This chapter explores the potential medico-legal implications of operative vaginal birth (OVB). There is a balance of risks and benefits with operative birth; obstetricians are often faced with the dilemma of making a difficult choice between OVB and caesarean section when birth needs to be expedited at full cervical dilatation. Litigation is often complex and the use of instruments alone is seldom the only factor in a medico-legal action. The following are some of the more common claims against obstetricians after completed or attempted OVB: inappropriate indication and/or conditions for safe OVB, inappropriate instrument, incorrect technique and application of instruments, procedure failure. It also includes failure to anticipate impending complications, maternal and fetal complications, and inadequate consent and poor communication. The chapter discusses these potential litigation areas in detail and outlines strategies that clinicians can adopt to optimise safe clinical practice and improves outcomes for mothers and their babies.