Ensuring Newborn Safety: Modern Delivery Techniques and Risks

Safety of Newborns

(Forwarded from the Director's mailbox) Dear Director Yeh: Recently, I heard that many obstetricians are now using modern machines to suction the baby's head and pull it out, which is different from the traditional method where midwives pull the baby out by the arms after seeing the shoulders.
This new method of delivery seems to carry more risks compared to the traditional approach, as the neck of a newborn is quite fragile, and incorrect angles can easily lead to injury.
Therefore, if machines are to be used, it is essential to employ qualified and licensed midwives rather than general nurses for deliveries, to prevent harm.
I am not a professional and have not witnessed this firsthand; my concern arises from hearing about injuries to children due to insufficient experience among nurses, which could harm the nation's infants.
Director Yeh, with your great compassion, could you please have the relevant authorities investigate this matter? Wishing you good health and all the best.

Mr. Lu, 30~39 year old female. Ask Date: 2009/07/28

Dr. Huang Jianxun reply Obstetrics and Gynecology

Dear Mr.
Lu,
According to Article 25 of the Midwifery Personnel Act, the duties of midwives are as follows: 1.
Assisting in childbirth.
2.
Conducting prenatal examinations and providing health guidance.
3.
Conducting postpartum examinations and providing health guidance.
4.
Providing infant health guidance.
5.
Offering fertility guidance.
6.
Other items recognized by the central competent authority.
In principle, if complications arise during labor that require instruments or necessitate a cesarean section, the midwife should notify the collaborating obstetrician or refer the patient to a hospital for further management.
In many regions around the world, including advanced European countries, a well-established midwifery system for childbirth is still maintained.
Instrument-assisted delivery refers to the use of devices such as vacuum extractors or forceps to assist in delivering the baby when vaginal delivery is not progressing smoothly, such as when the fetal head is stuck in the birth canal.
Vacuum extraction was introduced by Mulstorm in 1956, while the use of forceps dates back to the 1600s.
There are risks associated with instrument-assisted delivery, including tearing of the birth canal, hematomas, or lacerations of the fetal scalp, among others.
Consequently, obstetricians are increasingly cautious when faced with the decision to use instruments for delivery, and this hesitation has directly contributed to the rise in cesarean sections.
Wishing you safety and health.
Sincerely,
Dr.
Huang Chien-Hsun
Director, Department of Obstetrics and Gynecology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2009/07/28

More Info

Ensuring the safety of newborns during delivery is a critical concern for both healthcare providers and parents. The evolution of delivery techniques has introduced various methods, including the use of vacuum extraction and forceps, which can be seen as modern alternatives to traditional delivery methods. While these techniques can be effective in certain situations, they also come with their own set of risks and considerations.

Modern Delivery Techniques
1. Vacuum Extraction: This method involves using a suction device to attach to the baby's head to assist in delivery. It is often employed when labor is not progressing adequately, or when the baby shows signs of distress. The vacuum can help guide the baby out of the birth canal while minimizing the need for more invasive procedures like cesarean sections.

2. Forceps Delivery: Forceps are metal instruments that resemble large spoons and are used to grasp the baby's head to help guide it out of the birth canal. This method requires a skilled practitioner, as improper use can lead to injuries to both the mother and the baby.

Risks and Considerations
While these modern techniques can be beneficial, they also carry risks, particularly if not performed by qualified professionals. Some potential risks include:
- Injury to the Baby: Improper use of vacuum extraction or forceps can lead to injuries such as cephalohematoma (bleeding between the skull and the periosteum), skull fractures, or nerve damage (such as Erb's palsy, which affects the arm). The baby's neck is particularly vulnerable, and incorrect angles or excessive force can exacerbate these risks.

- Maternal Complications: The use of these instruments can also lead to complications for the mother, including vaginal tears, pelvic floor injuries, or increased recovery time.

Importance of Qualified Personnel
Given the potential risks associated with these delivery methods, it is crucial that they are performed by qualified healthcare professionals. This includes obstetricians and certified midwives who have received specialized training in these techniques. The experience and skill of the practitioner can significantly influence the outcomes of the delivery.

Recommendations for Expecting Parents
1. Choose a Qualified Provider: When selecting a healthcare provider for delivery, ensure they have the necessary qualifications and experience in using modern delivery techniques safely.

2. Discuss Delivery Options: Have open discussions with your healthcare provider about the delivery methods they use, including the circumstances under which they would recommend vacuum extraction or forceps. Understanding the risks and benefits can help you make informed decisions.

3. Stay Informed: Educate yourself about the various delivery methods and their associated risks. This knowledge can empower you to advocate for your preferences during labor and delivery.

4. Prepare for Contingencies: While many deliveries go smoothly, complications can arise. Being mentally prepared for various scenarios can help alleviate anxiety.

Conclusion
In summary, modern delivery techniques such as vacuum extraction and forceps can be effective tools in assisting childbirth, but they come with inherent risks that must be carefully managed. Ensuring that these procedures are performed by qualified professionals is essential to minimizing risks to both the mother and the newborn. Open communication with healthcare providers and thorough preparation can help ensure a safer delivery experience. If you have concerns about specific practices or the qualifications of your healthcare provider, do not hesitate to seek a second opinion or consult with a specialist in obstetrics.

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