In Egypt, the proportion of CSs has been steadily increasing in recent years and has reached an alarming level. According to data from the Royal College of Obstetricians and Gynaecologists (RCOG), approximately 6% of caesarean sections (CS) are performed on average because of inadequate supervision from junior staff members or a lack of training, particularly during the critical decision-making phase of this second stage. The unfamiliarity and lack of experience with operative vaginal delivery is a major cause for the rise in the rate of second stage caesarean section. This survey targets obstetricians with different levels of experience to find practical solutions to increase the rate of assisted vaginal delivery which subsequently will decrease the rate of second stage CS.

Egypt is a populous African country with a population of about 102 million people in 2020. Egypt has the highest cesarean section (CS) rate in the Middle East, which has increased from 20% in 2005 to 52% in 2014. Globally, the estimated number of births by Cesarean section (CS) increased from 16 million (12%) in 2000 to 29.1 million (21%) in 2015. Furthermore, during the same period, several studies have demonstrated a remarkable increase in the rate of second-stage cesarean section.

Whereas forceps-assisted vaginal delivery represented 38% of deliveries in rural areas of Egypt, in the United States, operative vaginal delivery in the form of either forceps-assisted vaginal delivery (FAVD) or ventouse-assisted vaginal delivery (VAVD) has declined remarkably since 1990. The utilization of operative vaginal delivery in live births decreased from 9.0% in 1990 to 3.1% in 2016. During the same period, the percentage of VAVD deliveries fell from 3.9 to 2.6%, and FAVD from 5.1 to just 0.5%. The declining rate of assisted vaginal delivery contributed to the rise in the cesarean section rate from 22.7% in 1990 to 31.9% in 2016.

The performance of AVB by physicians with a high level of experience and certified training courses should be considered a safe alternative to second-stage cesarean section. This does not only depend on the physician, but it also depends on the patient's preference. In this survey, the investigators explore Egyptian obstetricians 'attitudes and perceptions on AVB.

Inclusion Criteria:

• Obstetricians with at least 3 years of experience in practicing obstetrics
• Obstetricians with their primary health care facility being one of the three Tertiary centres, Ain Shams University Maternity Hospital, El Hussein University Hospital, and El Kasr Alaini Hospital

Exclusion Criteria:

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Obstetricians from three tertiary maternity hospitals in Cairo, Egypt. The three hospitals are Ain Shams University Maternity Hospital, El Hussein University Hospital, and El Kasr Alaini Hospital