OBJECTIVE To evaluate the immediate maternal and neonatal outcomes associated with sequential instrumental delivery (vacuum plus forceps) compared with the use of one instrument only (forceps or vacuum). METHODS A longitudinal observational study was carried out, including all instrumental deliveries performed in term singleton pregnancies, in vertex presentation, at station level 0 or +1. According to the type of the instruments, the deliveries were divided in three groups: the vacuum group, the forceps group and the sequential group. Immediate maternal and neonatal outcomes were evaluated. RESULTS A total of 275 instrumental deliveries were performed: 126 (45.5%) vacuum assisted deliveries, 62 (22.6%) forceps assisted deliveries and 87 (31.6%) sequential deliveries. Regarding maternal morbidity, there was a significant difference between the three groups (p < 0.001), with a higher rate of complications in the sequential group. The type of instrument was the only factor associated with significant maternal morbidity. The rate of immediate neonatal morbidity was 4.4% and there was no significant association with the instrument type or with other identifiable factors. CONCLUSIONS Sequential delivery is associated with a higher maternal morbidity and it seems not to increase neonatal morbidity.