BMJ 1994;309:366-9 (6 August)

Papers

Active management of labour: current knowledge and research issues

J G Thornton, R J Lilford 

Institute of Epidemiology and Health Services Research, University of Leeds, Leeds LS2 9LN.

Abstract

Objectives : To review the evidence that the package of labour interventions collectively called "active management" - namely, strict diagnostic criteria for labour, early amniotomy, early use of oxytocin, and continuous professional support - reduce rates of caesarean sections and operative vaginal delivery in first labours.
Design : Review of observational data, supplemented by evidence from four separate overviews of relevant randomised trials previously published as part of the Cochrane Collaboration pregnancy and childbirth database.
Results : Observational data do not permit a clear conclusion. There have been no randomised trials of the total package of active management or of the use of strict diagnostic criteria alone, but trials of early amniotomy, early oxytocin, and these interventions combined do not suggest that these interventions are effective in reducing rates of caesarean sections or operative vaginal deliveries. In contrast, the provision of continuous professional support in labour seems to reduce both types of operative delivery, although the effect on caesarean sections is confined to those settings where non-professional companions are not normally present in labour.
Conclusions : Delivery units should endeavour to provide continuous professional support in labour, but routine use of amniotomy and early oxytocin is not recommended.

Practice implications

  • Practice implications

  • Some or all of the components of active management of labour have been adopted by hospitals in the United Kingdom since the 1970s

  • Perinatal mortality has fallen with no obvious increase in infections, but the rate of caesarean sections and instrumental deliveries has risen

  • Several randomised controlled trials of the components have been carried out; this study analyses their results

  • Provision of continuous professional support in labour seems to reduce rates of caesarean sections and operative vaginal deliveries, but early amniotomy and early oxytocin do not

  • Delivery units should provide continuous professional support in labour, but amniotomy and early oxytocin need not be used routinely


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This article has been cited by other articles:

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