Aims To assess the impact of RCOG Green Top Guideline (No.26 published 2005) on operative vaginal delivery (OVD). We aimed to examine the venue for OVD; the types of anaesthesia used and identify reasons why practice has changed.

Methods All women that delivered in Ninewells Hospital, Dundee between 1 January 2005 and 31 December 2009 were included (n=22793). The local electronic maternity database was used to identify women that had OVD, the location of delivery and the method of anaesthesia used.

Results There were 22793 deliveries. OVD rates fell from 571/4316 (13.3%) in 2005 to 573/4692 (12.2%) in 2009. 3122/22793 (13.7%) had an attempt at OVD and 2989/3122 (96%) were successful. The rate of successful OVD increased from 571/624 (91.5%) in 2005 to 573/589 (97%) in 2009 (p<0.0001). The number of women requiring rotational OVD increased from 114/4316 (2.6%) in 2005 to 142/4692 (3.0%) in 2009. 286/2989 (9.6%) had pudendal nerve anaesthesia for OVD and 2703/2989 (90.4%) had regional anaesthesia. The use of pudendal nerve anaesthesia remained constant 53/571 (9.3%) in 2005 to 53/573 (9.2%) in 2009. The number of women that had an attempt at OVD in the maternity operating theatre increased from 271/624 (43%) in 2005 to 290/589 (49%) in 2009 (p=0.04).

Conclusions Since the publication of RCOG Green Top Guideline more women are likely to have a successful OVD. The number of women that require rotational OVD has increased and this has in part may have contributed to more women requiring OVD in the maternity operating theatre.