Operative vaginal deliveries: practical aspects.

Forceps, vacuum, and cesarean sections are relatively recent additions to the obstetrician's armamentarium. The art of modern obstetrics is one that mandates from obstetricians the attentive vigilance of the development of natural processes and an active intervention when such processes fall outside normally accepted standards. What constitutes the "normal process" and the "accepted standard" is subject to discussion, and international variations in obstetric practice are in part the reflection of such controversies. This article presents a practical approach to the contemporary issue of instrumental deliveries, outlining supporting evidence (when available) and the most current position of professional colleges in obstetrics and gynecology.