Despite much discussion of the increase in elective caesarean rates over the past 20 years,1 ^w1 little attention has been paid to the rise in second stage caesarean section rates. The maternal risks of second stage caesareans include major haemorrhage, longer hospital stay, greater risk of bladder trauma, and extension tears of the uterine angle leading to broad ligament haematoma.2 Although second stage caesarean section is sometimes appropriate, many could be prevented by the attendance of a more skilled obstetrician.

Currently, obstetric trainees perform most of the second stage trials of instrumental delivery. A recent UK study found that decisions made by consultant obstetric staff are important in determining whether a second stage caesarean section is the optimum method of delivery for women with delay in advanced labour.3 The investigators found substantial differences between consultants' and specialist registrars' opinions on factors affecting safe vaginal delivery—such as position of the fetal head in …