Evidence-based reviews and practice guidelines have identified a number of risk factors associated with vacuum assisted delivery (VAD) that may result in adverse effects on the newborn infant, injuries to the mother's genital tract, and difficulty or failure of the procedure. In addition, clinical circumstances that predispose to increased risk, such as the use of the vacuum extractor for rotational and mid-cavity procedures, have been highlighted as possible avoidable factors. Although there is general agreement that success of vacuum delivery depends on the knowledge, experience and skill of the operator, system analyses of adverse outcomes often reveal inadequate training as a major contributing factor. It is beyond the scope of this review to present the detailed knowledge and technical skills required for correct use of the vacuum extractor. A variety of teaching resources is available for this purpose and practitioners who wish to obtain more information are referred to them.