Objective To evaluate maternal and neonatal outcomes by attempted mode of operative delivery from a low station in the second stage of labor. Methods Retrospective study of 2,518 women carrying singleton fetuses at ≥37 weeks gestation who underwent attempted forceps-assisted delivery, attempted vacuum-assisted vaginal delivery, or cesarean delivery from a low station in the second stage of labor. Primary outcomes were stratified by parity and included a maternal adverse outcome composite (postpartum hemorrhage, transfusion, endometritis, peripartum hysterectomy, or intensive care unit {ICU} admission) and a neonatal adverse outcome composite (5 minute Apgar<4, respiratory morbidity, neonatal intensive care unit {NICU} admission, shoulder dystocia, birth trauma, or sepsis). Results In nulliparous patients the maternal adverse composite was not significantly different between women who underwent attempted forceps (12.1% vs.10.8%,aOR 0.77,95%CI 0.40–1.34) or vacuum (8.3% vs. 10.8%,aOR 0.68,95%CI 0.40–1.16) delivery compared to cesarean delivery. Among parous women, the maternal adverse composite was not significantly different with attempted forceps (10.7% vs. 12.5%,aOR 0.40,95%CI 0.09–1.71) or vacuum (11.3% vs. 12.5%,aOR 0.44,95%CI 0.11–1.72) compared to cesarean delivery. Compared to infants delivered by cesarean, the neonatal adverse composite was significantly lower among infants born to nulliparous women who underwent attempted forceps (9.4% vs. 16.7%,aOR 0.44,95%CI 0.27–0.72) but not among those who underwent vacuum delivery (11.9% vs. 16.7%,aOR 0.68,95%CI 0.44–1.04). Among parous women, the neonatal adverse composite was not significantly different after attempted forceps (4.1% vs 12.5%,aOR 0.28,95%CI 0.06–1.35) or vacuum (12.5% vs. 12.5%,aOR 1.03,95%CI 0.28–3.87) compared to cesarean delivery. Conclusion A trial of forceps delivery from a low station compared to cesarean delivery was associated with decreased neonatal morbidity among infants born to nulliparous women.