51. Operative Vaginal Delivery

  1. John T. Queenan MD2,
  2. Catherine Y. Spong MD3 and
  3. Charles J. Lockwood MD4
  1. Edward R. Yeomans MD

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch51

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Yeomans, E. R. (2012) Operative Vaginal Delivery, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch51

Editor Information

  1. 2

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 3

    Bethesda, MD, USA

  3. 4

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Lubbock, TX, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783



  • operative vaginal delivery;
  • neonatal and maternal outcomes, with operative vaginal delivery;
  • vacuum extraction over forceps;
  • instrument selection;
  • operative vaginal delivery, cervix fully dilated;
  • current three-level classification system;
  • criteria, types of forceps deliveries;
  • operative vaginal delivery skill;
  • NOTSS, for operative vaginal delivery


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.