In Reply

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In Reply:
We thank Dr. Davis for her interest in our study1 and for the opportunity to respond to her letter. We agree that forceps delivery is becoming a lost art; this is one reason that our department recruited senior obstetricians to train residents in the labor and delivery department. Unfortunately, we cannot reliably ascertain from our database whether the forceps deliveries were rotational or midpelvis. Our best guess is that very few were midpelvis or involved rotation more than 45 degrees. Similarly, we could not reliably verify the final cervical dilation in all patients who underwent cesarean delivery, so we could not report the outcomes for the subgroup of women who achieved full dilation. However, given that operative vaginal delivery is performed only in these women, we suspect the effect of senior obstetrician supervision would have been more pronounced in this cohort.
As to the author's question of “why bother,” we firmly believe that dedicated educational programs can increase forceps rates and reduce the cesarean delivery rate. Many of the residents who trained during the time period of our study are now junior attendings at our institution and are using forceps in their own practices as well as training the current residents. Our hope is that this program will continue to have a snowball effect and reverse the trend of decreasing operative vaginal delivery and increasing cesarean delivery seen in this country and in our institution.
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