Assessment of mother and fetus in labour

The management of labour used to be largely expectant—“wait and see” or “never let the sun set twice on a labouring woman,” implying that a labour taking up to 48 hours was acceptable. Labours of this length are often emotionally traumatic for women, may hide hazards to the fetus, and are very demanding on staff resources. In the 1960s, '70s, and '80s O'Driscoll and colleagues promoted “active management” of labour for women in their first labour. This management emphasised:

• A policy of non-interference for women not definitely in labour;

• Regular assessment of cervical dilatation;

• Early intervention, with artificial rupture of membranes and infusion of Syntocinon if labour progressed more slowly than 1 cm/h;

• One to one care with a skilled birth attendant

Subsequent studies showed that, although thisapproach reduces the length of labour bya small amount, the onlycomponent with a clear benefit in promoting spontaneous vaginal birth is the continuous presence of the birth attendant. Women have declared their intolerance of long labours, however, by increasingly requesting delivery by caesarean section. In many major maternity units in the developed world, the rate of caesarean sections is now 16% or higher. In the United Kingdom this process has been accelerated by the ChangingChildbirth initiative, which emphasises the importance of maternal preferences.