Normal labor and the induction and augmentation of labor.

The management of labor is based on a sound understanding of labor's biochemistry and physiology. The interaction between prostaglandin synthesis and other mechanisms postulated to control the initiation of labor shows promise, but the definitive explanation for the initiation of labor awaits further research. The procedures associated with the management of routine labor, including perineal preparation and the use of enemas, intravenous fluids, and analgesics and anesthetics, are generally best applied on the basis of individual need rather than protocol. The Friedman labor curve and intrapartum risk scoring have proved to be useful indices in the evaluation of the course of labor. Oxytocin and prostaglandin are two clinically useful agents in the induction and augmentation of labor. Currently, prostaglandin is used generally in the induction of preterm labors with oxytocin reserved for the induction of labor at term. The effects and side effects of the medications may be controlled by careful use and monitoring. A protocol for the successful use of oxytocin includes careful fetal monitoring and control of intravenous infusion with careful incremental increases in the dose of oxytocin based on uterine response.