Hi Nikki et al,
  Thanks for the FDA reference. It confirms what I've always felt about 
VE, the necessity to perform a risk benefit analysis before applying a 
vacuum. It does seem that the logical response to a stalled second stage 
due to an epidural, is to let the mother rest and let the epidural wear 
off, not to jump to an assisted delivery, though OB's don't always use 
logical thinking.
  I guess what I was kind of getting at, is that women and babies have 
death and near death experiences in labor every day, particularly in the 
third world. And that often in L&D the near death experiences I saw were 
caused by precisely the kind of thing that a VE might be used to assist 
with. If vacuums were used only when absolutely indicated, to deliver a 
baby who must be delivered, not just because an OB is feeling impatient, 
then the statistics on bad outcomes related to VE could be greatly 
reduced. I think if we have bad decisions being made we should blame the 
doctors, but not necessarily the equipment. If reserved for cases of 
significant fetal distress, or some other serious medical indication, the 
possibility of a vacuum extraction seems a comfort rather than a threat. 
It always seemed to me that the best OB's were the ones who could sit on 
their hands and let nature take it's course, until that moment if and when 
they were needed, at which point they could dive in with the necessary 
intervention. A rare breed.
  I don't for a minute doubt that a vacuum extraction could leave a baby 
with a sore head or worse, which could certainly interfere with 
breastfeeding, leaving a baby languishing in the birth canal who needs to 
be born, seems like a worse alternative. Birth has always been accompanied 
by the possibility of death, for mother or infant, but I feel that 
advances in modern medicine have made birth infinitely safer not more 
dangerous. I feel so lucky to live in a place where there are so few near 
death experiences, in birth and life, compared to places like Somalia or 
Afghanistan or 19th century America.
  Okay guys, you can really let me have it now. I'm running for cover...
Kathy Lilleskov RN IBCLC

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