Vacuum devices can be used at the time of cesarean delivery to effect delivery of a high unengage fetal head or as an alternative to extension of the hysterotomy when delivery of the vertex is difficult. Once the head is visible through the uterine incision, the vacuum device can be applied directly to the vertex and delivery achieved with gentle upward traction in concert with fundal pressure. Although such an approach may reduce the risk of extension of the original hysterotomy, it is not recommended for all cesarean deliveries.