The concept of active management of labor was first implemented by
O’Driscoll and colleagues at the National Maternity Hospital in Dublin in 1968
[1]. This management system contains both organizational and medical components
with physicians supervising normal spontaneous labor in nulliparous
women and intervening only when labor progress slows (Table 1) [1]. Several
institutions have implemented components of this management scheme with
varying results. Applying only certain tenets of the active management technique
may account for the differences in the cesarean rate and use of oxytocin
experienced by other investigators.
A source of great controversy, the active management of labor, as classically
defined, is routinely misunderstood and misapplied in many clinical settings.
Aggressive induction protocols, early amniotomy, operative delivery, epidural
analgesia, and even early admission to labor and delivery units are actions
frequently thought to be synonymous with ‘‘active management of labor.’’
To regain an understanding of the active management of labor, one needs to
examine the goal of this management scheme and become more familiar with
its components.
The concept of active management of labor was first implemented by
O’Driscoll and colleagues at the National Maternity Hospital in Dublin in 1968
[1]. This management system contains both organizational and medical components
with physicians supervising normal spontaneous labor in nulliparous
women and intervening only when labor progress slows (Table 1) [1]. Several
institutions have implemented components of this management scheme with
varying results. Applying only certain tenets of the active management technique
may account for the differences in the cesarean rate and use of oxytocin
experienced by other investigators.
A source of great controversy, the active management of labor, as classically
defined, is routinely misunderstood and misapplied in many clinical settings.
Aggressive induction protocols, early amniotomy, operative delivery, epidural
analgesia, and even early admission to labor and delivery units are actions
frequently thought to be synonymous with ‘‘active management of labor.’’
To regain an understanding of the active management of labor, one needs to
examine the goal of this management scheme and become more familiar with
its components.
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