BMJ 1994;309:1015 (15 October)

Letters

Standards vary among institutions

EDITOR,--James G Thornton and Richard J Lilford's dissection of the package of active management of labour into its various components is like that of a mechanic trying to decide which component of a car's engine makes it go.1 The authors fail to realise that it is the sum of the parts that makes active management of labour a highly skilled form of management that requires expert handling to be effective and safe. Meta-analysis of active management of labour can give meaningful results only when applied to the whole of the package delivered appropriately by expert staff. Different institutions are as likely to show different outcomes as two different models of cars are likely to give different performances.

Amniotomy and oxytocin are vital components to active management but are too often applied inappropriately: amniotomy may be deferred for several hours after the patient has been deemed to be in labour, oxytocin . . . [Full text of this article]


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Relevant Article

Active management of labour: current knowledge and research issues
J G Thornton and R J Lilford
BMJ 1994 309: 366-9. [Abstract] [Full Text]

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