Continuous audit is the most important component

Editor-Active management of labour was developed in the 1960s as a method of preventing prolonged labour.1 Over the subsequent 30 years the approach has been constantly modified and now includes the package described by J G Thornton: antenatal classes, early diagnosis of labour by senior midwives, amniotomy when membranes are intact before the onset of labour or at admission to the delivery ward (70%), selective acceleration of slow labour with oxytocin, personal support in labour by midwives, liberal availability of epidural anaesthesia, and regular rounds by senior obstet- ricians.2 The one factor that Thornton does not mention and that was not tested in the trial carried out in Boston (which Thornton does mention) was regular audit of outcome at the most senior level in the hospital.

The randomised trials conducted so far have clearly shown that active management, even when not introduced in its full …