Nowadays, concerns regarding operative vaginal birth (OVB) that need to be addressed at a national and institutional level in many countries. This chapter presents general notes on vacuum extraction and forceps to assist vaginal birth. The varying circumstances of practice between countries and hospitals within countries mean that, unless a trainee has opportunities to be trained in a variety of hospitals and regions, it is unlikely that the goals of the RCOG Green-top Guideline on operative vaginal delivery will be attained. One of the purposes of this book, and the ROBuST training course that accompanies it, is to ensure that trainees have the opportunity to develop skills in both methods of OVB. In the developing countries where operative obstetric skills have been maintained, OVB is carried out when there are concerns in terms of 'fit'. Skills training workshops in emergency and newborn care are many and varied too.

Operative vaginal births (OVB) have an important role to play in modern obstetric care. OVB should be offered only when the benefits outweigh the potential risks, taking account of both maternal and neonatal perspectives. A systematic clinical assessment, effective communication and expertise in the intended procedure are prerequisites for OVB. OVBs are classified primarily by the station and position of the fetal head. OVB are performed when birth needs to be expedited and may be indicated for conditions of the fetus or the mother or both. Suspected fetal compromise, as revealed by a suspicious or pathological fetal heart rate pattern on cardiotocography (CTG), is also a common indication for OVB. Careful patient assessment, observing the rules of safe obstetric practice and working within the appropriate clinical indications for OVBs should ensure that the benefits of recommending OVB outweigh the risks.

This chapter explains the importance of non-technical skills in obstetric practice. It describes the non-technical skills useful when conducting operative vaginal birth (OVB). Non-technical skills have been studied in surgical, anaesthetic and acute medicine domains using methodology from the aviation industry. OVB merits non-technical skills unique to this very intimate and emotive time for the mother and her birth partner. A three-tier behavioural system is used to classify non-technical skills. The first level has five major categories of these skills. When conducting an OVB, the main categories to be considered are: situational awareness, decision making, team work and communication, professional relationships with the woman, and maintaining professional behaviour. The social and interpersonal skills not only contribute to patient safety but also can lead to a lasting impression on the mother. Therefore, the value of these should not be underestimated and need to be carefully built into teaching and formative assessments.