The late Dr Aldo Vacca (OAM, MBBS, FRCOG, FRANZCOG, Grad Dip Ed) was renowned as a tireless advocate and educator of vacuum-assisted delivery (VAD), both in Australia and internationally. His efforts are estimated to have avoided 100,000 cases of maternal trauma in Australia alone*. Dr Vacca identified and refined the five steps common to all vacuum deliveries.
Locate the flexion point by identifying the posterior fontanelle with the middle finger and moving the finger along the sagittal suture anteriorly a distance of 3cm to find the flexion point.
The operator retracts the perineum with two fingers to form a space into which the cup is inserted gently with one movement immediately following a contraction.
The cup is pushed down the midline of the maternal pelvic axis until the centre of the cup is judged to be over the flexion point (the cup insertion distance).
The recommended vacuum pressure of 60-80kPa (450-600mmHg) should be achieved rapidly. A check for maternal tissue entrapment should always be made.
The 2&2 finger tip and finger thumb technique. Traction for VAD is a two-handed exercise, one hand providing the traction and direction of traction, the other monitoring descent of the head with each pull and controlling the force applied to the fetal head.
Individuals should learn to grade instrumental procedures according to the technical skill that is required and attempt only those vacuum deliveries that fall within their own level of expertise.