HSE dismisses former National Maternity Hospital master's concerns about labour guidelines

Peter Boylan warned in a recent opinion piece in the Irish Times that the new definition and management of the early stages of labour is so 'deficient' that it risks introducing into Irish maternity services problems that have led to unnecessary deaths and injury in the UK. File picture

The HSE has dismissed concerns raised by a former master of the National Maternity Hospital around its National Clinical Practice Guidelines on Labour.

Peter Boylan warned in a recent opinion piece in the Irish Times that the new definition and management of the early stages of labour is so “deficient” that it risks introducing into Irish maternity services problems that have led to unnecessary deaths and injury in the UK.

In his view, at issue is what he called the “retrograde and harmful concept” of a so-called “latent phase” of labour, a concept that defines when a woman is or isn’t in established labour but one that he believes is “clinically meaningless, but highly dangerous”.

Although the new guidelines came in more than a year ago, his comments followed the publication in the UK of the Ockenden review of maternity services at the Nottingham University Hospitals NHS Trust.

The review team identified recurring examples of what was described as “suboptimal care” in unborn baby fetal monitoring, assessment and management of the early stages, or latent stage, of labour.

It found that common themes found in assessing care during the latent phase included: “inappropriate communication, poor documentation, inconsistent local guidelines, unsupportive culture, clinical mismanagement and the inappropriate and untimely use of oxytocin”.

Clinical director of the National Women and Infants Health Programme, Dr Cliona Murphy pointed out that Dr Boylan has been “retired for 10 years”, and that “what Peter fails to recognise is that things have moved on in Ireland”.

Speaking on Morning Ireland, she said he “has over-interpreted the guideline” and “focused primarily” on the early stage of labour.

She said: “Women are involved in their care, women are advocates for their care, and midwives develop good relationships with women, so it's individualised care.

“It's the previous model where a slightly more paternalistic model, where women were told what was happening, and there was no discussion with women, that has gone with regards to pain relief care, which should be individualised.

“The National Women in Infants Health Program has a rigorous program of guideline development, so we don't just have one guideline, we have 27 guidelines.

“These are developed in collaboration with the Royal College of Physicians in Ireland. All guidelines are multidisciplinary, so there's a multidisciplinary writing team, and they have peer review.” 

She also described as “absolute nonsense” his claim that women experiencing painful contractions at home or in hospital antenatal wards are not being transferred to the labour ward because they have not met the 4cm dilation test.

She said: “Peter spoke about there might be declined pain relief, that is absolute nonsense. “If anybody wants to be admitted, wishes to transfer care to an obstetric model of care, that's totally appropriate.” 

She also said that, in Ireland, “midwives are the experts in normal birth, midwives see multiple labours (and) there is no need to be explaining to midwives the differences between types of births”.

Earlier on Morning Ireland, Mr Boylan defended his remarks.

He said: “My main concern is that when you look at the first stage of labour, which is the beginning of labour up to 10 centimeters dilation, the guidelines are saying that that doesn't start until a woman is at four centimeters dilation, which is 40% of the way.

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“In the meantime, a woman can either be sent home or she is kept in an antenatal ward in pain in the early stages of labour.

“The guideline also goes on to say that you don't need to start fetal monitoring until the first stage of labour starts, which is four centimeters.

“So that means that from zero to four centimeters, the woman, the baby, is not monitored under these guidelines, and that's dangerous.”