Information is presented from hospital visiting reports with focus on Caesarean section and vaginal instrumental delivery rates from training units in European countries during the period 1999-2023. In a considerable number of countries training units were audited more than once, allowing assessment of trends in both obstetric interventions. There is a notable rise in Caesarean section rate in a number of European countries, with the highest rates in Poland (55.1%), Turkey (54.8%) and Greece (48.6%). Conversely Caesarean sections were low in France (19.3%) associated with a higher rate of instrumental vaginal delivery rates. Some countries like Germany and Poland have high variability in their rates, indicating fluctuations or regional differences over the years. Vaginal instrumental delivery rates varied across countries having very low rates (Turkey with 1.0% and Poland with 1.2%) and others having relatively high rates (like Switzerland, France and Belgium). Germany and Belgium showed a balanced use of both Caesarean sections and vaginal instrumental deliveries but with considerable variability in both practices. Countries in Central Europe display marked differences in Caesarean section rate: Hungary 37.8%; Slovakia 34.5%, Czech Republic 27.5% and Slovenia 20.7%. Apart from Poland (1.2%), differences in vaginal instrumental delivery rate between these countries are relatively small with Hungary 2.7%, Slovakia 2.8%, Czech Republic 2.9% and Slovenia 2.9%. Low instrumental delivery rates have major effect on the quality of training for the trainees in their formative years. Having a limited experience in this area of clinical practice would influence their future clinical obstetric practice.

1st Department of Obstetrics and Gynecology Aristotle University of Thessaloniki Papageorgiou General Hospital Thessaloniki Greece and President European Network of Trainees in Obstetrics and Gynaecology Leuven Belgium

Chief Perinatal Centre of the institute for the care of mother and child 3rd Medical School of Charles University of Prague Czech Republic Chief WHO Collaborating centre in perinatal medicine Prague Czech Republic and Chair EBCOG Standing Committee on Training Recognition Leuven Belgium

Visiting Gynaecologist Spire Murrayfield Hospital Edinburgh Scotland United Kingdom Past President EBCOG and Chair EBCOG Standing Committee on Standards of Care and Position Statements Leuven Belgium

Visiting Obstetrician Department of Obstetrics and Gynaecology Erasmus University Medical Centre Rotterdam the Netherlands and Past chair EBCOG Standing Committee on Training Recognition Emeritus Council Member of EBCOG Leuven Belgium

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