Practice Bulletin 154.  Despite significant changes in management of labor and delivery over the past few decades, operative vaginal delivery remains an important component of modern labor management, accounting for 3.30% of all deliveries in 2013.  Use of obstetric forceps or vacuum extractor requires that an obstetrician and obstetric care provider be familiar with the proper use of the instruments and the risks involved.  The purpose of this document is to provide a review of the current evidence regarding the benefits and risks of operative vaginal delivery.