Approximately 5% (1 in 20) of all deliveries are operative vaginal deliveries. The past 20 years have seen a progressive shift away from forceps in favor of the vacuum extractor as the instrument of choice. This article reviews in detail the indications, contraindications, choice of instrument, and Application and Technique for vacuum-assisted vaginal delivery. The use of vacuum extraction at the time of cesarean delivery will also be discussed. With vacuum extraction becoming increasingly popular, it is important that obstetric care providers are aware of the maternal and neonatal risks associated with such deliveries and of the options available to affect a safe and expedient delivery.