Vacuum and forceps assisted births account for 10-15% of all births in England and a small number of cases are complicated by significant morbidity and mortality. For most women and babies, it is a balance between the risks and benefits of not intervening, of using an instrument, or performing a second stage caesarean section. There are short- and long-term potential complications and implications for future births. Not surprisingly there are individuals who hold strong views about AVB, and some believe that forceps should be abolished entirely. This was reflected in one submission during the consultation phase from a patient advocacy organisation who suggested that planned caesarean section should be recommended to women as a means of avoiding AVB. The co-author group together with the Guidelines committee, felt that the point they were making was about avoiding labour, rather than avoiding AVB, and was better addressed by the RCOG guidance “Choosing to have a Caesarean section ”. We did, however, make specific recommendations on the importance of antenatal education, intrapartum counselling, shared decision-making, informed consent, and postnatal review. There was an entire section on the importance of the Montgomery ruling.