Trends in operative vaginal delivery, 2005-2013: a population-based study

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health
• Clinical Epidemiology

Background:

• Operative vaginal delivery (OVD) using forceps or vacuum extraction is a critical skill in obstetrics.
• Understanding temporal trends and associated factors of OVD is essential for clinical practice and education.

Purpose of the Study:

• To determine temporal trends in forceps and vacuum delivery rates in the United States from 2005 to 2013.
• To identify obstetric, medical, and demographic factors associated with operative vaginal delivery.

Main Methods:

• Retrospective cohort study utilizing US birth records from 2005 to 2013.
• Analysis included live-born, non-anomalous singleton gestations between 36 to <42 weeks of gestation.
• Multivariable logistic regression models were employed to identify factors associated with forceps and vacuum use.

Main Results:

• A total of 22,598,971 vaginal deliveries were analyzed.
• Both vacuum-assisted (4.8%) and forceps (1.1%) deliveries decreased significantly during the study period.
• Vacuum deliveries declined from 5.8% to 4.1%, and forceps deliveries from 1.4% to 0.9% between 2005 and 2013.

Conclusions:

• Operative vaginal delivery rates, including forceps and vacuum, have significantly decreased in the US.
• The declining volume of OVD poses challenges for resident education and may limit alternatives to cesarean delivery.
• Urgent educational initiatives are needed to ensure future obstetricians maintain expertise in operative vaginal delivery.