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WOMEN SHOULD HAVE the option of having labour induced at 39 weeks and returning home, a consultant at the Rotunda Hospital has said.
Professor Fergal Malone, a former master of the Rotunda, said the Dublin maternity hospital will soon give women the option of having labour medically induced at 39 weeks – full term – and then returning home to begin their labour, if they choose.
At present, women whose labour is induced – using hormones or a device to dilate the cervix – stay in hospital for their entire labour, which could last two or three days. Induction is particularly used if a woman has not gone into labour by 41 weeks, two weeks past normal full term, or if her waters break but contractions do not start.
A new study conducted in the Rotunda and published in the prestigious Lancet medical journal concluded that healthy first-time mothers can safely labour at home after induction at 39 weeks, coming back into hospital to deliver the baby.
Malone said: “Our goal was informed choice – giving people choice on how to manage the end of pregnancy. We haven’t come out and said, ‘everybody should have an induction’. But we do believe that everyone should be told the benefits and the risks of both spontaneous labour and induced labour.”
The study was criticised in 2021, while it was still being conducted, by a Trinity College Dublin professor of midwifery and by an Irish patient advocacy group, among others. Critics of the research suggested an information leaflet told women more about the potential benefits than about the potential risks of agreeing to be induced as part of the research.
Critics also questioned the rationale for inducing labour at 39 weeks in healthy pregnant women rather than allowing them to go into labour spontaneously.
No changes were made to the information leaflet or any other element of the research as a result of these criticisms.
The study was funded with a grant from Medicem, a medical technology firm which makes a cervical dilator used in the research as one of two initial methods to induce labour. Funding was also provided by the charitable Rotunda Foundation. Neither funder had a role in trial design or any other element of the research.
Malone said it was true that people who have induced labour tend to have a slower labour and are more likely to have a caesarean section than those who go into labour spontaneously.
However, he argued that it was “simplistic” to therefore conclude that patients should “keep away from induced labour”. That’s because women cannot choose to have a spontaneous labour. Some women who wait past 39 weeks will end up being induced anyway at 41 weeks, when the baby might be heavier and harder to deliver vaginally.
“The correct comparison isn’t women who have spontaneous labour at 39 weeks versus women who are induced at 39 weeks; the comparison should be women who had induced labour at 39 weeks versus women who waited, who did nothing,” he said.
This comparison was investigated in a large study in the US six years ago, which found lower rates of c-section in the induced group (18.6%) compared with the group that waited (22.2%). There was no significant difference in the risk of death or serious complications.
The Rotunda study found that 25% of women who were admininistered either a dilator or a hormonal gel to induce labour ended up having a c-section. This compares with a 30-40% c-section rate in Ireland, and closer to 40% for first-time mothers, Malone said.
Malone said the findings in the new study represented a “significantly reduced” chance of c-section. He said women may ask for induction at 39 weeks because their baby is getting big or they can’t sleep, or for other reasons.
He said once the Rotunda’s day assessment unit is resourced to offer it, women will be able to go home after induction at 39 weeks, and this will be cheaper than keeping women in a prenatal ward.
HSE data shows that 31.1% of women who had a baby in 2021 were induced.
Malone said it was a “myth” that induced labour was more painful than spontaneous labour, and randomised trials had confirmed this.
Krysia Lynch, spokeswoman for the Association for Improvements in the Maternity Services – Ireland, a patient advocacy group, disputed the idea that induced labour was no more painful than spontenous labour, adding that it could mean women were more likely to need pharmacological pain relief.
She noted that the HSE’s guidlines on induction of labour, updated last year, recommend women with uncomplicated pregnancies should be offered induction of labour at 41 weeks.
The guidelines state that requests for induction from 39 weeks “should be considered, after discussing the benefits and risks with the woman, and taking into account the woman’s circumstances and preferences as well as the maternity hospital or unit’s resources and established care pathways”.
The guideline document states that induction “may impact on the need for pain relief as induced labour may be more painful than spontaneous labour”.
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Why do we continually need to interfere with nature? I had natural prolonged labour for which I was given two doses of oxytocin to speed it up! After the 2nd dose it sped it up alright so much so an emergency section that should have happened did not and my son was born with an erbs palsy. Had it nit progressed as normal the section would have happened and he would not have his disability. Let nature take its course.
@Lydia Mcloughlin: I’m sorry to hear about your little one’s disability. But birth mortality rates, both mother and baby, were a lot higher when humans used to just do it naturally. Following medical advice has reduced this drastically.
Irish maternity hospitals are overwhelmed and so obsessed with speeding up everything, a long natural labour is something they cannot afford hence the very high C section rate.
My first two births were emergency c sections. My third was an elective c section. Result was 3 healthy children now adults. Each time I got over the operation and got on with my life, and rearing my children. My eldest would have died had I not had a c section.
Ah comments open! in the comment closed app. And sorry to go off topic briefly everyone. And sorry everyone I’m new this and a little thick obviously. Can anyone tell me why 75% of stories on this app are closed comments? What is it. Is it an irish media thing, or legal thing. Can some explain like I’m a 10 year old. Very annoying. Thanks in advance
@Ian Mc: Why should they be open??? You do NOT have an automatic right to comment everywhere. Like writing a letter to a newspaper, you don’t have a right to get your views published. And also if many of the news items allowed comments the usual knuckle draggers would be out in force.
@Sean O’Dhubhghaill: Tell us more about what you don’t know about boxing, you absolute sap.
@Ian Mc: because some people cannot control themselves when it comes to topics like immigration etc
@YKwkSIqW: from Sean’s comments earlier, I think he knows quite a lot about boxing, but obviously has a different opinion to you and a lot of other people. I for one commend him for voicing his opinion in the face of such vitriol. No need for insulting remarks
@SYaxJ2Ts: Thanks, Kevin! :-)
@YKwkSIqW: I know that subjective judging in boxing has led to complete corruption at times, to such an extent that it can NOT be viewed with any form of objectivity and as such, in my opinion, is NOT a sport in any meaning of the word.
@Ian Mc: I’m sure the tone and content of Bronagh’s comment will go some way to answer your question.
@SYaxJ2Ts: From his comments earlier, he doesn’t have a clue about boxing or the judging system. You should also stay in your lane, Kevlad.
@YKwkSIqW: It seems the boxing judges don’t have a clue about boxing!
Starting to sound like America,
Funded by private medical companies.this isn’t about women’s health. It’s about profits. If it read doing it at 39 weeks and keeping them in hosp, maybe. Sending them home surely increases risk of infection, I have a serious problem with ex Masters making decisions also. Is he being paid by same company.
Since when was 39 weeks full term? 40 weeks is officially full term. So 41 weeks would be 1 week past full term. Inductions can be brilliant but considering that baby’s weight is an estimate, basing the need for one solely on the potential birth weight seems to be a bit off. I can understand if there’s other factors involved but not even letting woman go full term before suggesting it goes a little far. My understanding was previously induction was only mentioned if you were 40+10 or more on a “normal pregnancy” & only earlier if you had something like gestational diabetes.
@Susan Walsh: I wish I had a obgyn sensible enough to do an induction at 40 weeks. After a very healthy pregnancy I went 3 weeks/ 21 days overdue. When finally induced and after 23 hours in labour my baby became distressed and I was taken down to do a C section. At the last minute the doctor decided to do a high forceps delivery instead and my baby was born with brain damage. 38 years later my intellectually and physically challanged child and us her parents are still in the prison of that doctors making. Nowadays I would definitely opt to be induced at 39-40 weeks.
A word to the wise, if you are pregnant and choosing a birthing partner, make sure they are strong willed enough to stand up to medical bullying. Make them aware of your wishes so they can fight your corner.
Conveyor belt… Ready
Can we not just allow nature take its course! Everything in the world doesn’t need to be changed….. just for the sake of it!
@Niall Binéad: when you can get pregnant and carry a baby for 39-40 weeks, I hope I’d be around to see nature take it’s course. Until then you know nothing.
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