title: The disappearing art of instrumental delivery: time to reverse the trend.
abstract: OBJECTIVE
  This paper focuses attention on declining rates of instrumental (vacuum or forceps) delivery. The decline often means that women must travel further to deliver in hospitals with capacity for cesarean delivery.
  
  
  BACKGROUND
  The paper illustrates recent trends in the use of vacuum extraction and forceps in low- and high-income countries. It describes some of the obstacles to the use of instrumental delivery and why the techniques, especially vacuum extraction, should be reintroduced. Over the past two decades, many countries have observed a decline in instrumental delivery rates while cesarean rates have increased. Objections to instrumental delivery are largely due to the potential harm it causes newborns. Some medical schools no longer train their professionals to perform instrumental delivery. Elsewhere, only specialists are permitted to perform the procedures.
  
  
  RESULTS
  As this is a policy paper rather than a research report, the methods and results sections are not applicable.
  
  
  CONCLUSIONS
  Vacuum extraction can be taught to midlevel practitioners (midwives, nurse practitioners and general physicians), thereby increasing access to emergency obstetric care especially at the periphery. This allows women to give birth closer to home in midlevel facilities when hospitals are not easily accessible or are overcrowded. Where instrumental and cesarean delivery are both available, instrumental delivery could potentially reduce the risks associated with cesarean delivery and reduce the costs of obstetric care.
authors.affiliation: Family Health International, Research Triangle Park, NC, USA. pbailey@fhi.org
authors.forename: P E
authors.initials: PE
authors.lastname: Bailey
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data; D002983:Clinical Competence; D019049:Developed Countries; D003906:Developing Countries; D005113:Extraction, Obstetrical / Q000193:education / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008428:Maternal Mortality; D009772:Obstetrical Forceps; D009774:Obstetrics / Q000193:education; D011247:Pregnancy; D014620:Vacuum Extraction, Obstetrical / Q000193:education / Q000706:statistics & numerical data*