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Giulia Muraca and colleagues argue that Canada’s high rates of maternal and neonatal trauma following operative vaginal delivery warrant urgent recognition, transparency, and action Operative vaginal deliveries forceps and vacuum assisted deliveries are recommended as safe, acceptable alternatives to caesarean delivery for women in the second stage of labour when descent of the fetal head is arrested, there is imminent risk to the baby, or there are conditions that contraindicate pushing (expulsive) efforts.123 Although available data on maternal and neonatal mortality and morbidity show no clear advantage of operative vaginal delivery over caesarean delivery, such comparisons often fail to recognise the impact of maternal trauma, the most common injury associated with operative vaginal delivery.3 This is particularly pertinent in Canada, which has the highest rate of maternal trauma after operative vaginal deliveries among high income countries (fig 1).4 Fig 1 Rate of obstetric

United kingdomUnited statesSarka lisonkovaRoxana geoffrionGiuliam muracaRohan dsouzaGiulia muracaLaurae ralphBritish columbia children hospital research instituteUnited kingdom royal college of obstetriciansMichael smith foundation for health researchNorth americaUnited kingdom royal collegeMichael smith foundationBritish columbia childrenHospital research