**1. Introduction**

254 From Preconception to Postpartum

The Worldwide Atosiban versus Beta-agonists Study Group. (2001). Effectiveness and safety

Zingg, H.H., Rozen, F., Breton, C., Larcher, A., Neculcea, J., Chu, K., Russo, C. & Arslan, A.

of preterm labour. BJOG, Vol. 108: 133-42.

expression. Adv Exp Med Biol, Vol. 395: 395-404.

of the oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment

(1995). Gonadal steroid regulation of oxytocin and oxytocin receptor gene

The expectation of every pregnant woman is to undergo a spontaneous vaginal delivery with minimal or no resort to operative procedures at the end of pregnancy. For the majority of women this expectation becomes a reality. For some however, assistance is required either in the form of caesarean sections or operative vaginal procedures in order to avert adverse maternal and fetal outcomes. Assisting laboring women to deliver vaginally using specialized instruments is a practice that dates back several centuries. Forceps and ventouse are the most popular of the operative vaginal procedures with comprehensive documentation of their development and use in the lay and medical media. Procedures like symphysiotomy and destructive operations to remove a dead fetus are probably now materials for the waste bins of medical history. However some still argue for a place for them in modern obstetric practices especially in low income countries where the indications for their use may still be found (Maharaj and Moodley, 2002).

Instrumental vaginal delivery is a key element of essential obstetric care, scaling up its use in resource poor countries through training and supply of appropriate equipment is likely to contribute significantly to reduced maternal and newborn morbidity/mortality(Ameh and Weeks, 2009).
