A package of care to actively manage labour in women who are at low risk of complications to reduce caesarean section rates

Many countries have an increasing rate of caesarean section. Higher rates do not always give additional health gains, they can increase maternal risks and affect subsequent pregnancies. Active management of labour has been proposed to reduce the number of caesarean births. Active management includes routine amniotomy (artificial rupture of the membranes), strict rules for diagnosing slow progress, use of the intravenous drug oxytocin to increase contractions of the uterus and one-to-one care. The disadvantages of active management are that it can possibly lead to more invasive monitoring, more interventions and a more medicalised birth in which women have less control and less satisfaction. The review included seven trials involving 5390 women. These studies show that women who received active management were slightly less likely to have a caesarean section and were more likely to have shorter labours (less than 12 hours). There was no difference in the number of assisted deliveries, nor was there any difference in complications for mothers or their babies when comparing women in the active management group with those receiving routine care.