The vacuum extractor has become a widely used instrument in many settings. It has proven to be a reliable method of ensuring safe passage of the fetus and/or enhancing maternal effort during the second stage of labor. The principles of vacuum-assisted birth are learned relatively easily and have been incorporated into many nurse-midwifery practices. This article reviews the principles of vacuum extraction as they apply to the practice of nurse-midwifery. Vacuum extractors available to nurse-midwives are compared. Nurse-midwives are familiarized with vacuum extraction so that they can make an Informed choice concerning the vacuum extractor as an appropriate tool within their practice. This article is not intended to teach nurse-midwives to use the vacuum extractor. It does, however, provide guidelines for credentialing those nurse-midwives choosing to incorporate the principles of vacuum extraction into their practice.