Birth is, without a doubt, a physiological process. However, the normal processes of labour and birth exist alongside substantial risks from complications such as haemorrhage, infection, obstructed labour, and hypertensive disorders. The emergence of modern obstetrics brought profound improvements through advances in anatomy, anaesthesia, antisepsis, blood transfusion, antibiotics, and surgical techniques. These developments changed the landscape of maternity care and saved countless lives.
The twentieth century saw further transformation, with the increasing movement of birth into hospital settings and the development of sophisticated systems for surveillance, intervention, and emergency care. Caesarean birth, operative vaginal birth, fetal monitoring, and diagnostic imaging became important tools in reducing preventable maternal and neonatal morbidity and mortality. However, as the capacity to intervene expanded, so too did the responsibility to consider when intervention is beneficial, when it may be unnecessary, and how care can remain centred around the individual woman. This is even more important as patient autonomy, patient choice, and informed consent are the focus of modern obstetric care.
This edition of O&G Magazine brings together the expanding toolkit clinicians rely on as labour becomes more complex, maternal expectations evolve, and evidence continues to reshape practice.
The unifying theme is clear: operative birth is not a narrow set of procedures but a spectrum of skills that demand mastery, reflection, and adaptability.
Various operative birth techniques are covered in this edition. Articles on operative vaginal births and caesarean births will provide practical advice, and safety criteria and considerations, such as the Operative Vaginal Birth Safety Bundle, aim to ensure safe outcomes for mothers and babies. Technology continues to reshape intrapartum care. Ultrasound in labour offers real-time insights into position and descent, bringing objectivity to assessments once reliant solely on clinical feel. Enhanced Recovery After Surgery (ERAS) principles, now applied to caesarean birth, demonstrate historical shifts toward multidisciplinary perioperative care. Likewise, pain management during caesarean births reflects decades of progress in anaesthesia, patient comfort, and postoperative mobility. Although episiotomy rates are declining, this surgical procedure remains one of the most common in obstetric practice, and its pros and cons are discussed in this edition.
Sadly, complications can occur following any form of birth. Articles on the prevention and management of complications such as obstetric anal sphincter injury (OASI) will provide guidance on identification and repair. Readers will also gain an insight into the detection and management of pelvic floor injuries. As caesarean births have become safer, we are seeing a rise in their rates globally. These increased rates have been associated with an increasing incidence of placenta accreta spectrum (PAS). Readers will get the opportunity to review the latest international guideline on the caesarean scar pregnancy and the evolution to PAS.
Antenatal education has shifted to concentrate on the normality of pregnancy and labour. Patients should also be informed of what to expect if intervention becomes clinically necessary, to ensure comprehensive understanding and informed decision-making.
History shows that operative obstetrics has never been static. It is a craft shaped by innovation, reflection, and the lived experiences of women. This edition honours that lineage while challenging us to continue refining, questioning, and improving the care that we provide.
As this is my first Editorial as Chair and Editor of O&G Magazine, I would like to thank all members of the O&G Magazine Committee, the Publications team, and the contributors for their excellent work. The interesting and high-quality publications are testaments to their dedication and hard work.
I hope readers will find the articles stimulating and educational.
