Caesarean delivery in the second stage of labour: Revisit the past

doi:10.1136/bmj.333.7571.753-b

BMJ 2006;333:753-754 (7 October), doi:10.1136/bmj.333.7571.753-b

Letter

Caesarean delivery in the second stage of labour

Revisit the past

The first 150 words of the full text of this article appear below.

EDITOR—For me as a general practitioner to respond tothe editorial by Spencer et al may seem surprising,¹ but theeffects of poorly managed labour spill over into primary carewith general practitioners having to pick up the pieces of anexhausted woman having endured a 48 hour labour, a failed forcepsdelivery, and, finally, a caesarean section.

The focus of the management of labour seems to have shiftedfrom ensuring the outcome of a healthy mother and healthy babyto the more nebulous outcome of a positive or meaningful experiencein keeping with the philosophy of patient choice. It is faultylogic to examine outcomes of the second stage of labour in isolation.Each stage requires monitoring and its own set of decisions.In the National Maternity Hospital in Dublin active managementof labour set out to describe and manage what these should be.²This led to . . . [Full text of this article]

Dermot Ryan, general practitioner principal

Woodbrook Medical Centre, Loughborough LE11 1NH DP.Ryan@gp-c82070.nhs.uk

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