Operative vaginal delivery with forceps or vacuum is uncommon but high-stakes. This episode covers the current incidence, indications, consent considerations, preparation checklist, and contraindications – including what to say about forceps vs. vacuum success rates and laceration risk. Show Outline: Incidence – 3.3% as of 2013 Indications – Prolonged second stage, risk of fetal compromise, shortening 2nd stage for maternal benefit (e.g., cardiac conditions) Consent – Comparison is typically c-section. Failure rate of OVD is ~3–6%. Forceps has a higher success rate over vacuum but also higher risk of 3rd/4th degree laceration. Risks to both mom and baby. Preparation Fetus at appropriate station/position Anesthesia Empty bladder Assess pelvis/passenger sizes/fit OR ready Pediatrics available Episiotomy – NO! (Not routinely indicated.) Contraindications – Fetal conditions, known or suspected: bone disorders (OI), bleeding disorders. Maternal infections: Hep C, HIV, etc. Concern...