Managing difficult labor: avoiding common pitfalls

The suggestions offered in this article represent an effort to reduce the incidence of cesarean delivery for dystocia while maintaining a safe course to vaginal birth. Avoiding difficult labor induction in which a compelling indication is lacking, providing prompt and effective oxytocin therapy of arrested first stage labor, and liberalizing the use of oxytocin therapy in selected cases of second-stage arrest are emphasized. With the widening use of conduction analgesia, indicated operative vaginal delivery has an increasingly important role in tempering cesarean birth rates. Operative vaginal delivery can play an effective role only when strict conditions to insure its safety are met.