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.”

Criticism

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.

Fergal Malone PA / Alamy PA / Alamy / Alamy

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.

‘Maximising choice’

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.

National guidelines

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”.