New Study Finds That Instrumental Vaginal Delivery Carries Risks of Birth Injuries and Neurodevelopmental Challenges

Births assisted by devices such as vacuum or forceps shown to cause injuries and adverse impacts on development, study finds.

Researchers out of  Al Wakra Hospital and Women’s Wellness and Research Center in Qatar studied birth injuries in babies born using assisted devices such as vacuums and forceps. These devices are sometimes used during delivery to expedite the process, known as an instrumental delivery, but can pose significant risks to both mother and child.

The study, published in April 2025, analyzed birth injuries, neonatal intensive care unit (NICU) admission rates, and neurodevelopmental outcomes at 18 months in babies born via instrumental delivery. Researchers studied 390 infants born with the use of vacuum or forceps 35 weeks’ gestation or more between 2021 and 2022. Among them, 80 of the infants—over 20%—experienced 84 birth injuries in total. Cephalohematoma was the most common injury, making up approximately 50% of the injuries, followed by bone fractures and subgaleal hemorrhage (where blood accumulates between the skull and the scalp), and intracranial hemorrhage. One death was associated with the combined use of vacuum and forceps during delivery. 

The team found that birth injuries occurred more frequently when both vacuum and forceps were used, and also noticed a trend toward increased risk for injury when an instrument was used more than three times. 25% of the babies studied were admitted to the NICU after birth.

The researchers performed neurodevelopmental assessments at 18 months on 289 of infants, and found that about 10% of those had abnormal outcomes. Chief among those outcomes was problems with the communication domain of the brain (67%), followed by personal-social skills, fine motor, and problem-solving, and gross motor skills (data was not able to be collected for all of the babies in the study, largely due to the impact of the COVID-19 pandemic).

The researchers concluded that instrumental vaginal delivery does indeed carry risks of birth injuries and neurodevelopmental challenges. To minimize risks to both mom and baby, instrumental delivery should be used only when there is a valid reason, and the operator must be properly trained and skilled in the use of the instrument. Long-term follow-up is also essential to minimize complications and ensure optimal outcomes.

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