A Cochrane review included 61 studies with a total of 12 819 subjects. Oxytocin alone compared with expectant management (6 660 women) reduced the rate of unsuccessful vaginal delivery within 24 hours (8.4% vs 53.8%, RR 0.16, 95% CI 0.10 to 0.25; 3 studies, n=399) but the caesarean section rate was increased (10.4% vs 9.0%, RR 1.17, 95% CI 1.01 to 1.35; 24 studies, n=6620). The use of epidural analgesia was increased when oxytocin alone was compared with expectant management or no treatment (RR 1.10, 95% CI 1.04 to 1.17; 10 studies, n=5150). Fewer women were dissatisfied with oxytocin induction in the one trial reporting this outcome (5.9% versus 13.7%, RR 0.43, 95% CI 0.33 to 0.56).