The management of labour in the primiparous patient.

Dystocia continues to be the leading indication for caesarean birth. The active management of labour as developed in Dublin is one approach that could be applied to the problem. It is not generally appreciated, however, that the word 'active' describes the active involvement of the consultant obstetrician and not medical intervention with oxytocin infusions. In this article, the Dublin protocol is reviewed in broad perspective and is compared to more traditional North American methods of dealing with dysfunctional labour.