Fast Track

If the fetal heart rate is reassuring, the second stage of labor need not be limited to 2 or 3 hours

Reserve vacuum extraction for fetuses at more than 34 weeks’ gestation because of the increased risk of intracranial hemorrhage associated with prematurity

Vacuum extraction can be performed comfortably in the absence of regional anesthesia

The incidence of shoulder dystocia with vacuum extraction is 3.5%, compared with 1.5% for forceps delivery

Once full vacuum is achieved, encourage the mother to push with the next contraction, and apply steady traction in concert with her efforts

If vacuum extraction fails, do not switch to the forceps; the risk of intracranial hemorrhage is greatest when the 2 methods are combined

The vacuum cup will “pop off” if it is applied incorrectly, if traction is excessive or applied in the wrong direction, or if cephalopelvic disproportion is present