Operative delivery: yesterday and today.

The normal mechanism of labour leads to spontaneous vaginal delivery in many patients. However, from the beginning of time there has been a requirement for operative intervention to achieve delivery in some women. For centuries, to save the mother in an obstructed labour, the only option was craniotomy to deliver a dead child. The requirement for craniotomy decreased with the introduction of obstetric forceps and Caesarean section, but it is still needed in some situations. The role of obstetric forceps in the management of the second stage of labour has evolved over the last 300 years, initially for failure of the mechanism of labour and subsequently to shorten the second stage of labour for the benefit of the mother and child. The use of obstetric forceps peaked in the first half of the 20th century and has been decreasing steadily since that time. Caesarean section became a reasonable option for operative delivery towards the end of the 19th century with the availability of anaesthesia and procedures to control hemorrhage and prevent infection. The use of Caesarean section has increased steadily but variably in different countries throughout the 20th century. The incidence of operative intervention has increased from less than 1% of deliveries historically, to 10% at the end of the 19th century and to 40% at the end of the 20th century. The continuing challenge for those responsible for the delivery of the obstetric patient is to continue to examine the indications and appropriate procedures for operative intervention.