Nowadays, concerns regarding operative vaginal birth (OVB) that need to be addressed at a national and institutional level in many countries. This chapter presents general notes on vacuum extraction and forceps to assist vaginal birth. The varying circumstances of practice between countries and hospitals within countries mean that, unless a trainee has opportunities to be trained in a variety of hospitals and regions, it is unlikely that the goals of the RCOG Green-top Guideline on operative vaginal delivery will be attained. One of the purposes of this book, and the ROBuST training course that accompanies it, is to ensure that trainees have the opportunity to develop skills in both methods of OVB. In the developing countries where operative obstetric skills have been maintained, OVB is carried out when there are concerns in terms of 'fit'. Skills training workshops in emergency and newborn care are many and varied too.