Vacuum extraction can be an effective technique for operative vaginal delivery, and in some circumstances, it may even be a useful aid in abdominal delivery. Specialized equipment is required, but surprisingly little time is necessary to effect delivery in uncomplicated applications. Rigid vacuum extractors are more effective than pliable instruments but are associated with more fetal scalp trauma. Vacuum extraction spares maternal soft tissue trauma compared with forceps but also more often fails to effect delivery. Unfortunately, both failed vacuum extraction and operative success with delivery can be associated with fetal/neonatal morbidity. It may be that vacuum extraction is an easier technique to learn than forceps, but there is indirect evidence that the ease of application may tempt misuse. Clearly, the technique can be misused, and therefore, good judgment and skill of the operator remain as important as they are in any operative procedure. There are some rare circumstances in which the unique properties of the vacuum confer advantages over forceps, but neither these indications nor the advantages are frequent or clear enough to recommend that every obstetric unit have the availability and capability of vacuum extraction instrumentation and expertise.