Instrumental vaginal deliveries can be hazardous in inexperienced hands and should be undertaken with due care and supervision. In cases of fetal distress it is essential that the instrumental delivery be straight forward as the combination of trauma and hypoxia is potentially damaging to the fetus. In general, ventouse delivery is preferred when the position is occipitotransverse or occipito-posterior to allow for autorotation of the fetal head during traction unless the accoucher is experienced in Kielland's rotational forceps delivery. Where maternal expulsive efforts may be compromised, forceps may be better than ventouse delivery. Maternal complications are higher with forceps whilst neonatal complications are more common with the use of ventouse. Although instrumental delivery is a service provided in both basic and comprehensive essential obstetric care, it is under-used in low-resource settings. After delivery, an adequate review of overall conduct of the delivery, perineal repair and postpartum care should follow.