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Recording available 2/16-5/2
Recording available 2/16-5/2
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Abstract Award
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Poster Session 4

Category: Operative Obstetrics

Poster Session 4

(1243) Forceps Use in Flux: Trends in Assisted Vaginal Delivery Across the United States

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Objective:
To evaluate national and state-level trends in forceps-assisted vaginal delivery (FAVD) in the United States over the past decade.

Study Design:
This was a retrospective cohort study using 2014 and 2023 National Vital Statistics data from 48 states to assess FAVD rates in nulliparous term singleton vertex (NTSV) births. Connecticut and Rhode Island were excluded due to missing operative delivery data. For each year, the proportion of total deliveries that were operative vaginal deliveries (OVDs) was calculated, as was the proportion of OVDs performed via forceps. States were ranked by FAVD rate for each year. Change in rank order from 2014 to 2023 was assessed using Kendall’s Tau for ordinal association, with P< 0.05 considered significant. Analyses were performed using R version 4.4.1. 

Results:
There were 1,225,588 NTSV births in 2014, of which 13,161 (1.1%) were FAVD (17.7% of 74,428 total OVDs). There were 1,177,636 NTSV births in 2023, of which 9,388 (0.8%) were FAVD (15.6% of 60,268 OVDs). Overall, there was a 27.3% decrease in the rate of FAVD, and an 11.9% decline in the proportion of OVDs that were done via forceps. Utah (3.3%), Wyoming (3.3%), and New Jersey (3.2%) were the states with the highest rates of FAVD in 2014, and rates declined in almost all states by 2023 (Figure 1). However, 4 states had increased rates of FAVD (California, Massachusetts, Maine, and New Hampshire). There was a statistically significant shift in rankings (Kendall Tau=0.440, P< 0.001) for the 48 included states (Figure 2).   

Conclusion:
While FAVD rates have declined nationally among NTSV births over the past decade, state-level trends varied, with a significant change in rank order. These findings suggest evolving regional practice patterns and may inform future efforts to standardize training and access to operative vaginal delivery techniques.