ObjectiveTo document operative vaginal delivery rates of ACOG Fellows and to stratify practice patterns with regard to mid-pelvic delivery and deep transverse arrest by the time elapsed since residency.MethodsA survey was mailed to a random sample of 1600 ACOG Fellows. Of the 597 respondents (37%), 558 who still practice obstetrics formed the study group. Selection bias regarding recipients of the survey was reduced by random-ization by an uninvolved third party. The length of time since residency was categorized as 10 years or fewer (“recent,” 31%), 11–20 years (“intermediate,” 43%), and more than 20 years (“remote,” 26%).ResultsThe majority of respondents (338 of 558, 61%) reported an operative vaginal delivery rate of 15% or less. One hundred forty-two (25%) use only forceps, whereas 78 (14%) use vacuum extraction exclusively. More than half have abandoned mid-pelvic operative vaginal deliveries, and of the 41% who still perform these operations, about half use forceps. In cases of deep transverse arrest, about 25% perform cesarean delivery, whereas 26% and 42% use forceps or vacuum, respectively. Resident training and practice in vacuum delivery were more common in the recently trained groups (recent > intermediate > remote;P< .001). There were no differences among the groups with respect to attempting mid-pelvic operative vaginal delivery (P= .29), but the remote group was more likely to use forceps, whereas the recent group was more likely to use vacuum (P= .039). A large disparity existed among the groups regarding the management of deep transverse arrest, with vacuum use associated with group assignment (P< .001).ConclusionsThe majority of respondents have an operative vaginal delivery rate of no more than 15%. Most respondents have abandoned mid-pelvic operative vaginal delivery. Practice patterns reflect differences in residency training; the more recently trained Fellows more often were taught and use vacuum for delivery.