Management of the first stage of labor: potential strategies to lower the cesarean delivery rate.

To review management strategies associated with lower risk for cesarean delivery. Targeted literature review for labor interventions during the first stage of labor. There is evidence that policies regarding labor admission criteria, standardized policies regarding labor management including judicious use of oxytocin, standardized terminology and treatment for electronic fetal monitoring, standardized criteria for dystocia, and systematic implementation of policies that incorporate continuous supportive care during labor are associated with lower risk for cesarean. Evidence regarding use of amniotomy is conflicting. Management of the first stage of labor can affect the risk for cesarean delivery.