Operative vaginal delivery with the vacuum extractor or forceps is integral to the practice of obstetrics worldwide. The rates at which obstetricians in different countries intervene vary enormously. The wide range of operative vaginal delivery rates reported in the United Kingdom has been noted as a cause for concern. At a Royal College of Obstetricians and Gynaecologists consultants' conference, the participants of a discussion group were surveyed regarding their 'actual' and perceived 'optimal' operative vaginal delivery rate. The 'actual' operative vaginal delivery rate was 10.5% and the perceived 'optimal' was 8.7%. Given that there are approximately 600 000 births per annum in the UK, if the optimal delivery rate was achieved over 10 000 operative vaginal deliveries could be avoided, with significant reductions in maternal morbidity. Reductions could be achieved by examining practice at a number of points in the care pathway. Individual units should examine their practice to establish whether their guidelines and continuing education programmes reflect current knowledge of best practice.
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