Babies by Vacuum

After English obstetricians developed the forceps for extracting babies in difficult births, a century elapsed before it was generally adopted. Now, a new and supposedly less hazardous method has been devised to ease some slow and possibly dangerous births, but medical controversy in the English-speaking world may delay its widespread use. It consists of pulling the baby out by means of a vacuum-suction cup attached to the top of its skull.

The idea dates back to an English surgeon, James Yonge, who advanced it in 1706. Little was done to put it into practice until after World War II, when sev eral European researchers developed vacuum extractors, all based essentially on the ancient suction cup or ventouse (used for every imaginable ailment). Many obstetricians around the world now use the device freely. Yet it has won preliminary public approval from only one research team in Britain and one in the U.S.

Reverse Pump. The most widely accepted model, developed by Sweden's Dr. Tage Malmstrom, consists of a metal cup with a rubber hose (part of which serves as a handle) leading to an ordinary bicycle pump with a reverse valve so that it pumps air out instead of in. Drs. James A. Chalmers and Roger J. Fothergill, in the British Medical Journal, report use of the gadget in 100 cases at Worcester. The metal cup is inserted in the opening of the birth canal and applied to the baby's skull. Pressure is reduced to half an atmosphere or less, so the scalp develops a big bump or "chignon," which fills the cup. Danger of maternal infection is reduced, the doctors assert, because no foreign body passes beyond the baby's head. Risk of injury to the mother--and apparently to the baby--is virtually eliminated. The chignon subsides within a couple of hours after birth. A major advantage, say the Britons, though Americans disagree, is that the ventouse can be used to speed a slow labor in its early stages by synchronizing a pull on the handle with the mother's own contractions.

Avoid a Caesarean? In the U.S., only at New York City's Kings County Hospital has the vacuum extractor received extensive trial. Dr. Vincent Tricomi and colleagues have used it in 125 births since last September. Keenly aware of the suspicious attitude of the profession generally, they have been even more conservative than the British in selection of cases. But they have seen no ill effects, and believe the vacuum cup may save many mothers from difficult and dangerous forceps deliveries, or the alternative of a caesar-ean.* On results to date, the Brooklyn doctors are "cautiously enthusiastic" and are confident that the suction cup is worth a wider trial.

* It has been tried and conceded ineffective in breech births.

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