A Controlled Trial of a Program for the Active Management of Labor

OVER the past two decades, the rate of delivery by cesarean section in the United States has risen from 5 percent to 25 percent. 1 , 2 The more frequent use of cesarean section has increased costs and maternal morbidity without decreasing the rate of cerebral palsy or birth-related injuries. 3 Numerous aspects of obstetrical practice have contributed to the increased cesarean-section rate, among them the frequency of elective repeat cesarean section, the use of electronic fetal monitoring, and the declining frequency of vaginal breech deliveries. 1 The single factor that has contributed the most to the increase in cesarean deliveries, however, is the increased . . .