Use of assisted vaginal birth to reduce unnecessary caesarean sections and improve maternal and perinatal outcomes

Far too many birth-related maternal and perinatal deaths still occur in low-income and middle-income countries. Prolonged labour is a common cause of stillbirths, maternal deaths, and lifelong disabilities.1–3 Prolonged second stage of labour is a common indication for caesarean section; however, many of these caesarean sections could be prevented by the use of assisted vaginal birth, with vacuum extraction being the method of first choice.1–3 Compared with caesarean section, vacuum extraction is associated with a lower risk of infection and haemorrhage, and shorter decision-to-birth interval and therefore lower rates of birth asphyxia, intrapartum stillbirths, and severe maternal morbidity.