5. Instrumental vaginal delivery In case of a prolonged second stage of labor and for fetal bradycar- dia, use of instrumental delivery (vacuum need ceps) may help shorten the second stage of labor and reduce the for cesarean delivery [13, 14l. Instrumental delivery should only be attempted by care providers who are trained and qualified to recognize the indications, and are skilled and equipped to perform the procedure safely for mother and baby [13,15l.