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Most drugs have been found to be excreted in human breast milk. Usually when the drug is taken in therapeutic amounts for short periods of time by the mother, the levels of the drug in breast milk are sufficiently low to be of little hazard to the infant. However, is a breast-feeding infant should become ill or fail to thrive and the morbidity cannot be explained, one of the following should be done: 1. Discontinue the drug. 2. Discontinue breast feeding. Frequently this can be accomplished on a temporary basis with the mother pumping her breasts to maintain lactation while the response of the infant is monitored. 3. Collect maternal plasma, breast milk, and infant plasma samples for drug assay. In situations in which this can be accomplished, it may be possible to incriminate (or exonerate) a drug or one of its metabolites as the source of the morbidity on the basis of the amounts of drug found in the milk or the infant's plasma. As tedious and impractical as this approach may seem, it would eventually lead to the accumulation of a reasonable amount of data from which could be drawn sensible conclusions about the effect of drugs on the breast-fed infant.

For 300 years the use of midforceps by skilled obstetricians was the safest alternative to the prolonged, arrested second stage of labor. In the past 30 years the use of oxytocin augmentation for dysfunctional labor, the declining morbidity of cesarean section, and the greater skill of obstetricians in performing the abdominal rather than the vaginal operation have established cesarean section as the less hazardous method for dealing with most cases of abnormal second stage of labor. To prove conclusively that cesarean section is the safest method of delivery in all such cases a prospective, randomized study must be done.

The proper management of a patient in whom preterm delivery seems imminent includes the following. 1. Transfer of the patient to a tertiary perinatal hospital, if necessary and if safe 2. Prompt and skillful ultrasound examination for accurate estimation of fetal weight and gestational age 3. Consultation with the neonatologist regarding pharmacologic adjuvants to improve neonatal outcome 4. Meticulous intrapartum monitoring and physiologic support of the mother and her fetus during labor 5. Adequate pain relief and psychological support, with no specific form of analgesia or anesthesia being contraindicated simply because of preterm labor 6. The liberal but not universal use of cesarean delivery to avoid trapping of the fetal head in breech presentation (EFW less than 1,500 g) and to promptly deliver any fetus threatened by asphyxia 7. Skillful resuscitation of the newborn, especially those at the border of neonatal viability.