The authors review a protocol for the active management of labor, first developed by Kieran O'Driscoll, MB, and colleagues at the National Maternity Hospital in Dublin, Ireland, in 1969. This protocol is based on the principle that every pregnant woman would deliver within 12 hours of being admitted to the hospital. Although this approach to labor management has successfully reduced the number of cesarean sections performed in Dublin, Ireland, it has failed to do so in the United States, where active labor management has come under considerable criticism.