Obstetrical vacuum and forceps are incredible tools, when used correctly, to assist vaginal delivery. Appropriately selected and used, they can be pivotal in reducing the number of unnecessary cesareans and potentially decreasing certain fetal and maternal complications. However, there are several pearls of wisdom to remember when using them. In this episode, we will focus on a rare – but potentially fatal – complication of vacuum use: subgaleal hemorrhage. Although subgaleal hemorrhage can occur following normal birth processes, and even cesarean section, vacuum use is the strongest independent factor for its occurrence. In this, we will review these pearls of wisdom and the importance of detecting neonatal subgaleal hemorrhage quickly.