Understanding Vacuum Extraction Delivery: Steps, Risks, and Recovery

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What is vacuum extraction?

Vacuum extraction is an assisted delivery method used during the pushing stage of labor when progress stalls: a provider places a soft suction cup on the baby's head and gently pulls during contractions. [1] It is used for prolonged pushing, abnormal fetal heart rate or maternal exhaustion. [1] Most side effects for the baby are temporary, and serious complications are rare. [1]

What the research says

• Minor newborn problems are more common after vacuum delivery; major ones are uncommon. In a case-control study of 1,802 vacuum deliveries compared with 1,802 spontaneous and 909 forceps deliveries, vacuum was linked to a higher risk of cephalohematoma (adjusted OR 5.5), jaundice (aOR 4.4), and soft-tissue trauma (aOR 2.4), and to more neonatal intensive care admissions (OR 1.9); major complications were uncommon with no significant differences, and 2 deaths occurred in the vacuum group (1.1 per 1,000) (Ferraz et al., Anales de Pediatría, 2019) [3].

• How the vacuum is used matters. Among 596 vacuum deliveries in Sweden, 10% of infants had at least one complication: cephalohematoma 5.2%, subgaleal hematoma 1.5%, severe complications 4.0%, and brachial plexus injury 1.3%; extraction lasting over 15 minutes, with more than 6 pulls, or more than one cup detachment was associated with higher risk (OR 4.07 for severe complications) (Ekéus et al., Journal of Maternal-Fetal & Neonatal Medicine, 2018) [4].

• Infection prevention matters for the mother. Vacuum and forceps deliveries are reported to raise the risk of postpartum infection; in two trials of 3,813 women, a prophylactic antibiotic reduced superficial perineal wound infection (RR 0.53), deep perineal wound infection (RR 0.46), and serious infectious complications (RR 0.44), with most evidence coming from one multicenter study in a high-income setting (Liabsuetrakul et al., Cochrane Database of Systematic Reviews, 2020) [5].

When to Call Your Care Team

Tell your obstetric team promptly if you have heavy bleeding, fever, worsening pain, or trouble urinating after delivery. For your baby, call the pediatrician if jaundice is increasing, your baby is unusually sleepy or feeds poorly, or scalp swelling does not improve.

Seek urgent medical attention if your baby’s scalp swelling keeps growing or your baby looks pale. A subgaleal hemorrhage can appear anywhere from about an hour to 72 hours after birth and can be life-threatening, so do not wait. [1]

Overview of Assisted Delivery

Sometimes pushing doesn’t bring the baby out, and this can last for hours without much progress. Your care team monitors your vital signs and your baby’s heart rate for signs of fetal distress. If your health or your baby’s is in danger, or labor isn’t progressing, they may look at other ways to deliver. Assisted vaginal delivery, which includes vacuum extraction and forceps, can help avoid a C-section when certain conditions are met.

The vacuum extractor consists of a suction cup attached to a pump. The cup is applied to the baby’s head and provides traction while you push. [1] In the United States, vacuum extraction accounts for about 3% of vaginal births. [1]

When Is Vacuum Extraction Used?

What Can Be Tried First?

Before using a vacuum, your team may try helping you change positions, giving you oxygen through a mask, or giving you fluids through an IV. [1] If these steps don’t help, they may recommend vacuum extraction or forceps delivery.

When Vacuum Extraction Isn’t the Right Choice

Even when you need help, a vacuum isn’t appropriate if your baby is premature, is breech, hasn’t moved down low enough in the birth canal, might be too big to fit through the birth canal, or has a bleeding disorder. [1]

How the Procedure Works

Your provider will explain the risks and benefits and ask for your consent before starting. [1] If needed, you’ll receive pain relief, and your provider may sometimes cut the area between the vagina and anus (an episiotomy) or break your water. [1]

1. Preparation: Consent, pain relief, and a check that the criteria for using a vacuum are met.

2. Cup placement: The provider places the suction cup on the baby’s head. [1]

3. Active traction: When your next contraction starts, the provider gently pulls while you push. [1]

4. Completion: Once the head is out, the cup is removed and the provider guides the rest of the baby’s body out by hand. [1]

5. Afterward: Your team checks you and your baby for signs of wounding, repairs any tear or episiotomy, and keeps monitoring your baby for complications.

When the Attempt Is Stopped

The vacuum is abandoned if the attempt is unsuccessful, if the cup has unintentionally detached from the baby’s head three times, or if there is any sign of trauma to the baby’s scalp. [1] If vacuum extraction doesn’t work, your team may recommend a C-section. [1]

Understanding the Risks

For the Mother

Risks to the mother are similar to the risks of childbirth in general: vaginal tears, postpartum bleeding, and difficulty urinating or incontinence. [1]

For the Baby

• Caput succedaneum: Scalp swelling into a cone-like shape that improves in a few days. [1]

• Bruising and jaundice: Scalp bruising increases the risk of jaundice, a temporary yellowing of the skin that usually goes away in a few weeks. [1]

• Cephalohematoma: A collection of blood between the scalp and skull caused by damaged blood vessels. It doesn’t affect the brain and typically heals in one or two weeks. [1]

Serious complications are rare. [1] They include skull fracture (most are small and heal on their own, though severe ones can cause brain bleeding), intracranial hemorrhage (bleeding in or around the brain), and subgaleal hemorrhage, in which emissary veins rupture and blood collects between the skull and scalp, which can appear within an hour to 72 hours after delivery and can be life-threatening.

Recovery and Outlook

If there are no complications, you’ll recover in about six weeks, the typical recovery time for a vaginal delivery. [1] Your baby’s common short-term effects, such as bruising, jaundice, or scalp swelling, will improve over the next few weeks. [1] Take extra care to protect your baby’s head while it heals, and bring your baby to follow-up checkups with the pediatrician. [1]

Conclusion

Vacuum extraction is a useful tool in modern obstetrics. It can resolve a stalled second stage of labor without surgery, and it is used under defined conditions with clear stopping rules. Understanding when it is used and what to expect can help parents feel more prepared if labor takes an unexpected turn.

Open communication with your obstetric team is the best way to navigate these decisions in the moment. Discussing assisted delivery in advance helps you understand the risks and benefits and make a plan.

Your next step: If you are approaching your due date, ask your obstetrician how they approach assisted delivery and what they would do if you needed help during pushing. Include your preferences for pain management and communication in your birth plan, and prioritize the guidance of your delivery team.

Related reading: Forceps Delivery | The Three Stages of Labor | Subgaleal Hemorrhage in Newborns | Understanding Lochia

Sources: Cleveland Clinic — Vacuum Extraction Delivery | Jeon & Na, 2017 | Ferraz et al., 2019 | Ekéus et al., 2018 | Liabsuetrakul et al., 2020

Frequently Asked Questions

1. What is vacuum extraction?

Vacuum extraction is an assisted delivery method in which a suction cup placed on the baby’s head, attached to a pump, provides traction during contractions while the mother pushes.

2. Is vacuum extraction painful?

Your provider will give pain relief if needed, such as an epidural, and may sometimes perform an episiotomy to make more space.

3. When is vacuum extraction used?

When you have been pushing for a long time without progress, your baby’s heart rate is outside the normal range (110 to 160 beats per minute), or you are too tired or have a health problem that keeps you from pushing.

4. What do providers try before using a vacuum?

Providers may help you change positions, give you oxygen through a mask, or give you fluids through an IV.

5. How long does the procedure take?

Traction is applied only during contractions while you push, and the cup is removed as soon as the baby’s head is out. The pulling usually spans just a few contractions, and attempts that are not progressing are stopped.

6. When is vacuum extraction not appropriate?

If the baby is premature, is breech, hasn’t moved down low enough in the birth canal, might be too big to fit through, or has a bleeding disorder.

7. What happens if the vacuum doesn’t work?

Providers stop if the attempt is unsuccessful, the cup detaches from the baby’s head three times, or there is any sign of trauma to the scalp. The team may then recommend a C-section.

8. Can vacuum extraction cause brain damage?

Serious complications such as skull fracture, bleeding in or around the brain, or subgaleal hemorrhage are rare, and in a Swedish study of 596 vacuum deliveries severe complications occurred in 4.0% of babies.

9. What is the cone-head shape after delivery?

The cone-head shape is caput succedaneum, a swelling of the scalp into a cone-like shape that gets better in a few days.

10. Does vacuum extraction cause jaundice?

Bruising of the scalp raises the baby’s risk of jaundice, a temporary yellowing of the skin that usually goes away in a few weeks. Your baby’s care team will monitor and treat it if needed.

11. How many times can the cup detach?

Providers stop the attempt if the cup has unintentionally detached from the baby’s head three times.

12. Is an episiotomy always required?

No, but your provider may sometimes cut the area between the vagina and anus to make room for the delivery.

13. Can I still push during the procedure?

Yes. When your next contraction starts, your provider gently pulls while you push, and the suction adds extra help.

14. How common is vacuum extraction?

In the United States, it accounts for about 3% of vaginal births.

15. How do I care for my baby’s head afterward?

Take extra care to protect the area while it heals, and bring your baby to follow-up checkups with the pediatrician.

16. When should I call the pediatrician?

Call if jaundice is increasing, your baby is unusually sleepy or feeds poorly, or scalp swelling does not improve. Seek urgent care if the swelling keeps growing or your baby looks pale.

References

1. Cleveland Clinic. Vacuum extraction delivery. Cleveland Clinic. April 29, 2025. https://my.clevelandclinic.org/health/treatments/22305-vacuum-extraction-delivery

2. Jeon J, Na S. Vacuum extraction vaginal delivery: current trend and safety. Obstet Gynecol Sci. 2017;60(6):499-505. PMID 29184857. https://doi.org/10.5468/ogs.2017.60.6.499

3. Ferraz A, Nunes F, Resende C, et al. Short-term neonatal outcomes of vacuum-assisted delivery: a case-control study. An Pediatr (Engl Ed). 2019;91(6):378-385. PMID 30981643. https://doi.org/10.1016/j.anpedi.2018.11.016

4. Ekéus C, Wrangsell K, Penttinen S, Åberg K. Neonatal complications among 596 infants delivered by vacuum extraction (in relation to characteristics of the extraction). J Matern Fetal Neonatal Med. 2018;31(18):2402-2408. PMID 28629251. https://doi.org/10.1080/14767058.2017.1344631

5. Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Antibiotic prophylaxis for operative vaginal delivery. Cochrane Database Syst Rev. 2020;3(3):CD004455. PMID 32215906. https://doi.org/10.1002/14651858.CD004455.pub5

Medical disclaimer

This article is for education only and is not a substitute for professional medical advice, diagnosis, or treatment. Heavy bleeding, fever, or worsening pain after delivery, and increasing scalp swelling, paleness, unusual sleepiness, or poor feeding in a newborn, warrant prompt medical attention. Always consult a qualified healthcare professional about your individual health situation.