushing in people with certain health conditions. The other option is typically a surgical Caesarean section.
Forceps and vacuum deliveries have accounted for about 10 to 15 per cent of all deliveries in Canada, Australia and the United Kingdom in recent years, a figure Muraca says has been dropping over the past two decades. The U.S., which relies more on C-sections, uses OVD in about five per cent of its deliveries.
Muraca says use of OVD is based on guidelines that recommend they be performed by trained health-care professionals. But with the interventions being used less frequently now, Muraca says there are fewer opportunities for clinicians to get that training.
The study analyzed more than 1.3 million term deliveries in Canada, excluding Quebec, from April 2013 to March 2019. Of those, 38,500 were attempted deliveries using forceps while 110,987 were attempted vacuum deliveries.
Muraca says rates of trauma may be higher in Canada than some other countries because of differences in reporting. But it could also be impacted by Canada's lower rate of episiotomy — cutting through the area between the vagina and anus — during forceps or vacuum deliveries.
She says previous studies have shown that some trauma can be prevented when episiotomies are used in conjunction with forceps deliveries.
Muraca says Canadian clinicians should start "meaningfully interrogating" why rates of trauma are so high among forceps and vacuum deliveries and reassess safety guidelines around them.
The study says OVD may be associated with low rates of morbidity "in carefully selected circumstances," but the high rates of trauma suggest those "ideal conditions do not apply to obstetric practice in Canada."
This report by The Canadian Press was first published Jan. 10, 2021.
Melissa Couto Zuber, The Canadian Press