Born With the Help of a Vacuum Cup or Forceps: What Happens to Babies, Now and Years Later?

A guide for families to two large 2026 studies from Canada (Rajasingham et al.) and Sweden (Björk et al.) on newborn injuries and children's long-term development

Two large studies from Canada and Sweden followed over a million children to see whether birth with a vacuum cup or forceps affects later development. Babies delivered by vacuum from higher in the birth canal had more bleeding and seizures as newborns, though these were rare. Over the next 13 to 14 years, they were no more likely to be diagnosed with ADHD, autism, cerebral palsy or epilepsy than babies born by emergency caesarean.

If your baby was born with the help of an instrument, or you are expecting and want to understand your options, this article explains what the new research found, why the two studies did not agree on one point, and what it means for your family.

Why a baby sometimes needs help to be born

The final part of labour, when the cervix (the opening of the womb) is fully open and the mother is pushing, is called the second stage. Sometimes this stage goes on too long, or the baby's heartbeat suggests they are under stress. The team then has two main ways to help. One is an "assisted" or "operative" vaginal birth: a cup attached to the baby's head by suction (a vacuum), or curved metal tongs called forceps, used to guide the baby out while the mother pushes. The other is a caesarean section, an operation to deliver the baby through the mother's abdomen, which at this late point is called a second-stage caesarean.

What families and doctors knew before

For many years, research on birth and children's development mostly compared caesarean births with all vaginal births. A large review of 61 studies found that children born by caesarean were slightly more often diagnosed with autism or attention-deficit/hyperactivity disorder (ADHD), a condition affecting attention and self-control [1]. But when researchers using Swedish family records compared brothers and sisters from the same families, the link largely disappeared [2][3][4]. This suggested that family factors, such as shared genes, rather than the caesarean itself, explained the difference. We have described the same pattern for diabetes in pregnancy and ADHD.

Studies of instrument births were older or smaller. A study of more than 52 000 young people in Jerusalem found no difference in intelligence test results at 17 years between those born by vacuum, forceps or a natural birth [5]. A study in Bristol, England, followed 264 children to age 5 and found few developmental problems after either an instrument or a caesarean [6]. A Swedish study found similar school results at 16 years after vacuum birth and unplanned caesarean [7]. Doctors also knew that instruments can occasionally injure a baby's head, causing bleeding under the scalp or inside the skull [8][9][10], and that difficult, prolonged vacuum births carry more risk [11]. What nobody knew well was whether those early injuries leave lasting effects, compared with the real alternative of a caesarean late in labour. Meanwhile, in Ontario, Canada, more babies are being born by second-stage caesarean [12], while UK experts have published guidance on how to carry out assisted births [13], and others argue that skilled assisted births can help avoid unnecessary operations [14].

Two studies, two countries, one question

In January 2026, a Canadian team led by Rajasingham published a study using health records for almost all births in the province of British Columbia [15]. They looked at 504 380 babies born at full term, one at a time and not bottom- or feet-first (breech), between 2000 and 2019, all born after the pushing stage began. They compared 46 493 vacuum births, 23 140 forceps births and 3009 births where a vacuum was tried first and then forceps, with 23 946 second-stage caesareans. They then checked which children were later diagnosed with ADHD, autism or intellectual disability (lasting difficulties with learning and everyday reasoning).

In July 2026, a Swedish team led by Björk published a separate study using Sweden's national health records [16]. They looked at 630 985 full-term babies born to first-time mothers between 1997 and 2014. They divided 73 215 vacuum births by how far down the baby's head had travelled: "outlet" (head already at the bottom of the birth canal) or "mid/low" (head higher up). They compared these with 73 739 emergency caesareans, not just those in the pushing stage. They recorded newborn problems and then followed children for 13 to 14 years on average for ADHD, autism, cerebral palsy (a condition affecting movement), epilepsy and intellectual disability. The two teams worked independently.

Both are "registry studies": researchers used records that hospitals and doctors already keep, rather than assigning births at random. That makes them very large, but it also means they show links, not proof of cause.

What happened to the babies right after birth

The Swedish study shows what happens in the first days [16]. Compared with emergency caesarean, mid/low vacuum births had more serious bleeding inside the skull caused by pressure or injury: about 7 in every 10 000 babies, compared with about 1 in every 10 000 after caesarean. A collection of blood under the scalp, called a subgaleal haematoma, occurred in about 70 of every 10 000 mid/low vacuum babies versus 19 of every 10 000 caesarean babies, and seizures in about 61 versus 37 per 10 000. Outlet vacuum births, where the baby's head was already low, still had somewhat more bleeding inside the skull, but did not have more seizures or subgaleal bleeding than caesarean births, and breathing difficulties were less common. The researchers stressed that, although the relative increases looked large, these injuries were rare. It also helps to know that not every bleed causes symptoms: in an earlier study that scanned the brains of newborns with no symptoms at all, bleeds were found in about a quarter of babies born vaginally [17].

What happened as the children grew up

This is the most reassuring part. In Sweden, children born by either type of vacuum birth were no more likely than children born by emergency caesarean to be diagnosed with ADHD, autism, cerebral palsy or epilepsy [16]. In Canada, autism rates were similar whatever the type of birth, and forceps births showed no differences [15]. Children born after a vacuum followed by forceps had slightly more ADHD diagnoses, but this finding was weak and faded in some of the extra checks the researchers ran.

The two studies disagreed about intellectual disability. In Canada, it was slightly more common after vacuum births than after second-stage caesarean: roughly 3 versus 2 new diagnoses per 10 000 children each year [15]. The Canadian researchers said such a small difference was unlikely to matter in practice. In Sweden, it was slightly less common after vacuum births: about 4 versus 5.5 new diagnoses per 10 000 children each year [16].

Why the two studies did not agree

The most likely reason is the comparison group. The Canadian team compared vacuum births only with caesareans done during the pushing stage, the real alternative at that moment. The Swedish team compared them with all emergency caesareans, which the authors said were likely a mix of very different situations. Mothers in that Swedish caesarean group more often had longer pregnancies, diabetes, high blood pressure in pregnancy or very large babies, which might make vacuum births look better by comparison. The studies also counted intellectual disability differently, and neither result held up in every extra check the researchers performed. Both teams warn that the reason a baby needed help, such as signs of distress, may itself affect development.

What this means for your family

If your child was born with the help of a vacuum or forceps, these studies are broadly reassuring about their long-term development. The extra risks belong mainly to the first days after birth, which is why your baby's care team may keep a close eye on your baby in the first days after an instrument birth. Babies who did have bleeding or seizures as newborns may be offered closer follow-up, because large population studies can miss effects in a small number of children.

These studies are not meant to tell doctors whether to choose a vacuum or a caesarean during an emergency; the Swedish authors say this clearly. That decision depends on what is happening in the moment. If you have questions about your own birth or your child's development, your midwife, obstetrician or paediatrician is the best person to talk with.

What researchers are working on next

Researchers would like to combine detailed information about why help was needed, how long the pushing stage lasted and how the instrument was used, and to follow babies who had injuries with careful developmental check-ups rather than relying on diagnoses in health records. They are also interested in how the instrument is used: an earlier Swedish study found that stronger pulling during vacuum births was linked with more serious problems for babies [18]. Studies comparing brothers and sisters, like those described above, could help separate the effect of the birth itself from family factors.

The bottom line

Vacuum births from higher in the birth canal carry a small but measurable extra chance of newborn bleeding and seizures, but in the large Swedish study, children born this way were not more likely to develop ADHD, autism, cerebral palsy or epilepsy. Findings on intellectual disability went in opposite directions and were very small either way, offering families genuine reassurance about the years ahead.

References

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  2. Curran EA, Dalman C, Kearney PM, et al. Association Between Obstetric Mode of Delivery and Autism Spectrum Disorder: A Population-Based Sibling Design Study. JAMA Psychiatry. 2015;72(9):935-942. doi:10.1001/jamapsychiatry.2015.0846 ↩
  3. Curran EA, Khashan AS, Dalman C, et al. Obstetric mode of delivery and attention-deficit/hyperactivity disorder: a sibling-matched study. Int J Epidemiol. 2016;45(2):532-542. doi:10.1093/ije/dyw001 ↩
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