The former Master of the National Maternity Hospital has said new HSE guidelines on labour risk “baby deaths and severely traumatised mothers”.
The new guidelines pertain to the definition of latent and established labour and the care a woman receives in each phase.
Latent labour is when a woman’s cervix dilates up to 4cm, after which established labour begins.
On Newstalk Breakfast, Dr Peter Boylan said he has concerns that pregnant women will not receive the necessary care they need during latent labour under the new guidelines.
“What the guideline is saying is that she should not be admitted to the labour ward until she is four centimetres dilated,” he explained.
“In other words, 40% of the way [towards] completing the journey of the first stage.
“The guidelines also say that you do not need to institute intense foetal monitoring of the baby until four centimetres and also that it is perfectly acceptable for a woman to go home until she is four centimetres.”
View this post on Instagram
Professor Boylan continued that he fears such an approach carries significant risk to both the patient and her baby.
“How on earth is a woman supposed to know at home that she has crossed the threshold to beyond four centimetres?” he asked.
“It's impossible for her to know at home; so, she's wondering, should I go back in? Will I be sent home again?
“Also on antenatal wards, women are rolling around in pain and being told you're not in established labour yet.
“We can't send you over to the labour ward. In other words, you cannot access adequate pain relief, for example, in epidural.”
Professor Boylan further noted that the guidelines do not distinguish between a woman’s first and second labours, which he said “tend to be very different”.
“For example, about 60% of mothers on their first baby will deliver their babies within about eight hours if they're admitted into the labour ward,” he explained.
“Whereas women having their second or subsequent babies, 90% of them will deliver within six hours.”
Ockenden Review
Dr Boylan continued that Britain’s recent Ockenden Review into maternity services underlined that many maternal deaths can be avoided if the right clinical practices and care are in place.
“The Ockenden report makes very clear, with a whole series of catastrophic outcomes with baby deaths and severely traumatised mothers, that a theme right across the timeline of the review was women being told, ‘You're not in established labour yet, so we're not going to do effectively what should be done’,” he said.
“So, that is my problem.
“If a woman's cervix is one centimetre dilated and she's getting strong contractions, she is in labour and she needs to be in the labour ward, monitored and cared for by midwives and doctors, working together, not in separate units.”
Dr Boylan characterised the idea that a woman in latent labour does not need to be monitored by medical professionals as “quite frankly dangerous”.
He added that there are a significant number of women who have been “traumatised by their experience” of being denied access to the labour ward.
“They've been a long time suffering with an awful lot of pain, but denied access to the labour ward to adequate amounts of pain relief,” he said.
“When they do get over to the labour ward, they tend to be exhausted, dispirited, and just want the whole thing over.
“So, there's a lot of trauma out there among women who have been subjected to this philosophy and ideology about how you should manage care for women in the early stages of labour.”
In a statement to Newstalk, the HSE said it has "full confidence in the robustness and safety" guidelines for labour, which it said were developped through a "rigorous, multidisciplinary process" with medical professionals.
"The guideline is specifically designed to support the care of women with uncomplicated, normal-risk pregnancies who choose a midwifery-led model of care," a spokesperson said.
"It is important to stress that the guideline does not prevent hospital admission, limit access to pain relief or replace clinical judgement.
"Women are listened to, their concerns are taken seriously and decisions are made based on their individual circumstances; at all times, women can discuss their preferences with their care team, including admission, pain management and transfer to obstetric-led care where appropriate.
"The guideline includes clear safety measures, care pathways and escalation processes, including specific considerations for women whose labour may progress more rapidly."
Main image: A pregnant woman. Picture by: Tetra Images, LLC / Alamy.
