<it>Does not reduce the rate of caesarean section</it>

In the late 1960s, faced with rising numbers of hospital deliveries and staff shortages, obstetricians in Dublin introduced a package of care for first labours that they called active management.1 This included special classes preparing women for labour, strict criteria for determining onset of labour, psychological support, and regular supervision of the delivery area by senior staff. None of these measures was controversial, but the package also included some revolutionary changes: routine amniotomy, early recourse to high doses of oxytocin under supervision of a midwife to accelerate slow labours, and an undertaking that labour would never last more than 12 hours. Previously, amniotomy and oxytocin had been used only selectively by senior medical staff, and it had been assumed that limiting the duration of labour would result in more caesarean deliveries. The Irish obstetricians thought otherwise, and in a series of influential reports claimed …