To my knowledge there are at least three instruments in use for vacuum
extractions.  There are steel cups, developed in Sweden, which can in theory
be used to facilitate both rotation and descent, and there are silicone
cups, from Japan, which are analogous to Simpson's forceps for so-called
lift-out deliveries, and there are also something called Kiwi cups, perhaps
from NZ?  They are disposable and can be used in the same situations in
which a silicone cup is used.  Both the silicone and the Kiwi cups seem to
cause very little trauma, but the old Malmstrom cups were much more
traumatic, with frequent seeping scalp wounds where they were applied, even
if only being used to get the head over the perineum.  They also caused more
marked deformation of the scalp and forming of the skull.

Whenever I am caring for a baby after an operative birth, I feel a need to
know what instruments and what maneuvers were used to effect delivery,
regardless of whether there are feeding problems or the baby is showing
signs of aftereffects.  My personal bias is that the separation of mother
and baby immediately following most operative births is probably just as big
a problem as whatever mechanical effects there are on the baby.  There are
more maternal complications such as serious tears or hemorrhage so mother is
moved elsewhere for more intensive care, and VE's are frequently performed
due to a perceived need to get the baby out quickly, so the baby may be
separated from mother for observation even though we all know that these
observations could in nearly all cases be done with baby skin to skin with
mother so breastfeeding is supported.

My other bias is that I think if the baby can be born with the aid of a
silicone or Kiwi cup, it's better than CS in late second stage.  But that
holds only if there are birth attendants who know how to use the VE
equipment.  The less you need to do, the better, in labor as in
breastfeeding.

Rachel Myr
Kristiansand, Norway

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