(Abstracted from Eur J Obstet Gynecol Reprod Biol 2017;212:119–125)In case of malposition, both rotational forceps (RF) and manual rotation (MR) followed by direct forceps are used to perform rotational operative vaginal birth (OVB), but evidence regarding the safest and most effective method to assist birth in such cases is still unclear. Although higher rates of complications were reported with the use of RF in the past, in recent times it has been associated with high rates of successful vaginal birth and lower rates of adverse outcomes than alternative modes of birth.