This is a useful diagram showing the differences between caput succedaneum,
cephalhematoma, subgaleal hematoma and epidural hematoma. Subdural hematoma
and intraventricular hemorrhage are not shown. 
The entry states that instrumental delivery and prolonged second stage labor
are the most common causes of cephalhematoma but I'm here to tell you that
in my institution they are much more commonly seen with precipitious,
spontaneous birth, in which the fetal skull does not have time to gradually
mold to the mother's pelvis, as birth occurs two or three contractions after
full cervical dilation even when the vertex is only at the pelvic inlet when
second stage begins.  We see births like this many times each week.  

http://en.wikipedia.org/wiki/Cephalhematoma

I don't want anyone to think that cephalhematoma in itself is generally
dangerous, even if it looks dramatic and weird.  It's the unseen trauma from
instrumental or assisted birth that is likely more of a challenge to
establishing breastfeeding, traction on the neck being prime amongst them. 
Of course it matters how babies are born!  I just want concern to be
directed where it is due.

In the FDA advisory from 1998 describing cases where babies had died of
trauma from vacuum extraction, it is noteworthy that cephalhematoma was not
mentioned at all, not anywhere in the advisory, while caput succedaneum is
named as a universal, non-dangerous finding following VE. The potentially
dangerous complications listed were subgaleal or subaponeurotic hematoma,
and subdural, subarachnoid, intraventricular, and/or intraparenchymal
hemorrhage.  These manifest very differently from cephalhematoma. 
http://www.fda.gov/cdrh/fetal598.html 

I'm not trying to downplay the risks of vacuum extraction, only
differentiate between the extraordinarily rare lethal neonatal
complications, and cephalhematoma.  The FDA notes that while at least 220
000 babies in the US were born with the help of VE in 1995, they had reports
of about five incidents yearly involving death or serious injury. The
advisory reminds clinicians to follow the indications and instructions for
use of VE devices, and reminds institutions to ensure that clinicians know
how to use them correctly (!).  It also emphasizes that all staff caring for
infants should be aware of the mode of birth, and both staff and parents
should know the early signs of complications.

Rachel Myr
Kristiansand, Norway

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