Indications for forceps delivery and vacuum extraction are essentially the same: Prolonged 2nd stage of labor (from full cervical dilation until delivery of the fetus) Suspicion of fetal compromise (eg, abnormal heart rate pattern) Need to shorten the 2nd stage for maternal benefit—eg, if maternal cardiac dysfunction (eg, left-to-right shunting) or neurologic disorders (eg, spinal cord trauma) contraindicate pushing or maternal exhaustion prevents effective pushing A prolonged 2nd stage is defined as follows (1): In nulliparous women: Lack of continuing progress for 4 hours with a regional anesthetic or 3 hours without a regional anesthetic In multiparous women: Lack of continuing progress for 3 hours with a regional anesthetic or 2 hours without a regional anesthetic Choice of device depends largely on user preference and operator experience and varies greatly.