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Assisted Vaginal Birth (Green-top Guideline No. 26)

Published: 29/04/2020

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This update was undertaken as part of the regular updates to Green-top Guidelines as outlined in our document Developing a Green-top Guideline: Guidance for developers (PDF 2.4mb) and prior to the emergence of the new COVID-19 coronavirus. Please note that the information provided in this update will be considered for update 3 years after publication, with an intermediate assessment of the need to update 2 years after publication.

There is currently no evidence to support change in the practice of assisted vaginal delivery during the COVID-19 pandemic from what is detailed in this guideline.  As with all maternity care, strict infection prevention and control measures, including the use of appropriate PPE, should be followed.

Detailed guidance on caring for pregnant women with COVID-19 is available in the current RCOG guidance Coronavirus (COVID-19) infection and pregnancy.

This is the fourth edition of this guideline, first published in October 2000 under the title Instrumental vaginal delivery, and revised in January 2011 and October 2005 under the title Operative Vaginal Delivery.

The aim of this guideline is to provide evidence-based recommendations on the use of forceps and vacuum extraction for both rotational and non-rotational operative vaginal births. In order to provide safe care for the full range of clinical scenarios, obstetricians should develop competency in the use of both vacuum and forceps for non-rotational birth and at least one specialist technique for rotational birth. The scope of this guideline includes indications, procedures and governance issues relating to operative vaginal birth.

Two new developments have occurred since the publication of the 2011 guideline: i) the Montgomery ruling has emphasised the importance of informed consent; and ii) a number of high profile manslaughter convictions on the grounds of gross negligence have highlighted the risk of a criminal conviction, where serious shortcomings are identified in medical care provided to a patient who dies. The Royal College of Obstetricians and Gynaecologists (RCOG) has also received reports of a number of neonatal fatalities associated with traumatic birth-related injuries. It is in this context that the safety aspects of this guideline have been reviewed and updated.


Declarations of interest

Dr DJ Murphy: personal fees from legal expert reports during the conduct of the study.

Dr R Bahl: none declared.

Dr BK Strachan: none declared.

Full disclosures of interest for the developers, Guidelines Committee and peer reviewers are available to view online on Wiley as supporting information.


Elsewhere on the site

Consent advice for operative vaginal delivery
Consent Advice No. 11 provides advice for clinicians on obtaining consent from a women undergoing operative vaginal delivery

Patient information

Information about vaginal birth assisted by ventouse or forceps

eLearning resource

eTutorial about vaginal birth assisted by ventouse or forceps