Abstract Within the strict confines of randomized controlled trials, vacuum extraction has been shown to be a safe method for assisting a woman to give birth. Yet, in the area of general obstetric practice serious injuries associated with the procedure, such as subgaleal haemorrhage, skull fracture and intracranial injury, continue to be reported. There is little doubt that many of the problems and unfavourable results encountered after vacuum delivery are a consequence of incorrect use of the instrument and should, therefore, be preventable. Incorrect use of the vacuum extractor may occur for a number of reasons, namely, uncertainty of the indications for the procedure, lack of familiarity with the equipment, inadequate technique of vacuum extraction and a lack of awareness of the safety measures. This review examines these important issues and presents a number of strategies aimed at reducing the rate of complications associated with vacuum extraction.