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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 2: Low-Risk Cesarean Deliveries

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pregnant woman reviewing a chart with a doctorPrograms to Promote Active Management of Labor

MCH Strategy. Promote the initiation by providers of oxytocin infusion when cervical dilation is less than 1 cm per hour during active labor.

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Overview. Active management of labor (amniotomy within 1 hour of labor diagnosis and oxytocin initiation when cervical dilation <1 cm per hour) for low-risk nulliparous women reduced the rate of cesarean section delivery due primarily to a decrease in dystocia.1

Evidence. Mixed Evidence. Evidence of effectiveness of provider-based interventions excluding labor support is less clear. However, this strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Providers.

Outcome. Reduction of primary cesarean delivery rates among nulliparous women. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. There are currently XXX ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the strategy “Promote the initiation by providers of oxytocin infusion when cervical dilation is less than 1 cm per hour during active labor,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of providers trained in the advantages of oxytocin in active labor when cervix dilating less than 1 cm per hour.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of women receiving oxytocin in active labor when cervix dilating less than 1 cm per hour.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of women who received oxytocin in active labor when cervix dilating less than 1 cm per hour and delivered vaginally.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of women who received oxytocin in active labor when cervix dilating less than 1 cm per hour and delivered vaginally.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 López-Zeno JA, Peaceman AM, Adashek JA, Socol ML. A controlled trial of a program for the active management of labor. N Engl J Med. 1992;326(7):450-454.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.