Operative vaginal delivery involves the use of a vacuum extractor or obstetric forceps to facilitate vaginal delivery. The indications for operative vaginal delivery include prolonged second stage of labor, maternal fatigue, concern for fetal acidemia, persistent fetal malposition after failed manual rotation, and the presence of a maternal medical condition that prohibits active maternal pushing effort. Nationally, in 2017, 3.1% of vaginal deliveries occurred with the assistance of forceps or vacuum, with 84% of those by vacuum, according to the National Vital Statistics Report.[1] The American College of Obstetricians and Gynecologists advises that, while the types and rates of complications differ between vacuum and forceps, when applied in appropriate circumstances and used with proper techniques, operative vaginal delivery is associated with low rates of major morbidities and is a good alternative to cesarean delivery in the second stage of labor.[2] The safe and effective management of the second stage of labor is one of the most challenging and demanding tasks faced on a regular basis by OB/GYN hospitalists. Operative vaginal delivery remains an important and valuable option available to hospitalists. In addition to caring for their own laboring patients, OB/GYN hospitalists are often responsible for assisting other obstetric providers in the management of the second stage of labor and the use of these procedures.