{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:26:25Z","timestamp":1781789185257,"version":"3.54.5"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We sought to compare severe neonatal morbidity associated with forceps versus vacuum birth among individuals with prior cesarean birth.<\/jats:p>\n                  <jats:p>We conducted a population-based retrospective cohort study using data on all full term, singleton, cephalic vaginal births among individuals with prior cesarean birth in the United States (2014\u20132021). The exposure was operative vaginal birth (forceps vs. vacuum) and the primary outcome was composite severe neonatal morbidity, defined as assisted ventilation\u2009&gt;\u20096\u2009hours, neonatal seizures, and Apgar score\u2009&lt;\u20094 at 5\u2009minutes. We primarily compared the distribution of severe neonatal morbidity among operative vaginal births by instrument (forceps compared with vacuum) and fit multivariable logistic regression models to obtain adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for severe neonatal morbidity in forceps versus vacuum births while accounting for confounders.<\/jats:p>\n                  <jats:p>The study population included 531,440 births. The rate of severe neonatal morbidity was 0.7% with spontaneous vaginal birth, 1.6% with forceps, and 1.3% with vacuum. Adjusted models showed higher rates of severe neonatal morbidity with forceps versus vacuum birth, but this association was not statistically significant (AOR: 1.20, 95% CI: 0.96, 1.50). Analysis of each component of the severe neonatal morbidity composite showed a 39% higher odds of assisted ventilation\u2009&gt;\u20096\u2009hours (AOR: 1.39, 95% CI: 1.07, 1.80) in forceps compared with vacuum births.<\/jats:p>\n                  <jats:p>Rates of severe neonatal morbidity are higher following operative versus spontaneous vaginal births with no difference based on type of instrument (forceps or vacuum). The choice between instrument should depend on the clinical situation, patient preference, and the experience, skill, and comfort of the operator.<\/jats:p>","DOI":"10.1055\/a-2682-6209","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T22:55:43Z","timestamp":1756335343000},"page":"751-760","source":"Crossref","is-referenced-by-count":1,"title":["Severe Neonatal Morbidity in Forceps versus Vacuum Birth among Individuals with Previous Cesarean Birth: A Population-Based Retrospective Cohort Study"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5747-0172","authenticated-orcid":false,"given":"Irina I.","family":"Oltean","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abirami","family":"Kirubarajan","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada"},{"name":"Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"H\u00e9bert","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth K.","family":"Darling","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada"},{"name":"Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, Faculty of Health Sciences, McMaster University, Hamilton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"D'Souza","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada"},{"name":"Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4618-0839","authenticated-orcid":false,"given":"Giulia M.","family":"Muraca","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada"},{"name":"Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Canada"},{"name":"Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Eugeniahemmet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"issue":"02","key":"ref3","first-page":"1","article-title":"Births: final data for 2022","volume":"73","author":"M JK Osterman","year":"2024","journal-title":"Natl Vital Stat Rep"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"262.e1","DOI":"10.1016\/j.ajog.2011.06.035","article-title":"Impact of multiple cesarean deliveries on maternal morbidity: a systematic review","volume":"205","author":"N E Marshall","year":"2011","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1097\/AOG.0b013e3181df925f","article-title":"Vaginal birth after cesarean: new insights on maternal and neonatal outcomes","volume":"115","author":"J-M Guise","year":"2010","journal-title":"Obstet 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