Obstetric labor management begins when the woman is first admitted. Many obstetricians or midwives are comfortable using ultrasound in the labor and delivery suite to verify the clinical examination. In the active phase of labor, the rate of progress in terms of cervical dilatation is a function of parity. This chapter discusses active management of labor. Progress in labor is commonly evaluated by plotting cervical dilatation and the descent of the presenting part against time. If marked cranial deflection is accompanied by abnormal labor progression, disproportion is likely, and cesarean delivery is normally the best management choice. Lesser degrees of deflection are common in many ultimately successful labors, especially in posterior and transverse presentations. Appropriate management protocols for oxytocin and epidural anesthetic use, makes it possible to provide adequate analgesia for a large percentage of labors and permit nearly normal labor progression with a low level of intervention.