Published in PLOS One on 2026-07-27, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Lydia S. Massae, Rashidi Heri Kiangi, Victor Zeno Chikwala, Ally Abdul Lyimo, Stella Emmanuel Mushy, Lilian Teddy Mselle
Source: PLOS One • DOI 10.1371/journal.pone.0354738
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Vacuum-assisted birth (VAB) is a critical obstetric intervention for saving the lives of the mothers and newborns, particularly in cases of prolonged second-stage labor, maternal exhaustion, or fetal distress. Despite its proven benefits, VAB remains underutilized, contributing to an increased rate of unnecessary cesarean sections, some of which could be avoided with timely vacuum extraction. This study aimed to explore the barriers to the use of VAB among clinicians at a tertiary hospital in Tanzania.
An exploratory qualitative study using in-depth interviews (IDIs) was employed. Twelve clinicians with relevant experience in vacuum-assisted birth were recruited purposively into the study. A semi-structured IDI guide was used to facilitate the interviews. Data were analyzed inductively using thematic analysis to identify key patterns and categories related to barriers in the use of VAB.
Organizational and individual barriers were identified as key challenges to the use of VAB. Organizational barriers included insufficient availability of VAB equipment, ineffectiveness of the available devices, and poor team dynamics that hindered collaborative decision-making regarding VAB use. Individual barriers centered on clinicians’ apprehension about potential adverse outcomes, along with limited skills and practical experience in performing VAB procedures.
The utilization of VAB by clinicians is hindered by both organizational and individual barriers. Addressing these challenges through improved availability of functional equipment, enhanced training to build clinicians’ skills, and improving working conditions has the potential to increase the use of VAB. Strengthening these areas could help reduce the rate of unnecessary caesarean deliveries.
Introduction
Vacuum-assisted birth (VAB) plays a critical role in improving maternal and newborn outcomes, particularly during complicated deliveries, by reducing the need for cesarean sections (CS). The procedure involves applying a suction device to the infant’s head to facilitate its passage through the birth canal [1,2]. VAB is especially important in settings with limited access to surgical interventions, offering a safe and effective alternative to CS when performed by skilled healthcare providers [1,3]. Clinical indications for VAB include prolonged second stage of labor, maternal exhaustion, or signs of fetal distress [4]. When used appropriately, it can mitigate the risks associated with unnecessary cesarean deliveries, especially in low-resource settings where CS-related complications are harder to manage [4,5].
Recent data indicate a considerable rise in the prevalence of caesarean sections (CS) in Tanzania over the past two decades. The 2022 Tanzania Demographic and Health Survey (TDHS) reported a nationwide cesarean section prevalence of 10.4%, up from about 4% in 2004/05, indicating a significant upward trend in surgical deliveries [6]. A 2024 systematic review and meta-analysis of 26 studies, encompassing over 600,000 women in Eastern Africa, reported a pooled regional prevalence of cesarean sections (CS) of 24.0%, with significant variability across nations and healthcare facility tiers [7].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Lydia S. Massae, Rashidi Heri Kiangi, Victor Zeno Chikwala, Ally Abdul Lyimo, Stella Emmanuel Mushy, Lilian Teddy Mselle. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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