51. Operative Vaginal Delivery

Summary

For women who progress to the second stage of labor, there are three options for delivery: spontaneous vaginal, operative vaginal, and cesarean. Between 1996 and 2006, cesarean delivery increased by 50%, while both spontaneous and operative vaginal births declined. Recent literature confirms that operative vaginal delivery remains a valid option when problems arise in the second stage of labor. However, training and practice are required to maintain that option. The American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canada have each published guidelines pertaining to operative vaginal delivery and exhort residency programs to teach the necessary skills. In order to optimize maternal and neonatal outcomes from operative vaginal delivery, trainees should receive instruction in both technical and nontechnical skills. Related skills including clinical pelvimetry, accurate interpretation of fetal heart rate patterns, and correct assessment of fetal head position are also very important and affect outcomes. Emphasizing contemporary data, the purpose of this chapter is to illustrate that it is possible to achieve equal neonatal and better maternal outcomes when operative vaginal delivery is compared to cesarean delivery in the second stage. Although the trend to choose vacuum extraction over forceps is undeniable, the evidence supporting that trend is unconvincing. A strong case will be made to preserve the option of forceps delivery for tomorrow's obstetricians.