Active labor management includes all measures implemented to modify the course of a dystocic delivery, with the aim of decreasing the duration of labor and reducing the risk of cesarean delivery. These measures include the two we study here: artificial rupture of the membranes (also called amniotomy) and the use of synthetic oxytocin.

In the 1980s, under the influence of doctors such as O'Driscoll, policies of quasi-systematic augmentation of labor were introduced, particularly for nulliparous women [1]. These guidelines were based on Friedman's partogram [2], which described a linear progression of dilation with a minimum speed around 1.5 cm/h.

These practices began to be called into question at the turn of this century. Zhang observed that labor patterns varied from one woman to another and proposed a new partogram for nulliparous women, with a curve showing less linear progression and slower dilation speeds [3]. This work led to important changes in labor management between 2010 and 2016. In France, the rate of oxytocin use among women in spontaneous labor fell from 57.6 % in 2010 to 44.3 % in 2016, and amniotomies from 51.1 % in 2010 to 41.4 % in 2016 [4]

Adverse effects associated with the use of synthetic oxytocin include uterine hyperstimulation with a dose-dependent effect [5], fetal heart rate abnormalities that can lead to neonatal hypoxia [6] and increase the risk of the infant's admission to a neonatal intensive care unit (NICU) [5], uterine rupture with fetal and maternal consequences [7], and postpartum hemorrhage (PPH) [8]. These effects induce an increase in emergency cesarean sections, often through uterine hyperstimulation that is responsible for fetal heart rate abnormalities [5,6].

In 2014, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine published a consensus statement of recommendations for obstetric management to prevent first cesarean deliveries [9]. They advocated that cervical dilation not be considered to have failed and intervention not be considered before 6 h have elapsed without progress.

In this context, new French recommendations concerning the administration of oxytocin during spontaneous labor, were issued in December 2016 [10]. It was based on observational studies including parturients at term, with no history of cesarean delivery, singleton pregnancy, and cephalic presentation.

These recommendations led the maternity unit of the Paris Saint-Joseph Hospital to modify its protocol starting in January 2017, with the aim of limiting active interventions during labor (especially in the latency phase) and allowing longer times until progress can be deemed to have failed, based on the national recommendations.

The primary objective of this study was to assess the association between the changes in labor management practices after the implementation of a new protocol within the department and the vaginal delivery rate among women with spontaneous labor. Secondary objectives were to evaluate the adhesion to the new protocol through changes in labor management practices, and the association between the protocol and the duration of labor and the rates of PPH and neonatal outcomes.