Labor Management: Guidelines From the American College of Obstetricians and Gynecologists
Am Fam Physician. 2025;111(4):379-381
Author disclosure: No relevant financial relationships.
KEY POINTS FOR PRACTICE
• When active phase arrest occurs, cesarean delivery should be performed; second stage arrest should prompt consideration of operative vaginal delivery before proceeding to cesarean delivery.
• Neuraxial anesthesia should be offered for pain relief during any stage of labor because it does not reduce vaginal delivery rates.
• Because the continuous presence of a person for one-on-one emotional support during active labor improves outcomes, systems of care should integrate nonmedical support.
• In the second stage of labor, pushing should commence as soon as complete cervical dilation occurs.
From the AFP Editors
Nearly one-third of births in the United States are cesarean deliveries despite a greater risk of maternal morbidity and mortality compared with vaginal delivery. Labor dystocia is the most common indication for primary cesarean delivery. The American College of Obstetricians and Gynecologists released guidelines on managing the first and second phases of labor.
DEFINITIONS OF LABOR
The onset of labor is when regular and painful uterine contractions result in cervical dilation or effacement. Determining when labor shifts from the latent stage to the active stage is important for defining when active labor arrest has occurred.
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