Operative vaginal delivery (OVD) is a common procedure accounting for more than 10 000 vaginal deliveries per year in Ireland. 1 The goal of OVD is to expedite delivery for fetal distress or prolonged second stage of labor. Historically, forceps were used exclusively to perform OVD, although with the advent of vacuum devices in the 1950s, there has been a steady decrease in the use of forceps. 2 Despite these advances, OVD remains a technically challenging procedure and is associated with both maternal and perinatal morbidity.Vacuum-assisted deliveries are associated with higher rates of fetal trauma and failure, 3 while forceps-assisted delivery is associated with increased risk of perineal trauma leading to potential long-term pelvic symptoms or fecal incontinence. 3 The Royal College of Obstetricians & Gynaecologists recommend that clinicians select an instrument based on the clinical circumstances and skill level of the operator. 4 Several studies examining OVD trends in Irish maternity units found variation in OVD practice throughout the country. [5][6][7] Ideally, clinicians should strive to maintain an adequate level of skill in performing both types of instrumental deliveries to adapt to each clinical situation.The current study aimed to examine the trend in the ratio of vacuum to forceps-assisted deliveries, over 15 years in a large tertiary referral center.