A new Irish research project on the management of labour could make monitoring less intrusive and potentially reduce the number of needless Caesarean sections.
Led by Prof Deirdre Murphy, chair of obstetrics in the School of Medicine in Trinity College Dublin, the study is aimed at making childbirth safer.
“The overall objective of this project is to make childbirth safer while reducing unnecessary intervention in labour,” said Prof Murphy.
The project that has received €1m in funding from the Health Research Board of Ireland will focus on tests of foetal wellbeing in labour.
Hypoxia in labour happens when a baby does not get enough oxygen to its brain before, during or after delivery and it can lead to irreversible brain injury and death.
Doctors use cardiotocography in high-risk pregnancies to monitor the foetal heart rate but cardiotocography abnormalities are relatively common and can result in a decision to deliver by emergency C-section.
However, in as many as 60% of cases, the foetus has been found to have been compensating for the stress of labour and was not actually compromised.
Foetal blood sampling is a more invasive secondary test that involves taking a blood sample from the scalp of the unborn baby.
In clinical guidelines in both Britain and Ireland, foetal blood sampling is regarded as a gold standard test but recent studies have questioned its validity and reliability, as well as the logistical challenges of getting a result quickly.
Foetal scalp stimulation is another test of foetal well-being in labour and involves the examiner using an index finger to stimulate the scalp for 30 to 60 seconds. The test is less invasive and produces results quickly.
Foetal scalp stimulation is highlighted as an alternative to foetal blood sampling in new Irish guidelines but there is a lack of evidence to support one test over another.
Prof Murphy wants to compare the two tests in a multi-centre randomised controlled trial to see how they compare.
If the study shows that foetal scalp stimulation is as good as or superior to foetal blood sampling then it could be used to change and improve the way labour is managed in maternity services worldwide.