Vacuum Delivery Complications
Vacuum-assisted delivery (also called vacuum extraction) can be a safe way to help a baby through the birth canal when birth needs to happen more quickly. As with any assisted delivery method involving tools, it comes with benefits and risks for both the baby and the mother.
What Is a Vacuum-Assisted Delivery?
Vacuum-assisted deliveries use a soft or rigid suction cup attached to the baby's scalp and connected to a vacuum pump. During contractions, the provider gently pulls while the mother pushes to help guide the baby through the birth canal with more ease.
In order to safely use vacuum extractors, doctors must make sure to reduce the suction of the cup between contractions and only increase suction during the contractions. Once the baby's head is out of the birth canal, the suction should be stopped entirely and the vacuum removed from the baby's head.
Doctors will consider using a vacuum when:
- Labor is in the second stage (the mother is pushing) but progress has slowed down or stopped.
- There are signs of fetal distress and the baby needs to be delivered quickly.
- Pushing needs to be shortened for the mother's safety (due to exhaustion or certain heart or lung conditions).
How Common Is Vacuum-Assisted Delivery?
As of 2025, less than 4% of vaginal births are vacuum-assisted deliveries. They are much less common than they once were but are still important in some situations when used appropriately.
Are Vacuum-Assisted Deliveries Safe?
Most vacuum-assisted deliveries have risks to both the baby and mother that are avoidable. It's important to understand which complications are mild and to be expected, and which require urgent care.
Maternal and neonatal trauma after vacuum extraction occurs in about 13% of mothers and 9.6 per 1,000 live-born infants, mostly from minor injuries like tears or scalp bruising. Compared to forceps, vacuum deliveries cause less maternal trauma but have a higher risk of scalp and bleeding injuries for the baby.
What Complications Can Vacuum Deliveries Cause?
Both the mother and baby can face risks in vacuum-assisted deliveries. Some effects may be uncomfortable but are only temporary, while other complications may be longer lasting.
Risks to the Baby
Minor and temporary complications include:
- Scalp swelling and bruising: The area of the scalp where the suction cup was attached may cause a soft and squishy swelling. This usually resolves on its own and does not affect the brain in any way.
- Minor scalp cuts and abrasions: Small lacerations can occur if the suction cup slides or pinches the skin. These cuts are mostly minor but must be cleaned and monitored for infection.
- Cephalohematoma (localized blood collection under the scalp bone covering): This only occurs in about 1 in 10 babies when vacuum or forceps are used.
- Retinal hemorrhages (small eye bleeds): Tiny blood spots can appear in the whites of the eyes. They are usually harmless and clear up without affecting the baby's vision.
Less common but more serious complications include:
- Subgaleal hemorrhage (SGH): Bleeding in the space between the scalp and skull occurs in about 60 out of 10,000 births with vacuum extraction.
- Intracranial hemorrhage (bleeding inside of the skull): Traction on the scalp can, rarely, contribute to bleeding inside or around the baby's brain.
- Skull fractures: Linear fractures (which are thin) stabilize and heal on their own, but cases of severe scalp swelling or cephalohematoma must be evaluated by a pediatric team.
- Severe jaundice / hyperbilirubinemia: Large cephalohematomas or bruising increase the amount of blood the baby's body needs to break down. This raises bilirubin levels and increases the risk of jaundice. Phototherapy may be required to treat severe cases.
Risks to the Mother
Common maternal complications include:
- Perineal and vaginal tears: Vacuum-assisted vaginal births slightly increase the risk of perineal tears (tissue between the vagina and rectum), anal sphincter injury, and perineal pain.
- Vaginal or cervical lacerations: Traction from the cup may contribute to tears in the vaginal wall or cervix that require repair.
- Postpartum hemorrhage (PPH): Studies show higher rates of postpartum hemorrhage after assisted vaginal birth, especially when labor is prolonged.
- Pelvic floor dysfunction: Pelvic floor weakness, urinary or fecal incontinence/leakage, or pelvic organ prolapse may be slightly more likely after an operative vaginal delivery.
Beyond just the physical effects, many mothers also experience emotional distress, birth trauma, or anxiety after an unexpected vacuum delivery. Making sure to follow up with your provider, receiving mental health support, or having a birth debrief can help you and your family process what happened.
Can Vacuum Delivery Cause Brain Damage or Cerebral Palsy?
In some cases, yes. However, most babies born by vacuum delivery do not develop long-term problems, but serious complications involving intracranial bleeding, subgaleal hemorrhaging, or prolonged oxygen deprivation may increase risks of:
- Developmental delays or learning difficulties
- Motor impairments such as cerebral palsy or Erb's palsy if brain injury is severe
- Seizure disorders or epilepsy
Note: Oftentimes, long-term disabilities like cerebral palsy are more related to the reason why vacuum extraction was needed, such as fetal distress or hypoxia, rather than to the device itself.
Although vacuum-assisted deliveries tend to have less maternal trauma than forceps deliveries, the risks of complications are more likely than with a spontaneous vaginal birth.
When Should a Vacuum Delivery Not Be Used?
In order to keep the mother and baby safe, professional guidelines list several situations where vacuum extraction is not recommended or should only be used with extreme caution:
- Gestational age under 34 weeks. Premature infants have a higher risk of brain bleeds.
- Suspected fetal bleeding disorders or bone fragility, such as hemophilia or osteogenesis imperfecta.
- Face or breech presentation, or when the baby's position in the birth canal is unknown.
- If the cervix is not fully dilated or when the baby's head is still high in the pelvis.
- Previous failed vacuum or forceps attempt in the same labor. Using both instruments back-to-back increases the risk of injury.
What Parents Should Watch For After a Vacuum Delivery
Most babies born by vacuum extraction are healthy and go home without any major issues. Still, it's important for families to recognize any potential signs of pain or distress from their baby that may signal something went wrong.
Signs of Potential Infant Complications
Call your pediatrician or seek emergency care if you notice:
- A rapidly enlarging or boggy scalp swelling. This is usually most noticeable across the top of the baby's head, indicating possible subgaleal hemorrhage.
- Excessive sleepiness, poor feeding, or difficulty waking your baby.
- Repeated vomiting, seizures, or abnormal movements.
- Jaundice (yellowing of the skin or eyes) that seems to be getting worse.
- Very high-pitched crying, unusual irritability, or changes in muscle tone.
Parents should always trust their instincts. If something feels "off," the best thing to do is ask for a closer look by your pediatrician to make sure your baby stays healthy.
Signs of Potential Maternal Complications
While it is normal for some mothers to experience a bit of pain from a mild vaginal tear or episiotomy, persistent pain that does not get better over time should be looked into.
As a mother, contact your doctor immediately if you experience:
- Vaginal or perineal pain that gets worse
- Fevers that won't go away
- Excessive bleeding or hemorrhaging
- Lack of bowel movement control
- Signs of a possible infection
Sometimes signs of complications from vacuum-assisted deliveries don't show up until later (days, weeks, or even months) after giving birth. You should always let your doctor know as soon as possible if you suspect something might be wrong.
Can Vacuum Delivery Complications Be Considered Medical Negligence?
Yes, some cases can be, but not every complication from vacuum delivery is directly caused by negligence. Because childbirth is unpredictable, even appropriate care that followed safe guidelines can still have risks.
However, some actions may indicate a possibility of medical negligence, such as:
- Vacuum extraction was used despite clear signs to not use it (very premature baby or wrong or unknown delivery position).
- The provider exceeded the recommended attempts limit on pulls, duration, or number of pop-offs.
- There were delays in recognizing fetal distress or subgaleal hemorrhage after delivery.
Note: Vacuum extraction deliveries should never exceed more than 3 attempts at pulling and go on for more than 20 or 30 minutes. Repeated failed attempts increase the risks of injury to the baby and to the mother.
If you have concerns about how your child's delivery was handled, you should request a full explanation and review of the birth from your child's care team.
Also be sure to obtain and keep copies of all labor, delivery, and neonatal records. This is especially helpful if you seek legal guidance from a birth injury lawyer who can review what happened and help your family understand what legal options are available.
Vacuum Delivery Complications FAQs
Written and Medically Reviewed by:
Cerebral Palsy Hub Team
Cerebral Palsy Hub was founded to help support children and their families with cerebral palsy and to create a safe space for those affected. We strive to provide the most accurate, up-to-date information, and tools to help give your child the life they deserve.
Last Updated: December 23, 2025
