Health workers’ perspectives on vacuum extraction in Mulago Hospital, Uganda

Abstract Background To explore perceptions of health workers of Mulago Hospital, Uganda, regarding the use of vacuum extraction. Methods A cross-sectional survey among midwives, residents and consultant obstetricians was performed. It was composed of questions pertaining to vacuum extraction, addressing reasons for low use, recommendations to increase use, preferred mode of birth in case of prolonged second stage for oneself or one’s relative, views about who is suited to perform the procedure and contraindications. Results Eighty-three of 134 (61.9%) participants returned the survey. The most frequent reasons for low use of vacuum extraction were lack of training (60/83, 72.3%) and equipment (59/83, 71.1%). Skills training and improved supply of equipment were recommended. Most participants (57/83, 68.8%) chose vacuum extraction over caesarean section as hypothetical mode of birth for themselves or a relative in case of prolonged second stage of labour. Opinions about contraindications varied. There was a tendency to cite contraindications not identified as such in international guidelines (big baby, caput succedaneum, moulding). Midwives, residents, interns and consultant obstetricians with appropriate training were generally all considered suited to perform vacuum extraction. Conclusions Health workers generally conveyed a positive attitude towards vacuum extraction, despite some perceived barriers, often unsupported by evidence. Organisation of skills training, supply of equipment and focus on knowledge of indications are essential to increase its use.