According to the protocol, women will not be admitted to the labor unit unless they are in progressive labor with effaced cervixes. By contrast, U.S. hospitals frequently admit women in very early labor or who are having prelabor contractions. Because progress is normally slow in early labor and nil if the mother isn't in labor, early admission plus impatience often equals unnecessary intervention. As originally conceived, active management assumed a minimal use of epidurals. The Dublin obstetricians believed that the promise of a 12-hour or less labor length would enable women to get through labor without pain medication, another thing they surely didn't consult women about.
Epidurals increase the cesarean rate for poor progress even when doctors practice active managment.
Active management also has serious drawbacks. At one stroke, deviation from the average has been defined as abnormal. Telling nearly half of laboring first-time mothers their bodies are incapable of birthing a baby without help could have significant psychological consequences. For example, the use of labor interventions, not surprisingly, links to postpartum depression. And high-dose oxytocin increases the chances of overly long, overly strong contractions, which, by depriving the baby of oxygen, can cause fetal distress and worse.