The most important element of "active management" during labour is simply the presence of a supportive person, researchers have concluded.

Active management of labour was introduced in the 1970s to reduce the rate of cesarean section. It is a very interventionist procedure which involves constant diagnosis, early amniotomy (breaking of waters) and early use of oxytocin (a drug to speed labour), as well as continuous professional support.

Researchers from the University of Leeds have concluded that, of all those procedures, only continuous support is necessary. They have recommended that amniotomy and oxytocin should not form part of the routine procedure, as they do not reduce the chances of a cesarean being performed.

Studying all the data available, researchers say that the use of oxytocin early during labour has shown side effects and no benefit.

"If oxytocin had been discovered in the 1990s we would not sanction its widespread use and would conduct further clinical trials," says the research team, led by Dr James Thornton.

But the presence of someone with the woman during labour and this could include the husband reduces the need for pain-killers and lowers the incidence of cesarean. Researchers point out that far more labours have ended in a cesarean when the woman has been on her own.

!ABMJ, 6 August 1994.