Before I ever learned how to use rotational forceps, I learned what they sounded like.

That unmistakable clunk as the rotational forceps gently rotated the fetal head within the pelvis. Like clicking your tongue.

Standing quietly at the end of the bed as the observing registrar, I remember wondering whether this could possibly end well. Surely that wasn’t the neck? My consultant, however, never seemed remotely concerned.

As the head delivered, there was a brief silence before the obstetrician and the newly delivered baby found themselves staring directly into one another’s eyes with expressions of almost identical surprise. Somehow, what had begun as an occipito-anterior position had ended as an occipito-posterior one. I suspect every obstetrician has heard some version of that story.

It remains one of my favourite memories of training. Not because it represented textbook obstetrics, but because it reminded me that even extraordinary clinicians occasionally have nature play a practical joke on them. Their greatness was never that they were incapable of surprise. It was that nothing rattled them. Mother and baby were perfectly well, everyone had a laugh and, by the time we walked out of the room, I had learned something far more valuable than the mechanics of rotational forceps. I had learned what confidence really looked like.

Long before that birth, however, Dr Kathy Saba had already taught me the first lesson, and her voice still rings in my head.

“Proper Preparation Prevents Piss Poor Performance.”

Before there was even the faintest suggestion that an instrumental birth might be required, her tray was immaculate. Every instrument had its place. Every swab had been counted. Every possibility had been anticipated. She was teaching us more than simply how to arrange a tray. She was treating us how to respect.

And who could forget Dr Aldo Vacca?

Watching Aldo teach ventouse birth was like watching someone solve a puzzle that everybody else thought required force. He taught us that success was measured in millimetres. Cup placement was never approximate. Every decision reflected an understanding of anatomy that seemed almost instinctive. It was impossible to watch him without appreciating that operative vaginal birth has very little to do with strength and almost everything to do with precision. It is wonderful that his legacy continues through his family, ensuring future generations of obstetricians continue to benefit from what he devoted his career to teaching.

Professor Ted Weaver taught something different again.

Before reaching for an instrument, Ted would often gently rotate the fetal head manually. “Dial the head,” he’d say, invariably accompanied by a series of unmistakable sound effects that I’m convinced he copyrighted many years ago. Anyone fortunate enough to have trained with Ted can still hear them today. It looked deceptively simple, until you tried it yourself and discovered that the fetal head hadn’t been reading from the same textbook. Watching Ted work was a lesson in restraint. There was never unnecessary force, only patience, exquisite judgement, and an understanding of labour earned over thousands of births.

Accordingly, when it came time to perform my own first outlet ventouse, I realised I wasn’t standing there alone. I had dozens of mentors standing beside me in spirit. Every obstetrician knows that feeling.

Our teachers never really leave the birth suite. Their voices become part of our own internal dialogue, surfacing exactly when we need them most.

One of the unexpected pleasures of becoming a consultant came years later, watching a registrar perform a beautiful instrumental birth for the first time. There is a particular satisfaction in seeing a trainee begin to trust both the instrument and themselves, and in witnessing the pride that accompanies a perfectly judged birth.

That is precisely why high-quality training in operative vaginal birth remains so important. Instrumental birth is not simply another procedural competency to be ticked off during specialist training. Performed poorly, it has the potential to leave lifelong physical and psychological scars for both mother and baby. Performed well, however, it can avert fetal compromise within minutes, spare a woman an unnecessary caesarean section, shorten a difficult second stage, and occasionally make the difference between a good outcome and a devastating one.

There are few moments in obstetrics more professionally satisfying than completing a carefully judged, technically elegant instrumental birth. Not because the obstetrician has demonstrated technical prowess, but because the intervention has achieved exactly what it was intended to do: safely bringing a mother and her baby through a difficult moment with the least possible harm. The finest instrumental deliveries are often the ones that attract the least attention. They appear almost inevitable, as though the birth simply unfolded as nature intended.

If we allow operative vaginal birth to become a neglected skill because it is technically demanding, feared, or infrequently taught, women will ultimately pay the price. There are circumstances in which no simulation, no guideline, and no emergency caesarean birth can replace an obstetrician capable of performing a safe instrumental birth when time matters. Preserving that capability is not about nostalgia or professional pride. It is about preserving options for women and babies when they need them most.

Patients should never feel as though they are the first real lesson. By the time a trainee performs an instrumental birth independently, countless hours should already have been invested in workshops, simulation, observing experienced clinicians, and understanding the nuances of technique. We should not be practising on our patients. By the time a woman entrusts us with her birth, she deserves an obstetrician whose hands have already been shaped by simulation, repetition, observation, and outstanding mentorship. We should be striving to ensure that, when the occasion finally arises, our trainees are as close to ready as it is possible to be.

The forceps and the ventouse are only ever tools. The real art has never been the instrument itself. It has always been the judgement to know when to intervene, the skill to intervene well, and the wisdom to recognise when not to intervene at all. Those qualities cannot be manufactured overnight. They are patiently handed from one generation of obstetricians to the next.

That, to me, is the art worth preserving.