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Active Management with Pitocin Does Not Reduce Cesarean Rate

BOSTON (Reuter)- A technique in which women are given large amounts of contraction-inducing drugs to speed up labor may not be as effective in reducing the likelihood of a Caesarean section as doctors once thought.

A comprehensive study of the technique, known as active management of labor, has concluded from tests on 1,934 women giving birth to their first child that aggressively administering the drug oxytocin did not reduce the rate of Caesarean sections. Oxytocin is produced by several companies.

Active management of labor was pioneered at the National Maternity Hospital in Dublin; its reputation for reducing the need for the surgical delivery of a child has prompted some insurance companies to recommend it be used in other centers.

``Although the active-management protocol did have some benefits -- such as shorter labor and a decreased occurrence of maternal fever -- our data do not provide justification for that recommendation,'' said the researchers from Boston's Brigham and Women's Hospital led by Dr. Fredric Frigoletto.

The study, to be published in Thursday's New England Journal of Medicine, was done between 1991 and 1993, just as researchers at Northwestern Memorial Hospital in Chicago were reporting in the Journal that they were able to bring the Caesarean section rate down from 14.1 percent to 10.5 percent using active management.

The Chicago study involved only 705 women and patients in the active management group were treated in the same place, by the same staff as women given conventional treatment.

Frigoletto and his team said they used the active management technique with separate staffs and separate treatment areas ``to guard against the bias that could result if the same staff simultaneously cared for patients in labor under both the active-management and usual-care protocols.''

Both studies were conducted against a backdrop of growing concern about the rate of apparently unnecessary Caesarean sections in the United States. In the past two decades, the number of women who have had babies delivered surgically has risen from five percent to about 25 percent, with no clear health advantages to either the babies or the mothers.