A former head of Ireland’s National Maternity Hospital has called for an urgent review of national maternity guidelines, warning that current recommendations on diagnosing labour could increase the risk of serious harm to mothers and babies.
Dr Peter Boylan said the existing clinical guidance on the early stages of labour should be reconsidered, arguing that it may contribute to adverse outcomes and expose the State to increased medical negligence claims.
Speaking after outlining his concerns in an opinion article, Dr Boylan said it was in the interests of Jennifer Carroll MacNeill to initiate a review of the guidelines.
He warned that without changes, the healthcare system could face more cases involving avoidable complications. “It needs to be looked at because from the state’s point of view this is going to result in more litigation because there will be more adverse outcomes,” he said.
Dr Boylan referred to the Ockenden Report in the United Kingdom, which examined maternity care failures and found that more than 500 mothers and babies suffered avoidable harm or died. The report identified shortcomings in fetal monitoring, clinical decision-making and oversight procedures.
According to Dr Boylan, Ireland should avoid adopting practices linked to those failures. His primary concern centres on current guidance defining the first stage of labour as beginning only when the cervix reaches four centimetres of dilation.
He argued that expecting women to remain at home until reaching that point is impractical because they cannot determine cervical dilation themselves. He also questioned recommendations that fetal heart monitoring does not routinely begin until labour is considered established at four centimetres, saying delayed monitoring could increase risks for babies.
Ireland introduced standardised maternity care guidelines following the launch of the National Maternity Strategy in 2016. The guidance is developed through the National Women and Infants Health Programme in partnership with the Institute of Obstetricians and Gynaecologists and is updated periodically.
Dr Boylan said the continued use of the term “latent phase of labour” is outdated. He explained that the concept originated from research conducted in the 1950s by American obstetrician Emanuel Friedman, whose observations later became widely adopted in maternity care.
He believes more recent research has shown that relying on the concept can delay recognition of active labour and leave women without appropriate assessment or monitoring. He said women experiencing strong contractions, even with less than four centimetres of dilation, should not automatically be told they are not in labour or be sent home.
The retired obstetrician has written to the HSE and the Institute of Obstetricians and Gynaecologists calling for the terms “latent phase” and “established labour” to be removed from national guidance. He also said future guidelines should better distinguish between first-time mothers and women who have previously given birth.
The HSE had not issued a response to the concerns at the time of publication.
