Operative vaginal delivery (OVD) is an obstetric skill that can result in the safe delivery of a baby and the avoidance of a fully dilated Caesarean section. It is becoming more common, but the knowledge of when to undertake an OVD, how to perform it and the possible outcomes are increasingly the subject of medicolegal action by couples who believe that mistakes have been made by the doctors involved in giving care to women. The consequences of a fully dilated caesarean section are now the subject of much research and the increase in subsequent preterm birth has ensured that operative vaginal delivery remains an essential part of the management of women in labour. This chapter will focus on the indications, prerequisites and the practical elements of OVD as well as the new aspects of care such as the use of IV antibiotics routinely in women who have been delivered by assisted vaginal delivery.