For the purpose of this chapter, discussion will be confined to intrapartum events requiring assistance at vaginal delivery with forceps or vacuum extraction, shoulder dystocia and cesarean section. The classical forceps are used more for an outlet or low cavity forceps delivery. These have a pelvic curve directed upward so that when the forceps are applied to the fetal head presenting in an occipito-anterior position, the curve of the instrument approximates the pelvic curve. The presence of caput may obscure the fontanelles and sagittal sutures and may make the determination of fetal position difficult; palpating the fetal ear in this situation is helpful. Overall much less scalp trauma occurred with soft cup than had been cited in several series using the metal cup. Silastic cup extractor effects delivery in a shorter time period but a higher failure rate compared with metal cups has been observed. These cups are most suited for occipitoanterior position. Although the studies are more favorable for vacuum delivery, reports of fetal complications such as scalp abrasions, caput succedaneum, intracranial bleeding and subaponeurotic or subgaleal hemorrhages suggests that this technique should be practiced with care. The bladder and cervix is not disturbed. It is useful for cases of carcinoma of cervix in pregnancy (prior to performing radical surgery), major placenta previa and transverse lie with back turned downward or after a previous vesico-vaginal fistula repair or extensive bladder adhesion to the uterus. Shoulder dystocia is an obstetric emergency. There are many identifiable risk factors like maternal obesity, previous shoulder dystocia or big baby, macrosomia of present pregnancy and prolonged first and/or second stage of labor. Asphyxia—as the chest is compressed within the birth canal, inspiration is not possible; the umbilical cord, is also compressed. Postpartum hemorrhage from trauma to the genital tract due to uterine atony.