Vacuums, Forceps and Birth: What Every Parent Should Know About Assisted Deliveries

Curious about assisted deliveries? In this episode of The Pulling Curls Podcast, Hilary Erickson, The Pregnancy Nurse®, sits down with Dr. Tori O’Daniel, a board-certified OB GYN, to demystify vacuum and forceps deliveries. They explain when and why these tools might be used, how they work, the differences between them, and what you can expect if your delivery needs a little extra help. They also bust some common myths and share real-life experiences (including Hilary’s own forceps story), plus get honest about risks, benefits, and postpartum recovery tips. Whether you’re prepping for birth or just want to be informed, this episode has all you need to feel more confident about your options.

Find it here on Apple or Spotify Podcasts

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Big thanks to our sponsor Laborie, makes of the Kiwi® Complete Vacuum Delivery System: https://www.laborie.com/product/kiwi/

Today’s guest is DDr. Tori O’Daniel. She is a Board-Certified OB/GYN whom has been practicing for 14 years. For the past 11 years she has been an OB/GYN Hospitalist in OKC, Oklahoma. Dr. O’Daniel is the Medical Director for the OB Hospitalist and women’s services. She also is the Medical Director for Women’s Health Services at Mercy Hospital. She instructs educational classes and facilitates the OB Emergency Simulations for the nurses and physicians within her department. As an Adjunct Faculty at Oklahoma State University, she is the Director of the Medical Student Clinical rotations at her institution.

She has been actively involved in the Society of OB/GYN Hospitalists (SOGH) for the past several years. She co-chaired the Simulation committee in 2020 & 2021 and Co-Chaired the ACM 2022 & 2023. She currently serves on the Board of Directors.

Dr. O’Daniel is passionate about education and advocating for women’s safety in health care. Thus, she actively teaches across the country about vacuum assisted deliveries, treating post partum hemorrhage and other OBGYN Emergencies.

Links for you:

Previous episode sponsored by Laborie (#246) about plus size moms in labor: https://www.pullingcurls.com/246-plus-size/

Timestamps:

00:00 Assisted Delivery and Labor Mechanics

03:22 Assisted Vaginal Delivery Options

06:26 Decline of Forceps in Deliveries

10:38 Vacuum-Assisted Delivery Explained

13:54 Vacuum Procedure Timing Guidelines

16:10 Assessing Delivery Options and Pelvic Adequacy

19:26 Challenges in C-section Deliveries

23:15 Forcep Use in Obstetrics

25:50 “Consent Challenges in Childbirth Decisions”

31:43 Forceps vs. Vacuum Delivery Risks

33:16 Birthing Risks: Maternal and Fetal

37:24 Considerations for Assisted Vaginal Delivery

39:56 Navigating Birth Plan Conversations

44:07 Normalize Asking for Help

46:57 Flexible Tubing Revolutionizes Vacuum Use

49:15 Flexible Neck Vacuum for Childbirth

Keypoints:

• Assisted deliveries involve using tools like vacuums or forceps to help a baby out during vaginal birth, usually when there’s exhaustion, fetal distress, or a tricky position.
• The difference between forceps (which look like fancy salad tongs) and vacuum devices (like the KiwiVac) was explained—with forceps generally having a higher risk for maternal tearing, while vacuums can be safer for the mother but have their own set of risks for baby.
• Forceps use is becoming rare in the US, and many younger doctors are not trained in both tools; most providers specialize in one over the other.
• The vacuum method, such as the KiwiVac, doesn’t just involve pulling—the device helps rotate and flex the baby’s head to ease passage through the pelvis, working in tandem with the mother’s pushing effort.
• Not every provider can use both vacuums and forceps, and midwives in the US generally use vacuums regionally; outside the US, like in Europe, midwives may use vacuums more routinely.
• Assisted deliveries make up less than 5% of births, so most people will not need them, but knowing about the process can reduce fear if the situation arises.
• Before offering assisted delivery, doctors must ensure the baby is low enough, the mother’s pelvis is adequate, and water is broken—these tools can’t compensate for a truly “stuck” baby or incomplete dilation.
• Vacuums and sometimes forceps can even be used during C-sections if the baby is deeply engaged or in an awkward position, to help bring the baby up through the uterine incision.
• Consent and clear communication are vital—sometimes decisions have to be made quickly, so it helps when patients have discussed these possibilities in advance with their providers.
• The episode emphasized not to fear assisted deliveries—they’re tools to reduce C-sections and make births safer when used by skilled, well-trained professionals, and advances like the KiwiVac improve outcomes for both moms and babies.

Producer: Drew Erickson

[00:00:00] Hilary Erickson | The Pregnancy Nurse®: Hey guys. Welcome back to the Pulling Curls Podcast. Today on episode 260, we are talking about assisted deliveries. We’re gonna talk about what those are. We’ve got a doctor coming on, so let’s untangle it.

[00:00:08] Hi, I’m Hilary, a Serial over Complicator. I’m also a nurse mom to three and the curly head behind pulling curls and the pregnancy nurse. This podcast aims to help us stop overcomplicating things and remember how much easier it is to keep things simple. Let’s smooth out those snarls with pregnancy and parenting untangled the Pulling Curls podcast.​

[00:00:44] I wanna introduce today’s guest. She, this is actually her second time on the podcast. She is a board certified OBGYN for 14, maybe 15 now years in Oklahoma. She’s passionate about education and she actually teaches other doctors how to use the vacuum. I wanna introduce today’s guest, Dr. Tori O’Daniel.

[00:01:02] Hey Tori, welcome back to the Pulling Curls podcast.

[00:01:04] Dr Tori O’Daniel MD: Thank you. I’m excited.

[00:01:06] Hilary Erickson | The Pregnancy Nurse®: Yeah, guys, this is a thing I get a lot. People don’t really understand like how assisted deliveries work. And so I’m excited to have a real doctor here today because the nurses do not, we, we just hand things. We just hand things to the provider and then they do all the work.

[00:01:21] So I think this is gonna be really helpful you for you guys to understand them. Tori actually works for Laborie and this podcast is actually sponsored by Laborie. And the Kiwi complete vacuum system delivery. It is used globally. In fact, I’ve used it myself, well as the nurse, and it’s designed to give control back to the physician. Whatever your preference or needs are, the Kiwi family of products offers a vacuum to meet them. And I would agree. I was a nurse when Kiwi started, like being a thing. Like I remember, before, when I used to pump up the vacuum, I wasn’t a fan of that part. So it is so nice that we are advancing technology. ’cause I gotta say, as a labor and delivery nurse, there’s a lot of things that are exactly the same as when Hilary started day one in 2001.

[00:02:01] Dr Tori O’Daniel MD: Absolutely. I could not agree more with that. So it’s always fun to see an evolution of product that is providing better healthcare for our patients. So I couldn’t agree more, and I was right at the beginning of my training when I saw somebody, pump the vacuum from behind me and that, that was a bit much for me. So I’m glad that we switched over.

[00:02:16] Hilary Erickson | The Pregnancy Nurse®: Yes. So first off, we’ll talk more about like how these different vacuum systems work, but what is an assisted delivery? A lot of people are like, well, aren’t we like everyone? Unless you’re free birthing at home, which I’m not a fan of. If you’re a free birther, this isn’t the podcast for you.

[00:02:30] Dr Tori O’Daniel MD: Yeah.

[00:02:30] Hilary Erickson | The Pregnancy Nurse®: An assisted delivery means that we’re helping you through what, Tori?

[00:02:33] Dr Tori O’Daniel MD: Yeah, so I mean, you could look at this a couple of different ways. Honestly, an assisted delivery is trying to get this baby to do what we would love it to do naturally. And the baby is, um, known to go through what we call the cardinal movements of labor, which essentially tries to get the baby to flex or put its head straight down and to get in this position, which we call oa.

[00:02:54] So the back of the head is facing the mom’s interior body and trying to get the smallest diameter to come the pelvis. The thing about that is that some babies are stubborn and they don’t want to do that. And patients have all different shapes and sizes of pelvic boney structure and so sometimes we don’t have the best position of the baby.

[00:03:12] So assisted can be a lot of different options. We move patients around to try to get this baby to do what it needs to do. As obstetricians or midwives, we can put our hand inside and try to get the baby to maneuver or rotate, as we like to call it, or we have two options for an assisted vaginal delivery with either a vacuum system or Forceps. And really the concept with those two things is that you’re trying to get this baby to rotate, to get the smallest diameter to come through the pelvis while the patient is pushing, and then you provide traction with either forceps or with a vacuum to be able to assist in that rotation and pull while they push.

[00:03:51] Hilary Erickson | The Pregnancy Nurse®: Okay. First off, can a midwife use vacuums or forceps most across the board in general?

[00:03:56] Dr Tori O’Daniel MD: So I would say that really depends on the region. In Europe, midwives are routinely using vacuums. I don’t know about

[00:04:03] Hilary Erickson | The Pregnancy Nurse®: Oh.

[00:04:03] Dr Tori O’Daniel MD: forceps but I know they are routinely using vacuums. and as long as they’re well-trained, really we’re encouraging any provider to be able to use, a vacuum assisted vaginal delivery option in the United States.

[00:04:14] That is also very, very regional, but there are. Much fewer regions that are allowing midwives to do a vacuum assisted vaginal delivery. Some of the areas that we previously talked on our, other podcast about, deserts where you don’t have access to obstetricians, the midwives are trained in, kinda outlet vacuum deliveries to be able to have options to provide safe care for their patients.

[00:04:36] Hilary Erickson | The Pregnancy Nurse®: Yeah. and also family practice, like some of our family practice doctors when I worked with them, were able to use vacuums or forceps or sometimes they had to call in an OB to come do those things. Just so you guys know, sometimes that’s an advanced level of care that they’re just not trained to do. So I think that’s important to know. Midwives always have like an upgrade of care. The uncertified nurse midwife always has an OB that they can call in to come back them up for that type of a delivery.

[00:04:58] Dr Tori O’Daniel MD: Yep, exactly.

[00:04:59] Hilary Erickson | The Pregnancy Nurse®: Okay. What would you call the difference between like, okay, so forceps look like salad tongs. If you’re listening just with your ears.

[00:05:06] If you’re not listening with your ears or you’re listening with your eyeballs, then I will put, a picture of what forceps look like, but they basically look like very fancy, very expensive. I’m sure. Salad tongs.

[00:05:16] Dr Tori O’Daniel MD: Yes,

[00:05:17] Hilary Erickson | The Pregnancy Nurse®: Yeah.

[00:05:17] Dr Tori O’Daniel MD: And there are a lot of different shapes and sizes of forceps because depending on what your patient is presenting to you with, you want different sizes, and so there are some, that are smaller for, smaller infants. There’s also some that are a little bit more elongated for those heads that have had a lot of molding for an unmolded head that kind of came down quickly, but still needing some assistance. we would have one that’s a little bit, more rounded. So the obstetrician, midwife and or, a family practice doc that if they’re trained to know how to do this, and again, midwives are typically trained in vacuum over forcep, but you would know which one that you would prefer. There’s actually also, forceps for a breach delivery if in fact you are, Trained to do breach delivery with something called Piper Forceps. And they’re shaped differently ’cause the baby’s coming out, in a totally different direction. And so the, the those little salad tongs that you described have to go on the head in a different way, in a safe method.

[00:06:07] Hilary Erickson | The Pregnancy Nurse®: Yeah. and are most doctors trained in both? Like, I’ve probably seen two doctors in my life that were good with vacuum and forceps. I feel like either they do one or the other. What do you think?

[00:06:17] Dr Tori O’Daniel MD: Yeah, so if you look statistically what’s happening with assisted vaginal delivery across the United States, they’re both less than 5% and about three and a half to 4% vacuum assisted vaginal deliveries. And then forceps, unfortunately, are almost extinct. It’s like in some in some places, not at all, and in others 0.5 to 1%. And that’s unfortunate because if you’re not getting trained in both options, then you have less opportunity to provide people who could be appropriate candidates for assisted vaginal delivery. So back to your original question. No, unfortunately, I find that it’s very rare that people are trained in both.

[00:06:53] I was really fortunate to have, attendings in my residency that knew how to do forceps and some that did vacuum, and so I just hounded my, my attendings that knew how to do forceps and I was taught how to do both. So I, I do both and I think that it actually taught me so much more about why assisted vaginal deliveries work and how they physiologically rotate the baby and what kind of additional force that you need to be able to provide that traction. and it’s important to know both skillset. There’s a huge misnomer that forceps have kind of gone out of practice ’cause they’re so much more difficult to learn. And I, I really couldn’t think that that’s farther from the truth. You have to know how to use them both well. To use either of those devices, but no, most people are either trained in forceps and think the vacuum is not something they want to do, or they’re trained in vacuum and never have even seen a forcep, let alone watched a, a forcep assisted vaginal delivery.

[00:07:46] Hilary Erickson | The Pregnancy Nurse®: Yeah, I a lot of times have people say, oh, which should I ask for? And I am always like, whichever one your doctor is good at using. Because if they’re, again, not trained in how to do a forceps, you definitely don’t want them sticking the salad tongs in you.

[00:07:57] Dr Tori O’Daniel MD: absolutely, I don’t want people to be using instruments and devices that they are not well-trained, to use. But I love being able to offer a patient either option and I may, Choose one over the other based on what I’m being presented with. When I first started using vacuum, I did not completely understand the beauty of the rotation that the vacuum provides.

[00:08:18] And then I learned really well how the vacuum works, and I know that it helps reinstitute those cardinal movements of labor and help rotate the baby. And so I know I can rotate a baby with delivery, with vacuum or forceps, and if a patient provides me, um, an opportunity as a candidate. For either one, then I have the opportunity to use either, and so I’m extremely grateful for knowing how to use both.

[00:08:41] Hilary Erickson | The Pregnancy Nurse®: Yeah, you are a woodland fairy. Okay, Tori.

[00:08:43] Dr Tori O’Daniel MD: Yeah, I honestly think as I’m stubborn, I knew I was gonna go practice in a really rural area, in Oklahoma, and I just wanted to have all of the tools that I could in my tool belt. and so I, I’m grateful, but I think that whenever we go train, ’cause we train, I train, to teach, vacuum assisted vaginal delivery, I will not stop advocating for making sure people get the opportunity to learn both if they can.

[00:09:03] Hilary Erickson | The Pregnancy Nurse®: That’s amazing. I was just thinking that we wanna emphasize what a vacuum can do. We talked about it a little bit at the beginning. I think a lot of people think it’s just like us just yanking down on that baby,

[00:09:12] Dr Tori O’Daniel MD: Yep.

[00:09:13] Hilary Erickson | The Pregnancy Nurse®: it can be used to turn the baby, which is not something you really need to know.

[00:09:17] Babies, a lot of times they’ll do it on themselves, but a lot of times they don’t because babies are the worst. And sometimes it is pulling and, and helping a mom. So, a lot of times the doctors will give the mom like a choice. Like at the end where they’re just not pushing very well. You know, you’re in your fourth hour of pushing, as you can imagine, as somebody who does YouTube workout videos, at the very end, I am done.

[00:09:37] I am not gonna be doing burpees on those last 10 minutes of the workout. Right. And that’s how it is. When you push, sometimes you’re like, I am done. I can’t help push anymore. And of course, we also need you to be pushing. A lot of times we’re like, oh, the doctor’s just doing all the work. Absolutely not.

[00:09:52] You are still doing your work as well.

[00:09:53] Dr Tori O’Daniel MD: Absolutely. so I think you hit the nail on the head about. The point or the purpose and the mechanism of a vacuum is to reinstitute the cardinal movements of labor that occur with traction. Right. So traction helps that because, and I have actually a fetal head, so don’t, don’t be shocked that there’s no baby, there’s just a, a fetal head. and then there’s the vacuum. So for those of you looking, obviously this is the front of the head. This is the back of the head, and this is that

[00:10:20] Hilary Erickson | The Pregnancy Nurse®: So This is a podcast you’re gonna wanna watch on YouTube. So the podcast will be on YouTube also. Tori is showing us a baby head, just so you’re aware if you’re just got me in your ear holes. Hello.

[00:10:29] Dr Tori O’Daniel MD: Thank you for clarifying. I forgot that people are sometimes just listening, but this is really a good visual that I think that people often miss when learning. And I also go through this with nurses at my facility and where we train to walk them through understanding. ’cause as Hilary mentioned, you’re not the one using the vacuum, but I genuinely want you to understand how this vacuum works. Because if a baby is not coming down directly OA with this fontanel or that posterior fontanel, that posterior soft box coming down this way and then out, and it might be turned to one side or it might be transverse or it might be what we call sunny side up or op. We really need that baby to flex and then rotate, right? So the vacuum goes right along that sagal suture just anterior to that posterior fontella or that soft spot. And when you pull through the vagina, so this right here is that vaginal canal, and when I pull down it gets this baby because of the spot. Like the physics guys, we gotta go back to what we learned in undergrad and in grad school.

[00:11:31] If you went there, I hated physics, but you have to know this and understand this flexes. And then if your baby is not positioned as you’re pulling down, it flexes and rotates the baby to get the smallest diameter to come through the pelvis. Now the key to this is that pulling down with this system actually flexes and auto rotates that baby with the pulling down mechanism ’cause it uses the vaginal canal like a pulley system. So we don’t pull up, we don’t do a ton of different movements. With the vacuum, you pull down and then towards yourself, and then that gets that baby to get flexed and then come underneath that pubic bone like it would have done without assistance. And so it is traction, but it’s assisted traction.

[00:12:14] So I still need maternal effort. This system is allowing that rotation to get the smallest diameter. So I should have. The least amount of effort that I should need with traction and Mom to get the baby delivered. It’s not just about traction or pulling it out. I’ve heard that sort of like tow truck mentality.

[00:12:30] I’ve had patients cannot, can you just do this for me? And whether I’m using forceps or vacuum, I say, no, I’m gonna help you. I’m gonna assist, but I really need you to give me your effort. So this is a combined effort that I’m providing traction while rotating and you’re pushing for me.

[00:12:46] Hilary Erickson | The Pregnancy Nurse®: Yeah, you know, I just realized we didn’t really talk about how the vacuum works. Like people are thinking we’re like throwing up our Dyson in there. That is not the case. So it is just a real gentle type suction cup. It looks like if you’re not watching, it looks like a little bagel

[00:13:00] Dr Tori O’Daniel MD: yep.

[00:13:01] Hilary Erickson | The Pregnancy Nurse®: on that has a little bit of gentle suction, that they put on the baby’s head.

[00:13:04] Dr Tori O’Daniel MD: Yep, it goes right here on that baby’s head, and then you’re, the afterward you’re gonna see what I call a little hickey. The formal word for that is a chinon, and that’s because you’re pulling or creating, um, suction on the baby’s head. So it creates a little edema. It pulls some of that fluid into the scalp, and that usually will go away.

[00:13:22] That’s like a hickey slash bruise that goes away within a day or so.

[00:13:25] Hilary Erickson | The Pregnancy Nurse®: Yeah, and the doctors have like a little hand pump. They’re not, again, turning on their Dyson. They have a little hand pump that they squeeze that gets it to the right, like there’s a green spot that you’re like in the clear that this is when you can pull, and then they release it between pushes to just like minimal suction.

[00:13:40] So it’ll stay on. Right. Because we don’t wanna have to find the spot.

[00:13:43] Dr Tori O’Daniel MD: Nope,

[00:13:44] Hilary Erickson | The Pregnancy Nurse®: don’t?

[00:13:44] Dr Tori O’Daniel MD: No, I love that you said that. because we don’t, so we were originally trained several years ago, decade and a half ago or so, to release the vacuum in between. But the recommended time for a vacuum is about 15 to 20 minutes in length of your procedure.

[00:13:58] And so even when she’s not. Pushing. You do not release vacuum. You just don’t provide traction. So you leave that on so that it

[00:14:04] Hilary Erickson | The Pregnancy Nurse®: Okay.

[00:14:04] Dr Tori O’Daniel MD: slip off of your spot. Because this placement, which is why we teach this method, is that this placement and getting accurately placed over the spot is super important to get that flexion and then rotation into that smallest diameter plane in your pelvis, and you don’t wanna release the suction in between those pushes.

[00:14:23] So Let’s say the patient is pushed, three different times in one contraction. Contraction goes away. The patient feels the contraction goes away, or we can see the contraction goes away, and then we just sit. Everybody takes a deep breath and the contraction builds. Patient goes to push again, and then we provide the traction. The other thing is that I put my hand, just my finger and my thumb inside the vagina so that I can put my finger on the baby’s scalp and then my thumb is on the center of that cup so I can feel this flexion. And then I can also feel descent of the baby. And then my thumb provides counter pressure.

[00:14:55] ’cause you talked about that cup releasing or or letting go, which is called a pop off. And we don’t. Want to get a pop-off, that’s not our preference. It’s not a safety feature of the device, and so we wanna make sure we can decrease that chance of having a pop-off when the patient is pushing.

[00:15:09] Hilary Erickson | The Pregnancy Nurse®: Yeah. And one of the most important things that we’re all watching for when we’re using a vacuum is that the baby is actually descending because of course we don’t wanna try and bring a baby through a birth canal that will not fit.

[00:15:20] Dr Tori O’Daniel MD: Mm-hmm.

[00:15:21] Hilary Erickson | The Pregnancy Nurse®: so we wanna make sure that the baby is descending. The nurse and the provider are both watching for that, and we have to chart it like there is a lot of charting that the nurse somehow, I don’t know why. Even though I don’t touch the vacuum at all, that we still have to chart as we’re watching the doctor do the vacuum.

[00:15:35] Dr Tori O’Daniel MD: Absolutely. And you actually brought up a great point, you know, when you were offering, a patient the option of an assisted vaginal delivery. There are some prerequisites for me to go through and I’m kind of always assessing whether or not that’s gonna be needed. I like to go worst case scenario in my head, and then I tell the patient, Hey.

[00:15:53] This is how we plan to go through the delivery process. I get them to ask me questions. We kind of go through their birth plan with me to tell me what their options and suggestions are, and then I say, you know, if this is gonna happen, if X, y, Z happens, then I will offer you. These two options and I’d like to do that before we really get into the thick of labor so it’s not crisis moment. And then I can just ward off evil juju like I call it. And I go through what the possibilities are. And one of the prerequisites is that I need to assume that your pelvis is adequate for this baby. I either have a recent ultrasound that gives me a weight that I think it is, or I can Leopold and feel how big the baby is.

[00:16:29] I can assess the patient’s. Pelvis and make sure that I feel like we’ve got an adequate pelvis to deliver so that I know that I feel comfortable that a baby is gonna come out. I cannot predict all shoulder dystocia. That’s not the way that this works. Although I would love if we could do that, but I have to assume that the baby’s gonna be able to come out and that I’m not doing exactly what you said, like pulling a too big baby to come through the pelvis.

[00:16:50] Hilary Erickson | The Pregnancy Nurse®: Super smart, and I love that you go over it in advance. Sometimes I wonder if providers are doing that in the office because they never go over it in advance in general that I’ve ever seen because Tori is a woodland fairy.

[00:17:01] Dr Tori O’Daniel MD: Well, I’m also a hospitalist, so I don’t get the .

[00:17:03] benefit of doing this in the clinic. I think a lot of my colleagues go over these things through the prenatal process, just to kind of say closer towards the end of third trimester, Hey, this, this might be an option. And I don’t always get the benefit either, because sometimes as a hospitalist, I get called into an emergency and I.

[00:17:18] Literally have just met the patient and the baby’s heart tone are down, you know, so indications for assisted vaginal delivery are maternal exhaustion, like you mentioned. The patient is exhausted. We’ve been pushing, for quite some time, and we’re just not getting a delivery, fetal indications where if my heart tone go down and I need to expedite that process. That expedites the conversation. And so I consent a patient for this option, and then once it’s all said and done, I stay and then I just reiterate what just happened, right? Because if that happens really, really fast for them and then all of a sudden they’re like. I don’t even know what just happened to me in all of that. I stay afterward and say, Hey, everything’s good. Your baby’s good. You’re good. Let me just review what we, what we just did, and then if I get the chance, I’ll go back the next day too and just say, do you have any questions about any of that? Because this is, you know, sort of black out patient blacks out for a second with all of that crisis, and so I wanna make sure that they don’t start thinking about it afterward and then have questions they didn’t get a chance to ask.

[00:18:18] Hilary Erickson | The Pregnancy Nurse®: Yeah, and if your doctor is not the woodland fairy that Tori is, you can always ask those questions. Especially even if you think of them in postpartum and postpartum. Nurses don’t know a whole lot about vacuums and forceps, but they can always call up a labor nurse to address your concerns. Who can just basically say why it was used?

[00:18:34] You know, maybe your labor nurse is still there, maybe she’s not, but we have a basic idea of why it’s used, what to watch for, things like that. I did wanna mention that we sometimes use the vacuum in c-sections, and a lot of people are shocked by that one. Some providers use ’em more often than others I find. But if the baby is really like low in the pelvis or the head’s sort of wonky, which is a very technical term, baby’s head was wonky,

[00:18:54] Dr Tori O’Daniel MD: Uhhuh.

[00:18:55] Hilary Erickson | The Pregnancy Nurse®: a lot of times they’ll use the vacuum to kind of pull baby up out of the pelvis.

[00:18:59] Dr Tori O’Daniel MD: Yes, and wonky. I love that word. I also like, kitty wampus. I use kitty wampus in cat corner and all kinds of weird things, but yes. Okay. So you can use forceps or a vacuum in, a c-section. And again, depending on what you’re trained and what your comfort level is. You know, there are two issues with babies coming out in a c-section.

[00:19:17] one is that it’s been, they’ve been pushing for a while and the baby is really, really impacted or or engaged into that pelvis. And then the other one is a is a patient that may have had a scheduled section, unlabored, and those babies’ heads are not molded. It wasn’t attempting to come down into the pelvis.

[00:19:36] And so it’s just beautifully round head, which some would assume would be easier to deliver. But sometimes those stinkers just love hanging out in the uterus and they’re round and they’re floating. There’s a lot of amniotic fluid and it’s hard to get the baby to come. So you have an incision, and again, I’m just showing for those of you that are listening, I’m showing this baby’s head.

[00:19:54] But if you have a baby coming through the incision, I’m doing the same thing where I’m putting my hand underneath and lifting it so that the smallest diameter is coming up through the incision while my assistant is giving some gentle pressure on the top of the uterus to help get that baby to come out. If the baby’s head is really round and molded, and I cannot get it to come up into the, the incision or, I’m sorry, not molded, or if it’s really molded in the pelvis and I have to get it to come up to come into the incision, occasionally an assisted c-section delivery occurs because the vacuum, I can put the vacuum, on the baby and pull straight up and it gets that smallest diameter to come through.

[00:20:31] Or I could, if it’s like this and just not popping up, I could slide a forcep blade and a forcep blade and pull up to come out. Sometimes, when they’re really engaged, I have to get my hand deep into the pelvis to pull or disengage that suction, and then I can’t get it to flex to come up. So the assisted c-section deliveries occur, but for different reasons.

[00:20:51] I’m not asking the patient to give me that maternal effort, right? ’cause they’re, they have a spinal or an epidural, that this really helps get the smallest diameter to come through that incision.

[00:20:59] Hilary Erickson | The Pregnancy Nurse®: Yes. And a lot of times where people are like, well, just enlarge the incision, but your uterus is actually only a certain amount, so it’s not like a regular surgery where we could just cut you open like a magician. We only have so much room that we can cut, which is confusing when you see on the skin where they could have made it larger, but your uterus only has so much room for us to get into, so that’s why we sometimes use it.

[00:21:18] Dr Tori O’Daniel MD: it’s actually, it’s not. I mean, sometimes, sometimes it’s about the incision size, but it really is more about trying to get the baby into a position that creates the best delivery because babies know, they intuitively know that they’re trying to get the smallest diameter.

[00:21:37] I have no idea how that works. That’s way bigger than than me. It’s lovely, but they know to do this. And when I’m trying to get it and I just can’t get it to flex, for whatever reason, the assisted delivery, whichever device I’m using, gets the smallest diameter up there that maybe my hand can’t do for whatever reason in that scenario.

[00:21:56] Hilary Erickson | The Pregnancy Nurse®: Yeah. By the way, I extra love the Kiwi vac for C-section assisted deliveries because when I was trying to like not get in the field, but also use the pump and, and listen to the doctor, it was miserable. So I’m so glad we have new things.

[00:22:07] Dr Tori O’Daniel MD: That’s awesome. I love that.

[00:22:08] Hilary Erickson | The Pregnancy Nurse®: I also wanted to mention there might be people listening to this podcast who have already had their baby that are like, well, I couldn’t get, you know, failure to progress. Like they can’t push the baby low enough. And they’re wondering in their minds, maybe the doctor could have just used a vacuum and I could have avoided a C-section.

[00:22:22] And I don’t want you to feel like that is usually ever a, a thing. If you are pushing, a baby’s not descending and we’re just thinking maybe your pelvis is too small. We, that is not a point that we would use a vacuum or a forceps. Because we could get into trouble.

[00:22:34] Dr Tori O’Daniel MD: Absolutely. You have to have some prerequisites, so your water has to be broken. We like to have your bladder emptied. we need to make sure that your baby is engaged in your pelvis and we describe engagement in your pelvis in like, increments, centimeter increments. And if you are past this bony process in the patient’s pelvis, the baby is past that and it’s plus two.

[00:22:56] The way do we describe how far down the baby is in your pelvis and it’s plus two or greater than you’re a candidate for us to use this vacuum assisted vaginal delivery. Now, if you go back and read historically, if you have nothing better to do with your time and read about forcep evaluation and sort of evolution. They did do some high and what we call mid forceps, where that station could have been a little bit higher. That’s not typically performed now for lots of reasons, but partially because we’re trying to provide the best care with the least amount of harm. And so exactly what you just said, Hilary, we wanna make sure the baby is showing us signs that it can come down and out.

[00:23:32] It’s just some combination isn’t working. And if I can get the baby to rotate and give a little effort while the patient is pushing. I want to do that. So bladder emptied, your cervix has to be completely dilated. So if your failure to progress because you’ve got stuck at seven centimeters, neither one of these instruments are offered for you. I have to have an engaged baby down in that pelvis, and I have to assume that the pelvis is thick enough for this baby to come out. And I do that by either knowing the estimated fetal weight or I have done Leopolds and I know that.

[00:24:03] Hilary Erickson | The Pregnancy Nurse®: And Leopolds is where they just like manhandle you on your belly in case people are like, oh, that’s like a special thing.

[00:24:08] Dr Tori O’Daniel MD: Yeah, it’s like a guesstimation where I do this little trickery, this little trickery to, to make sure I can guess how much I think, that your baby is. And again, I think we talked about this before, but I can’t predict shoulder dystocia any better than anybody else can. And sometimes small babies have shoulder dystocia.

[00:24:25] And just to reiterate, shoulder dystocia is where that shoulders of the baby. So this diameter I’m just showing from one shoulder to the next is bigger or gets stuck in that pelvis. And so my. Top shoulder, my anterior shoulder gets stuck on the mom’s pubic bone and it won’t come out. And so sometimes small, babies, have this issue if the pelvis is shaped in a certain way or if the, the maternal pelvis is just smaller, that happens.

[00:24:49] So we cannot predict that all the time. But you clearly don’t want that to be an assumption that you’ve got a really large baby. For example, patients who have diabetes, and I know that their babies are going to be big, they also have extra fatty deposits, in that fatty tissue of those babies.

[00:25:04] And so those babies tend to have more dystocias even at the same size of, patients who do not have maternal diabetes.

[00:25:09] Hilary Erickson | The Pregnancy Nurse®: Yeah. So there’s a lot of things we’re considering before we use the vacuum. I don’t wanna ever want you to be like, oh, they should have used a vacuum. I could have avoided a c-section. That, that’s not usually the case.

[00:25:18] Dr Tori O’Daniel MD: Absolutely.

[00:25:19] Hilary Erickson | The Pregnancy Nurse®: And the way we’re talking, we’re like every delivery gets a vacuum or forceps, but I wanna remind you guys, you said at the beginning, this is about 5% of deliveries, but it’s enough that it’s awesome to know about so that you’re not caught off guard when your doctor’s like, Hey, I, what do you think about forceps?

[00:25:33] I don’t know if you would know this, Tori, ’cause you probably don’t see a lot of providers asking, but do you think they give informed consent really well with vacuums or forceps?

[00:25:41] Dr Tori O’Daniel MD: I think that, that’s a loaded question, right?? I think that, I think people intend to consent people, and meet them where they’re at. And so you wanna inform somebody as much as they can be informed to allow them to make an educated decision with you. But. You don’t wanna scare them and make them feel like a c-section is just the better option ’cause there are risks with an assisted delivery. And let’s be frank, right? a delivery, a vaginal delivery is risky regardless of how we look at it. Whether it happens without any assistant with plus or minus an epidural, plus or minus medication, it’s still a very risky thing that we go through.

[00:26:16] And so that’s a complicated question for me because I feel like people consent. But maybe not consent and go through all of the details because that seems so scary. And I try to make sure that what I’m using, the verbiage that I’m using, the words that I’m trying to say to explain what can happen is meeting a patient where they’re at.

[00:26:39] So I’m not using these words that are like, sure. Yeah. Okay. And they have no idea what I’m actually saying could happen. And so I don’t sugarcoat it. I mean, I say a C-section is an option, and these are the risks that come with that. And a vacuum. These are the risks that come with that. And the forcep, these are the risks that come with that.

[00:26:55] And then I also tell them if I have a preference based on how they’re presenting to me, and I say I would, I would prefer to use a forcep on you. And this is why I still say you’re still a candidate for a vacuum if you prefer one over the other. So.

[00:27:07] Hilary Erickson | The Pregnancy Nurse®: That’s awesome. and hopefully your provider’s going over this in the office, they should do things like, you might end up getting blood, you might need forceps or a vacuum. Like there are some very things that we do kind of just like in the moment, because a lot of times we don’t have 30 minutes to talk about should we use a vacuum.

[00:27:22] You know, it’s something that’s being done. Sometimes very quickly, if baby’s heart rate’s going down, sometimes it’s like, we need the vacuum, we need it now. We need to go. and in those cases, you, hopefully you’ve had that discussion in the provider’s office and you, and you trust your provider. I mean, hope everybody trusts their provider, although it can be tricky. I get it.

[00:27:37] Dr Tori O’Daniel MD: Yeah.

[00:27:38] Hilary Erickson | The Pregnancy Nurse®: Yeah.

[00:27:38] Dr Tori O’Daniel MD: Yeah. and so yeah, I think people intend to consent well. I think making sure that you consent and then discuss and then debrief and have conversations when it’s not in the heat of the moment. when it’s the heat of the moment, I. I really dial down to what I feel like is the most important conversation.

[00:27:55] Your baby is at risk because of X, Y, Z. Heart tones are down. I have two options. These are my options. These are my risk with these options, and I need you to tell me right now what you’d like to do, which is so hard for me to say because somebody’s trying. They’re like. I don’t know. What do you think that I should do? And if I have a preference either way, of course I say that if they’re not a candidate, I say, I’m so sorry. I do not feel comfortable offering you this because X, Y, z my recommendation is a C-section. You know, I mean, I just feel like everybody provides different, clinical scenarios to you, which is what makes obstetricians as fun and as, fear-based as we are.

[00:28:30] Because we, there’s a lot of educated fear that comes with, we know, right? You know. You know, as a labor and delivery nurse, it is good when it’s good and it is not good when it’s not good.

[00:28:38] Hilary Erickson | The Pregnancy Nurse®: Yeah, and I think a lot of people learn about forceps or vacuums and they’re like, well, those sound really barbaric. But I want you guys to realize that the reason we have these is to prevent a C-section. And most people that come into labor and delivery wanna do a large variety of things to try and prevent a C-section, including the staff, because we ultimately feel

[00:28:55] Dr Tori O’Daniel MD: Absolutely.

[00:28:56] Hilary Erickson | The Pregnancy Nurse®: that either a vacuum or a forceps when used appropriately by trained staff is less risky than having a C-section.

[00:29:03] Dr Tori O’Daniel MD: Mm-hmm. and again, if you go back and look at what we offer in the United States, a lot of places don’t even offer a trial of labor after a C-section. So if I can safely avoid that first C-section and offer people who are candidates for an assisted vaginal delivery safely, absolutely. I mean, this is going to help prevent long term possibility or risks. If I can avoid that first C-section. I am not gonna do that at all costs, though. I’m a very, very like, practical person If you have to have a C-section, because that is what has been presented to us, that doesn’t mean you’re damned for life. Right? And I don’t mean to say that harshly.

[00:29:41] I just, c-sections are not a bad word. It’s just. I would love to be able to allow us to get through a vaginal delivery, if you’re an appropriate candidate, your baby is cooperating. All of those things that I say, and if I have to do a c-section, we can work through that too. You know, I love how you empower people to know and to ask questions.

[00:30:00] Just ask questions like, if anybody is getting defensive with you, that should be a little bit of a red flag. if they’re comfortable with what they’re doing, they should be able to converse and have a conversation with you about it. For sure.

[00:30:09] Hilary Erickson | The Pregnancy Nurse®: Yes. Okay. So fun fact, Hilary had a forceps delivery on my first baby. So my first baby was born in 2000.

[00:30:15] Dr Tori O’Daniel MD: okay.

[00:30:16] Hilary Erickson | The Pregnancy Nurse®: I knew what forceps were ’cause I went to nursing school and I had done labor and delivery as a capstone. Didn’t work labor and delivery though at that point in time. I was with the old people.

[00:30:23] Literally thought, I mean. When you’re, you’re kind of like sugarcoating it. Like we just apply a little pressure. I thought he was gonna hurl me across the room. It was a point in time where my baby’s heart rate was down. I could tell that we were having decels. I knew what decels were. And he, old guy, by the way, I think he also delivered, me.

[00:30:40] So not a young fella,

[00:30:41] Dr Tori O’Daniel MD: Okay.

[00:30:42] Hilary Erickson | The Pregnancy Nurse®: came in, you know, and it was one of those situations where they couldn’t get the heart rate to come up. He said, we need, this is to avoid a C-section. And just like pulled the heck outta that baby. And side note, you can still feel the forcep mark on his head, but he is graduated college.

[00:30:56] He has a degree in computer science. You know, at the time I was kind of like, well, this, this could be a problem. And totally functioning human being. He is a boy that’s 25. So not fully functioning, but pretty darn functioning. So that was my, um, that was my. Thing with forceps. I believe he did go through the risks and the benefits, although I literally have no idea because it was very quickly and he had him out.

[00:31:18] He was one of those doctors who was super trained in forceps, um, and had him out very quickly. So that’s what happened with Hilary. But I do wanna talk a little bit about the risks and the benefits. Well, we’ve talked about the benefits, but what are the, some of the risks with, forceps or vacuum? ’cause I think they’re pretty well, a little bit different.

[00:31:33] Dr Tori O’Daniel MD: Yeah. there are some similarities and then there are some differences. And I think the first difference that people associate between risks for forceps with vacuum is that the forcep needs to go, like you just said, those little salad tongs, it goes around the baby’s head. So if I were a forcep, I’m showing. Sort of where my, my hands, are coming around the baby’s head to sort of sit right on here and be able to get the baby to come through. That in inadvertently widens the diameter of what is having to come through the pelvis because I now not only have the baby’s head, but I also have those blades.

[00:32:08] And those blades are thin, they still widen the diameter of what’s coming through. And so you have maternal risks with the, forceps that can cause, vaginal lacerations or what we call sulcus tears. You can also have, um, a tear on the posterior side, like right where we think of where we have an episiotomy, it can tear. And that tear then can go into, um, near your rectum, that’s called a fourth degree tear. That can have longer term sequelae or long-term Side effects.

[00:32:37] That’s your girl right here. Right here. Fourth degree, still functioning. Lot of para, a lot of, pelvic floor.

[00:32:43] doing pelvic

[00:32:44] Hilary Erickson | The Pregnancy Nurse®: gotta do your pelvic floor physical therapy. When you get one of those,

[00:32:46] Dr Tori O’Daniel MD: those, those, pelvic floor physical therapists. ’cause man, they are really like, they’re in the trenches with us, making sure the patients are doing well. But that’s a risk. And you could still have a fourth degree having a regular without assisted vaginal delivery, having a vacuum assisted vaginal delivery. But your risk with forceps is higher because it’s increasing the diameter. When you put a vacuum on a baby. You can see that this is not increasing the diameter of what’s coming out of the vagina, and so this device does not widen that.

[00:33:15] So you don’t have what I consider those maternal risks. And I just say that, that my maternal risk with forcep is more sulcus, vaginal. Up into the urethra and then posterior or rectal, tears, those fourth degree tears. You still can have risks, to the baby, with forceps and vacuum. And that is a skull fracture or tearing or shearing of the blood vessels that are in, those like in between the, the scalp and the skull, and that’s called a cephalic hematoma or a subgaleal hemorrhage. You do have a slightly higher risk with a vacuum for those fetal scalp, vessel lacerations. And then you can have, you can have a scalp laceration if this. Kind of shears off of the scalp.

[00:33:54] And that’s more of like a skin abrasion or a cut in the skin. Those vessel tears that cause that bleeding, those can be more significant. The ceal hematoma, it’s underneath the skin in a way that it can stop because of the suture lines of the baby. And a subgaleal hemorrhage is something that you can have more bleeding ’cause it can kind of extend over the scalp.

[00:34:16] And so those are risks with either one, but the fetal risks are slightly more with, a vacuum. And I counsel people that. Can people have a scalp, I mean a, cephalohematoma or a subgaleal hemorrhage without assisted vaginal delivery? The answer is yes. It’s just not as frequent. So if you look across, the United States, the subgaleal hemorrhage risk for vacuum assisted vaginal delivery is about 4.2, 4.3%.

[00:34:44] So there is some risk with that.

[00:34:45] Hilary Erickson | The Pregnancy Nurse®: Yes. And even, even if you don’t see, a lot of times there is just a little bruising, like you said, a hickey. but whatever you’re seeing on your baby, if you have any questions after an assisted delivery, please ask because we as nurses see it enough that we’re not like, oh my gosh, I don’t know what that is.

[00:35:00] No, we know what it is and we know when it’s a problem and we need to call like a provider.

[00:35:04] Dr Tori O’Daniel MD: Absolutely. And forceps can get that bruising, like right where the blades are sort of lying on the bony process of your cheek. You can have a little forcep bruise from that. You can have that chinon or hickey. And we, at our institution and what we counsel and, tell people is that you should let pediatrics know.

[00:35:18] If you use an assisted vaginal delivery, let them know. You assess. They always look if they’re concerned about anything, then baby would get imaging and things like that.

[00:35:25] Hilary Erickson | The Pregnancy Nurse®: Yes. And before, when you mentioned the blades of the forceps, that’s just a fun word we use for the salad tongs. There’s nothing sharp on the forceps. It’s all rounded. Nobody could get cut by the actual forcep blade. We just, we just use fun words at the hospital.

[00:35:38] Dr Tori O’Daniel MD: Thank you for clarifying. There is nothing sharp going in your vagina. It’s this nice rounded smooth, salad tong as she described it. And that’s really what it looks like. ’cause a big salad tong.

[00:35:48] Hilary Erickson | The Pregnancy Nurse®: Yeah, so Tori, what would you say to people who are pregnant and are like, sort of freaking out maybe a little bit with this conversation. Again. First off, only 5% of deliveries and I it does it happen more on your first baby? ’cause mine, it was my first baby. Second baby’s third baby. Easier.

[00:36:02] Dr Tori O’Daniel MD: and I don’t have the exact stats on that, but certainly anecdotally it does. And part of that is because, you’ve never had something that large come through your pelvis, right? So you’re trying to figure out how to push a baby out and, your pelvis has been new to that. and the other ones are, you know, a multip or somebody who’s had babies before still can have an assisted vaginal delivery, and that may just be either because of that fetal distress that we talked about, if something occurred. And or if the baby is malpositioned and just not coming down in the pelvis in the right way.

[00:36:28] Hilary Erickson | The Pregnancy Nurse®: Yeah, babies can get wonky at any stage

[00:36:30] Dr Tori O’Daniel MD: love,

[00:36:31] Hilary Erickson | The Pregnancy Nurse®: children can get wonky.

[00:36:32] Dr Tori O’Daniel MD: your, I love your, adjectives. Wonky is exactly what I say to people. I’m like, it’s just coming down their kitty wampus. I don’t know what’s, you know, I’ve tried to rotate, maneuver the nurse. We’ve tried to use the peanut ball and switch. It’s just not coming down. So

[00:36:43] Hilary Erickson | The Pregnancy Nurse®: Yeah, sometimes I’ve sat down to chart, you know, in your nurse’s notes and you’re like, fetal head feels real wonky. I’m like, I don’t know how to say that. Malposition, I guess

[00:36:53] not as fun.

[00:36:53] Dr Tori O’Daniel MD: for sure.

[00:36:54] Hilary Erickson | The Pregnancy Nurse®: Okay, so if you’re freaking out, first off, they don’t happen very often.

[00:36:57] Second of all, talk with your provider in your office.

[00:37:00] This isn’t something that like is taboo topic to talk. I mean, I probably wouldn’t talk to ’em about your 12 week appointment about forceps and vacuum, but if you’re in your third trimester, I think it’s, you know, it’s good to say, Hey, which do you usually use? Because again, most providers only use one. And, do you have anything you wanna tell me about it?

[00:37:15] Right?

[00:37:15] Dr Tori O’Daniel MD: And I think that asking is there anything that would encourage you to use one or the other if they know how to use both? And is there anything that would prevent me from being a candidate for this? So again, if my patient is, a type one, type two diabetic, and the baby is huge, I would say to them in their prenatal period. Hey, we, uh, you know, we’re gonna go through this delivery and there are options if I have any concerns towards the end of your delivery. One of them is assisted vaginal delivery. Unfortunately, in your case, I would not feel comfortable offering you that because we’re already a little concerned about the size of your baby, and I don’t wanna make that worse.

[00:37:48] And then the other thing is that talking with your physician about, you know. When would you choose to try it? And then you stop doing it if it’s not working? You have to get a physician who is really, really comfortable knowing when it is not working, and part of that assisting hand with a vacuum.

[00:38:04] And part of that feel with forceps is knowing I have placed this, I have attempted, and I’m not feeling a budge. If I put a vacuum on and I don’t feel any descent or flexion, I say to the patient, I stop. I take the vacuum off and I say. is not working. I gave it a valid effort. I don’t wanna make things more difficult in your C-section, and this is why.

[00:38:25] And then the second part of that is make sure that they’re capable of handling that abandonment swiftly, right? So I need to have an OR team ready for me to be able to go back to do a C-section if either of those options have not worked.

[00:38:36] Hilary Erickson | The Pregnancy Nurse®: Yes. the other thing, they’re probably like, oh, I wanna put on my birth plan that I do not want an assisted delivery, and I do not put assisted delivery on birth plans because A, nobody wants an assisted delivery. Right?

[00:38:47] And B, it’s such, it’s like made in the moment choice. It’s not like, are you planning to breastfeed?

[00:38:53] Yes or no? Like, it is such a, like this is what’s happening. We’re in the moment. I guess you could, if you’re like getting tired and do you want the assist with a vacuum or are you okay doing it on your own? Like that’s a choice. But, most often it’s, it’s a thing that’s made in the moment, which is a lot of birth.

[00:39:08] I think it’s great to be educated and you’re like, you know, if I, if I still have that effort in me, I wanna push it on my own instead of getting the vacuum. ’cause I prefer not to tear. But that in general is not most of the vacuums that I’ve seen placed.

[00:39:20] Dr Tori O’Daniel MD: Absolutely. And I think, you know, we laughed last time you and I spoke about the infamous birth plan. And people love or hate them, I think, and there’s very little gray in the love. They either love or hate. I am a little gray in that zone because I don’t feel like it’s fair to have, patients get so specific in something that they think that they have. A lot of control over. ’cause sometimes I don’t have control over it, right? And so your body does what it wants to do. Your baby presents how it wants to present. The clinical scenario is different with every single patient. So I just sit down and just have a little heart, heart and say, let’s go through this birth plan.

[00:39:55] And then we walk through it and say, okay, you said you want X, but what if? What if this happens? You know, that may change your mind. And so we just have that conversation more organically about what the options are. And I say, I would love for you to be able to deliver this baby without any assistance from me and or a C-section.

[00:40:11] However, let’s go through worst case scenario so we can ward off evil juju and then we can get that outta the conversation. And then, you know, and I know where we stand in case something like that presents and that seems to sort of, you know when somebody comes in and they’re feeling heightened, ’cause they’re like, I don’t want you to talk to me about it because it’s not gonna happen for me.

[00:40:26] I feel like it just sort of drops some of their guard and armor when I’m like, yeah, let’s just word it off. We’ll just talk about it that way we don’t have to worry about it later. And so, you know, we can go from there and that usually helps people.

[00:40:35] Hilary Erickson | The Pregnancy Nurse®: Yeah, I love that war. It’s like the bad juju.

[00:40:38] Dr Tori O’Daniel MD: Yeah, Yeah, I have, I have a little bit of a black cloud, which is probably why I talk about all these things. ’cause I like to just make sure that people are prepared. and a black cloud is not to freak anybody out, but a black cloud, like meaning, I have all kinds of strange things happen to me. So I have to anticipate them and I want you to know that I know how to handle them and that my team knows how to handle them.

[00:40:56] And I say, if I’m not talking to you. Really quickly in that moment, it’s because I’m trying to make sure I’m taking care of all the steps that need to be taken care of, but I promise you, I’ll talk to you about it as soon as I can, and I just say that to them.

[00:41:08] Hilary Erickson | The Pregnancy Nurse®: I love that. Okay. The other thing I would recommend is learning to take care of your bottom, like

[00:41:12] Dr Tori O’Daniel MD: Hmm.

[00:41:12] Hilary Erickson | The Pregnancy Nurse®: we sort of ignore, like I took a birth class and they were just like sunshine and rainbows. Once that baby’s come out, you won’t have a single problem for the rest of your life because it was so easy to parent this baby, right?

[00:41:21] Dr Tori O’Daniel MD: right?

[00:41:21] Hilary Erickson | The Pregnancy Nurse®: And that was a lie. So I didn’t know how to like take care of my bottom. So I think that’s a really important thing to learn. We’re not gonna go into that a ton in this podcast,

[00:41:29] But understanding that you might tear and your bum might hurt more than you thought it was going to. Because I swear with my fourth degree, my bum hurt.

[00:41:37] My other friend had a C-section like a week later and me getting in and outta the bed and her getting into bed was like, I was like, it’s worse for me.

[00:41:45] Dr Tori O’Daniel MD: Yeah.

[00:41:46] Hilary Erickson | The Pregnancy Nurse®: so that’s always a choice that we’re having to make. You know, he’s fine. So it, and then I ended up having vaginal deliveries with the rest of mine.

[00:41:52] So there were pros and cons, but learning to take care of your bottom, learning that it could be an issue. Learning that it even is gonna happen because a lot of people are really caught off guard by how much their bum hurts after they have a baby.

[00:42:01] Dr Tori O’Daniel MD: Abso, oh my gosh. I feel like this is one of those things we just don’t talk about enough. And Absolutely. Before you leave the hospital, you should ask about, pericare. And we call it pericare. So like your perineum, which is where your labia are, all the way into your rectum. You need to ask, and if you have a third or a fourth degree, you need to be asking, okay, what are my goals?

[00:42:21] How do I manage this? What are the things that I can do to help prevent any other side effects and they should be talking to you about stool softeners. They should be talking to you about these little donuts that you sit on to help provide some comfort. They should be talking about, a spray that helps numb stuff, ice pack, like all of these things.

[00:42:39] Are crucial to help you provide yourself the best environment to heal, but absolutely. And then sometimes you may not even had a third or fourth degree and it still stink and just hurts. Like it hurts. Like your vagina went through a huge transition and you have to talk about that to know what to expect, and then look for signs and symptoms of things that may be outside of what’s normal and know when to call and come in for sure.

[00:43:01] Hilary Erickson | The Pregnancy Nurse®: Yeah. let me just give an amen to a stool softener.

[00:43:04] Let me just give an amen to the, I wish I had a bidet.

[00:43:06] Dr Tori O’Daniel MD: Oh,

[00:43:07] Hilary Erickson | The Pregnancy Nurse®: If anybody’s thinking about getting a bidet, install it before your postpartum,

[00:43:10] Dr Tori O’Daniel MD: I

[00:43:10] Hilary Erickson | The Pregnancy Nurse®: because I would’ve just sat there.

[00:43:12] Dr Tori O’Daniel MD: should get bidets. Everybody.

[00:43:13] Hilary Erickson | The Pregnancy Nurse®: It’s shocking. They’re so cheap at like Home Depot. Like I was like, oh, this is gonna be thousands of dollars to add to my toilet wrong.

[00:43:20] But if I could have just sat there and ran the cold bidet water on my lady bits, that would’ve been, I probably wouldn’t have never left. I probably would’ve just breastfed from the toilet until it overflowed. I don’t know. But I’m just saying bidets are amazing. And also, I kept my tucks in my fridge. I had a sister-in-law who told me that one, and that felt really good.

[00:43:37] I mean, a lot of people make padcicles but sometimes padcicles, like melt. It can be hard, but just keeping my tucks in my fridge was something that I could do, and I wish I had put ice on actually longer once I got home. But I was like, I literally just thought I was weak,

[00:43:50] Dr Tori O’Daniel MD: Right.

[00:43:51] Hilary Erickson | The Pregnancy Nurse®: you know?

[00:43:51] Dr Tori O’Daniel MD: It’s

[00:43:52] Hilary Erickson | The Pregnancy Nurse®: I was like, it’s a third degree, but I can just still muscle through it.

[00:43:54] No, I couldn’t just muscle through it. It was miserable and that’s fine.

[00:43:57] Dr Tori O’Daniel MD: why we do that. I think we do that to ourselves and we do that collectively as a a whole, we just don’t talk about it enough to sort of normalize asking for help, and you shouldn’t have to be painfully recovering in a way that you don’t get things to help you with the pain.

[00:44:13] I don’t know why we do this, but Amen. I, I, unfortunately, or fortunately, however you look at it, had, a c-section, and then a repeat c-section. My first C-section, I had no idea what to expect even though I was an obstetrician at the time. I was a resident and I was still trying to figure it out, and I was just trying to be a hard ass, you know?

[00:44:28] My husband’s like, what are you doing? Why don’t you ask for help? I’m like, I can do this. He’s like, why do you have to do this, like, let me help you. And so I don’t know why we feel like we have to be, she rock going through all of, all of these of recovery and pregnancy and all of the things, but the tucks pad in the fridge, that’s like a golden nugget, guys.

[00:44:44] So if, if you take one thing out of here, that tux pad in the fridge is where it’s at.

[00:44:47] Hilary Erickson | The Pregnancy Nurse®: Yeah, well, especially, I lived in a very tiny apartment, so the fridge, the fridge was just a few walks away. Now I would be like, I’d have to go down the stairs. I would’ve put a fridge in my room. I literally would put a fridge in my room if I had to go back and do it again, and lived in a larger home.

[00:45:00] Just so you guys know.

[00:45:01] Dr Tori O’Daniel MD: we should also put on the the baby registry bidet. I mean, that should be your first number one baby registry bidet. Done?

[00:45:09] Hilary Erickson | The Pregnancy Nurse®: Yeah, It’s so helpful. Laborie, I hope you start building a bidet.

[00:45:13] Dr Tori O’Daniel MD: Yes.

[00:45:13] Hilary Erickson | The Pregnancy Nurse®: our next podcast with them. Alright, so I think, let’s sum it up. I think we’ve learned that these can be super, super helpful and This isn’t something to be afraid of. It’s another tool in our tool belt. Don’t come in afraid of this.

[00:45:24] And that providers are gonna use, which works best for them. And that’s okay. I think I see a lot of people online mad that a provider doesn’t know how to do absolutely everything in the whole wide world. And that’s that’s just not the way it is. Hopefully, you know, maybe you’re in a group where there’s like a lot of different people who are different at good, good at different things, but sometimes you’re also in the middle of nowhere and you’ve got the one provider and you’re gonna wanna cater to what they do best, which is how we do things. Like when my tile guy comes, I want him to do the best tile job he can do in the best way he knows how to do it, not me. Like, why don’t we do the ceiling, you know?

[00:45:59] Dr Tori O’Daniel MD: Absolutely. that’s such a huge thing, is just talk with them. Know what they’re capable of doing, know what, what instruments and devices they’re comfortable using, and then don’t steer from that. Don’t ask them to do something that they’re not proficient in doing. ’cause that’s just risky for you, which I know you don’t want. You want it to be the least risky option for you and your baby.

[00:46:18] So a hundred percent.

[00:46:19] Hilary Erickson | The Pregnancy Nurse®: Yeah. And also the third thing is I’m so glad that we have advances like the Kiwi vac so that we, we are able to do things better than maybe we were doing before or have another option because I’m not saying that the vacuum’s right for everything, and I think you’ve said that too, but this one is better than the one The nurse would like pump up and they’d be like, come on. And we’d be like all stressed out and freaking out at delivery. It’s so much nicer to have something that one person is controlling and then I’m able to do my other things, and

[00:46:44] Dr Tori O’Daniel MD: Yeah.

[00:46:44] Hilary Erickson | The Pregnancy Nurse®: think it’s just. I love that we’re having some advances in care.

[00:46:48] Tori O’Daniel, MD: one other thing that I, remembered about the vacuum when you were talking sort of like you had said previously where you have a squirrel moment and the idea is fleeting is that this vacuum, this particular evolution, this part of this vacuum that is so crucial is the fact that this tubing is flexible. So it makes this ability of the vacuum to be able to get to these really mal positioned babies who are op, that sunny side up baby or a baby that is transverse. And if it’s wonky, the term that we use is asynclitic. So it’s just in the pelvis wrong. And let’s say your physician has tried, your midwife has tried to rotate and it’s just not rotating. The thing about these flexible neck vacuum, so this kiwi vacuum gives me ability to offer candidates a vacuum who are mal presented like that. Previously when you had a vacuum that just had a rigid neck, I could not get a baby that it was OP to get a vacuum on appropriately to get it to flex and rotate. And I did not understand that part when I was trained. And that’s partially because I don’t think that my attendings that were training really understood that, which is why I became really passionate about teaching other physicians how a vacuum works. Like what is the actual process behind how a vacuum works and why a flexible neck gives you more options for candidates.

[00:48:04] So if my patient is op or sunnyside up, I can use a vacuum. I don’t just have to use forceps. And those docs that just use vacuums. They don’t even, they didn’t even think that they could have the option ’cause they weren’t using forceps. And if I can teach you and train you that you can show how this will rotate, then that opens up so many more people, which are usually the people that can’t deliver vaginally because those op babies don’t want to deliver vaginally because they’re de flexing and increasing that diameter.

[00:48:32] So to kind of like encompass this, you are so right. The evolution of the vacuum and how it’s evolved to really provide better care is huge over the last 15, 20 years.

[00:48:42] Hilary Erickson | The Pregnancy Nurse®: Yeah, in case you guys are like, well what did the other one look like? So this one looks like a bagel in case you’re not on the video. And the old one looked like the Liberty Bell. So it was like a cone shape. It didn’t have that big thing that a hang on the church, but it was a cone shape, very rigid.

[00:48:54] And so you couldn’t slide it. You were, and more likely to tear people. I felt like, I felt like we had less tears with the new vacuum than with the other one. ’cause they were like trying to slide it in and I was like, the Liberty Bell, not the Liberty Bell.

[00:49:06] Tori O’Daniel, MD: and they still make that, and it’s now what the evolution of that one is that that material is softer, and people use it and it’s still totally okay and appropriate to use it, but it’s only for those babies who are oA where that posterior fontanel is on the anterior part, like this, this, or this, you can still use them, perfectly safe to use them.

[00:49:25] And now they’re soft so you can squeeze ’em. So you can avoid like what she was describing. You can actually squeeze it to go into the vagina, but it cannot get to these positions. So that OP OT positions where you need to get deeper in the pelvis, you need a flexible neck vacuum, which is what this one is.

[00:49:41] And that’s, that’s such a huge thing to teach people that we say. All the time when we teach, you can open up the opportunity for people who are candidates to do that, and babies who are now op.

[00:49:52] Hilary Erickson | The Pregnancy Nurse®: Yes. And so thank goodness for companies like Laborie. I’ll put the other episode, in the comments or in the show link, whatever we call it. but we had another one about, Overweight moms or people with an apron belly and, and you guys have other things that can make those type of things better too.

[00:50:07] So I’m so grateful that there are companies out there who are looking to make a difference to better OB care because I feel like a lot of people are just like not doing that because they don’t want the, I don’t know, they think Mother Nature’s gonna do her job, but she doesn’t always do her job. So I’m grateful that we have things that can help us.

[00:50:22] Tori O’Daniel, MD: Yeah, absolutely.

[00:50:23] Hilary Erickson | The Pregnancy Nurse®: Yeah, which is why we love this video and this podcast sponsored by Laborie. They make, a lot of things that we can use to help prevent C-sections or make C-sections safer, when, if we have to do them. So big thanks to them for sponsoring this podcast. Big thanks to Tori for coming on. I hope you guys understand them a little bit better.

[00:50:38] That they’re not something to be afraid of. There’s something to learn about and just be prepared if they end up happening to you. And also just be prepared for all the things, including postpartum, because we want you guys to have safe, happy deliveries.

[00:50:49] Tori O’Daniel, MD: Thank you so much Hilary, for letting me come on and talk, about all of this stuff. I think it’s important to make sure that you’re as educated, as you can be when you’re going through this process because it certainly is a lot of unknown and a little bit scary if you don’t

[00:51:01] Hilary Erickson | The Pregnancy Nurse®: Yes. All right. Thanks, Tori.

[00:51:03] Tori O’Daniel, MD: Thank you so much.

[00:51:04] Hilary Erickson | The Pregnancy Nurse®: okay. I hope you guys enjoyed this episode. I think it’s something that’ll, there’s a lot of fearmongering that goes on, and I of course am never here for the fearmongering. I think it’s important to be educated on it, but again, it doesn’t happen that frequently, and hopefully you just have like a regular vaginal delivery.

[00:51:17] But in case this ends up happening to you, at least you’re educated. I hope you guys will join me for more episodes in the future.

[00:51:23] Thanks for joining us on the Pulling Curls podcast today. If you like today’s episode, please consider reviewing, sharing, subscribing. It really helps our podcast grow. Thank you.

[00:51:42]

Keywords:

assisted delivery, vacuum-assisted delivery, forceps delivery, Kiwi Complete Vacuum Delivery System, OB GYN, labor and delivery, childbirth, maternal exhaustion, fetal distress, vacuum system, assisted vaginal delivery, shoulder dystocia, c section, birth canal, perineal care, vaginal lacerations, episiotomy, pelvic floor therapy, chignon, subgaleal hemorrhage, cephalohematoma, labor nurse, midwife, family practice doctor, maternal risks, neonatal risks, delivery complications, birth plan, postpartum recovery, Laborie