Forceps and vacuum delivery: a survey of North American residency programs.

OBJECTIVE: To document resident instruction in operative vaginal delivery by forceps and vacuum.

METHODS: A survey was sent to all 291 obstetrics-gynecology training programs in the United States and Canada.

RESULTS: The overall response rate was 72% (210 of 291). Most programs (60%) have an operative vaginal delivery rate of 10% or less. Nearly all of the responding programs (199 of 209, 95%) teach operative vaginal delivery via the vacuum route; metallic cups are used in only 14% of centers. Forceps are the primary instrument in most programs (68%), but nearly one-third of responding centers use the vacuum method more often than forceps. Instruction in midpelvic operative vaginal delivery is offered in 64% of the programs, with forceps being more common by nearly a two-to-one ratio. Deep transverse arrest is handled initially by forceps by half of the respondents, whereas 28 and 22% would proceed with cesarean or attempt a vacuum extraction, respectively.

CONCLUSION: Instruction in both types of operative vaginal delivery is found in most programs. The forceps are used more commonly, but vacuum is the preferred instrument in about one-third of training programs. Instruction in midpelvic delivery is offered in 64% of programs, but we noted a declining trend.