Operative delivery means the use of obstetrical forceps or cesarean section to achieve the delivery.

Operative delivery is indicated any time it becomes safer to delivery the baby immediately than to allow pregnancy to continue.

Indications for operative delivery are many, but a partial list includes:

• Maternal hemorrhage
• Uterine rupture
• Unremediable fetal distress
• Fetal intolerance of labor
• Maternal exhaustion
• Failure to progress in labor
• Failure of descent in labor
• Arrest of labor
• Uterine inertia
• Placenta previa
• Placental abruption
• Previous cesarean section
• Previous perineal repair for incontinence
• Fetal malformation

Any condition that increases the maternal risk for pushing, including:

• Stroke
• Cerebral aneurism
• Eclampsia
• Fetal malpresentation or malposition, including:
• Fetal transverse lie
• Breech
• Deep transverse arrest
• Face presentation, particularly mentum posterior

These indications are sometimes relative, not absolute, and clinical judgment must be applied in any individual clinical situation to determine whether operative delivery is a good idea or not. Other aspects of clinical judgment are the specific form of operative delivery (forceps vs. cesarean section) and the timing of the operative delivery.

In a military or other isolated setting, qualified obstetricians or other resources may not be readily available. In such circumstances, any general surgeon should be able to perform a cesarean section. In the presence of obstructed labor, infection, or hemorrhage, such intervention may be life-saving for both the mother and fetus.