During vacuum extraction, the operator should deliberately rotate the cup to turn the fetal head.

The supplied material advises traction in line with the pelvic axis and perpendicular to the plane of the cup, and specifically says to avoid attempts at rotation. Rotation is expected to occur by **autorotation** as traction and descent proceed. Twisting or oblique movement can increase risk and is listed among actions to avoid.\n\n**Key takeaway:** Use aligned traction; do not twist the vacuum cup to rotate the head.\n\n**Glossary:** **Pelvic axis**: The curve followed by the birth canal; **autorotation**: Rotation accompanying descent without deliberate twisting of the instrument.