A HSE clinical director has rejected concerns raised by the former master of the National Maternity Hospital regarding the health service’s labour guidelines.
In an article published in The Irish Times at the weekend, Peter Boylan, the former master of the National Maternity Hospital, called on the HSE to revise the National Clinical Practice Guidelines on Labour “without delay”.
One guideline he expressed concern about relates to the definition and management of the early stages of labour.
He took issue with “the retrograde and harmful concept of a ‘latent phase’ of labour”, which he said means a woman is not regarded as being in “established labour” until her cervix is dilated to 4cm. Boylan described the concept of a latent phase of labour as “dangerous”.
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Speaking on RTÉ Radio 1’s Morning Ireland, Cliona Murphy, clinical director of the HSE National Women and Infants Health Programme, said Boylan had “cherry-picked one particular facet of a guideline and not the totality of the guideline which has checks and balances, which has safety netting and describes transfer of care very carefully”.
Murphy said there are 27 guidelines rather than one and these emerged from a “rigorous programme of guideline development” carried out in collaboration with the Royal College of Physicians in Ireland. She said there is a “multidisciplinary writing team and they have peer review”.
“I think Peter has overinterpreted the guideline,” she said, adding that “a number of aspects” of the wider guidelines had not been emphasised.
Boylan told the same programme there were women lying in antenatal wards or being sent home in pain while getting regular contractions.
He said these women have been told they are not in “established labour yet because your cervix isn’t 4cm” and “therefore your baby is not getting monitored as closely as it should do and you’re not getting access to pain relief”.
“If a woman is 1cm in labour and getting strong contractions, she’s in labour. She’s not in latent phase.”
He said the phrase of “latent phase” of labour “should be excised from the guidelines”.
Murphy said she was “absolutely confident” that women were going to be listened to when in labour.
“Obviously, if they’ve regular contractions and they are 2cm and wish to be admitted, that’s absolutely appropriate and what Peter fails to recognise is that things have moved on in Ireland. Women are involved in their care.”
She said it was “absolute nonsense” to suggest that someone might be refused pain relief.
“If anybody wants to be admitted, wishes to transfer care to an obstetric model of care, that’s totally appropriate.”
In his article, Boylan wrote about the “truly shocking” Ockenden review, which “found that more than 500 mothers and babies suffered avoidable harm or died” at Nottingham University Hospitals NHS Trust in England.
Boylan told RTÉ the review made it “crystal clear” that the latent phases played “a large part in many of the catastrophic outcomes”.
Murphy said it was a “very worrying report”, but added that “it was not about just latent phase or 4cm”.
Instead, she said, there was a “multiplicity of failures” identified including poor triage, misdocumentation, inappropriate communication, and lack of oversight and management.
She said she wanted to “reassure” women that “this notion that they may not be listened to, they may not be admitted that is erroneous and misinterpretation of the facts”.
Boylan has contacted the HSE in writing about his concerns. He said he had not raised them with the Health Information and Quality Authority, but would be contacting Minister of Health Jennifer Carroll MacNeill about the matter.
In a statement, the HSE said “the HSE National Women and Infants Health Programme has full confidence in the robustness and safety of its Midwifery Management of Labour guideline”.
It said this guideline was specifically designed to support the care of women with uncomplicated, normal-risk pregnancies who choose a midwifery-led model of care. It said the guideline does not prevent hospital admission, limit access to pain relief or replace clinical judgment.
The HSE also said there are clear safety measures, care pathways and escalation processes, including specific considerations for women whose labour may progress more rapidly.
