Reduction in the rate of cesarean birth with active management of labor and intermediate-dose oxytocin.

Active management of labor (AML) was introduced to lower the cesarean birth rate in nulliparas by using oxytocin at a dose higher than commonly used in this country but less than that used in other AML studies. Cesarean birth rates among nulliparas were compared before and after introduction of AML. When indicated, oxytocin was begun at 2 mIU/min rather than 6 mIU/min, as used in other, similar studies. Three-hundred fifty-two historical control and 160 AML study patients in labor were compared. Analysis utilized chi 2 and Student's t test. AML patients had a lower rate of cesarean birth, 6.3%, than did control patients in spontaneous labor, 13.1% (P = .03). The overall cesarean birth rate for all nulliparas (including inductions and cesarean sections prior to labor) fell from 23% to 16% (P = .04). The introduction of an AML program using intermediate-dose oxytocin into the clinic service at a large, private teaching hospital has safely reduced the rate of cesarean births among nulliparas.