Active management of physicians

Birth International: “The Active Management of Labour”.

This is an informative, readable article on a bit of the history of the Dublin protocol of “Active management of labour” (AML), a set of interventions used by hospitals to increase labour ward throughput and efficiency by controlling and interfering with women’s bodies. Birth is expected to adhere to a very narrow set of time-based guidelines. First, the membranes are ruptured by the birth attendant at the onset of active labour, putting an artificial timetable on labour (as rupturing the membranes creates an infection risk if birth does not occur within a set period of time.) Any dilation of less than one centimetre per hour after that is pathologised (and the diagnosis “dystocia” is falsely made), considered to be due to “inefficient myometrial activity” (there is zero evidence for this), and “fixed” by administering high doses of synthetic syntocinon. These delivery rituals carry a host of risks, and I can confirm from personal experience that they are routinely being administered without informed consent.

AML has been promoted as a way of reducing caesarean section rates, but in the time period that Australian hospitals have been using AML, C section rates have soared. In the studies that “showed” AML to reduce C section rates, the effects may well have been attributable to the watched-doctor effect – when doctors’ decisions are very closely monitored and audited, C section rates fall. Rothman calls this “the active management of physicians”. Labour companions and midwifery-led woman-centred care are more effective in reducing C section rates. And the importance of the essential and major beneficial factor in AML protocols – a single midwife staying full-time with the mother – is being ignored by the hospital system, as they are pushed for staff and stretched too thin.


The Age today reports: “Protesters seek better midwife services”. 300 Maternity Coalition protesters marched today on Canberra, some travelling form as far as the Mornington Peninsula to make their voices heard. The women are demanding funding for midwifery care and a resolution to the midwifery indemnity crisis that prevents women accessing safe, professional birthing care. The government has sunk an enormous amount of money into bailing out medical indemnity, but shows no interest in exploring much more cost-effective, safe care.

A spokesman for Health Minister Tony Abbott said the government had no intention of changing the current arrangements.

Categories: gender & feminism, health, medicine

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2 replies

  1. I guess midwives are unlikely to vote for the Coalition, huh? The little tidbit about how obstetrician fees have exploded since the introduction of the Medicare safety net was the last straw. What is there to change indeed, Tony Abbott – let’s continue to rort the system AND end up with worse outcomes for more women and babies!

  2. Ha! of all people to make statements about BIRTH!
    bloody Abbott. fk him (well maybe not).

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