Incidence: 

3.3% as of 2013 

Indications: 

• Prolonged second stage 
• Risk of fetal compromise 
• Shortening 2nd stage for maternal benefit (ex: cardiac conditions)

Consent: 

• Comparison is c-section typically 
• Failure rate of OVD is ~3-6% 
• Forceps has higher success rate over vacuum, but also higher risk 3rd/4th degree tear 
• Risks to both mom and baby

Prep: 

• Fetus appropriate station/position 
• Anesthesia
• Empty bladder
• Assess Pelvis/Passenger sizes/fit
• OR Ready
• Peds available 

Episiotomy – NO! 

Contraindications

• Fetal conditions, known or supspected: bone disorders (OI), bleeding disorders 
• Maternal infections: Hep C, HIV, etc 
• Concern for shoulder dystocia/cephalo-pelvic dysproportion