- Objective The objective of this study was to investigate the association between failed vacuum procedures and long-term pediatric neurological morbidity of the offspring (up to the age of 18 years). Study Design We performed a population-based cohort study to assess the risk of long-term neurological morbidity, including children who were born following either a successful operative vaginal delivery or a failed procedure leading to an emergency cesarean delivery. Results A total of 7,978 neonates underwent operative vaginal delivery during the study period, meeting the inclusion criteria. The procedure resulted in a successful vaginal delivery in 7,733 (96.9%) cases, while it failed in 245 (3.1%). Total neurological morbidity was comparable between the study groups (3.0 vs. 3.3%, p = 0.8). The Kaplan–Meier survival curve exhibited no difference in the cumulative incidence of total neurological morbidity (log rank, p = 0.967). In the Cox's regression model, a failed vacuum delivery was not associated with an increased long-term neurological morbidity, as compared with a successful procedure, after adjusting for confounders (adjusted hazard ratio: 1.04, 95% confidence interval: 0.5–2.1, p = 0.922). Conclusion A failed vacuum delivery does not appear to be associated with an increased risk for neurological morbidity of the offspring studied up to 18 years following the event.