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

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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.

COVID disclaimer

This guideline developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers, and prior to the emergence of COVID-19.

Version history

This is the fourth edition of this paper.

Please note that the information provided in this update will be considered for update by the RCOG Guidelines Committee 3 years after publication, with an intermediate assessment of the need to update 2 years after publication.

Developer declaration of interests

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.

This page was last reviewed 29 April 2020.