Active management of labor

Active management of labor is a system designed to ensure labor progression and intervene to decrease dystocia, particularly in the first stage. The benefits of shorter labor and reduced maternal and neonatal infection rates without a concomitant increase in other maternal or neonatal morbidity are proved benefits. A consistent decrease in the cesarean delivery rate has not been statistically demonstrated with active management of labor. Epidural use may impede the active management of labor in select patients but oxytocin may help to overcome slow progress caused by this form of analgesia. Despite the use of early amniotomy, high-dose oxytocin, and frequent cervical examinations, patients seem to be satisfied with shorter labors. Because recent studies of the active management of labor may differ in their individual components as compared with that originally described at the National Maternity Hospital in Dublin, caution is advised when evaluating the efficacy of this management system. Overall, it seems clear that a system that includes patient education, a disciplined approach to labor diagnosis and management, indications for intervention, and peer review of outcomes has been and will continue to be of great benefit to women and children.