Maternity advocates question need for induction study 

A research programme run by the Rotunda Hospital offering home inductions to women with a healthy pregnancy has been criticised for encouraging unnecessary medical treatment.  Picture: Mark Stedman/RollingNews.ie

A research programme offering home inductions to women with a healthy pregnancy has been criticised by advocates for encouraging unnecessary medical treatment.

The research programme is run by the Rotunda Hospital in Dublin. 

An information leaflet sent to pregnant women states: “You have been asked to take part in this study because you are a first-time mother with no major complications in your pregnancy.” Usually, inductions are carried out if a baby is overdue, a woman’s water has broken but labour has not started, or the health of either the baby or mother is at risk, according to the HSE and NHS in Britain.

The hospital hopes to enrol 465 women over the next two years and the research is being run by Master of the hospital, Professor Fergal Malone.

The leaflet tells women: “If you agree to take part, we will assign you a date for induction of labour between 39+0 and 39+4 weeks (based on your assigned due date).” 

The study will compare the benefits of two approaches with women assigned randomly to each method. 

The first uses a Propess device to release the hormone prostaglandin to prepare the cervix for labour.

The second involves inserting a Dilapan-S’ device into the cervix which expands to stretch the cervix.

Starting induction in hospital and continuing at home does happen here and in the UK but usually for clinical reasons.

'Unclear aim'

Almost 200 women have contacted maternity advocacy group AIMS Ireland to complain about the research, including dozens of midwives, said spokeswoman Dr Kyrisa Lynch.

“We are very disappointed to see this type of research being carried out here. You’d hope we would be advancing the Maternity Strategy rather than moving towards medicalising normal women,” she said.

Dr Lynch said the overall aim of the study is unclear from reading this pamphlet.

This study has caused some outrage among the birthing community, it is flying in the face of everything we have done with the Maternity Strategy.

Midwife and founder of Gentlebirth advocate Tracy Donegan said: “If you have complications at 39 weeks or something comes up with your baby then induction is brilliant and it would be good to start that at home.

“But if you are going through a healthy pregnancy and are without a medical reason to interfere, then why would you do this?” 

She said a three-arm trial comparing induction with midwifery care and working with a doula would be more useful in her opinion.

Induction should be reserved for women with a complicated pregnancy or where the baby needs to be born early. 

Research known as the ARRIVE trial is presented uncritically in the leaflet to support this project, but both Ms Donegan and Dr Lynch stressed there is a large body of work raising concerns around unnecessary inductions.

They both said this is already a difficult time for women due to Covid-19 and questioned the need for more procedures.

The Irish Examiner understands pregnant women were telephoned and offered this option in recent weeks.

A spokesman for the Rotunda Hospital said: “Unfortunately, there is no-one currently available to discuss this matter with you.”