Amniotomy is used routinely to induce and accelerate labour. It involves penetrating the vagina with an amniohook, an obstetric instrument resembling a crochet needle, designed to break the waters surrounding the baby in the womb.
Irish obstetricians generally accelerate the pace at which women labour through "active management". This requires all women having their first child to undergo amniotomy.
The system, which is highly cost-effective, obliges women to dilate at the rate of one centimetre per hour and mandates hourly vaginal examinations. After two or three hours in the labour unit, if the woman does not maintain this pace, she will be put on a drip of Syntocinon, a synthetic form of the hormone oxytocin, which causes increased contraction of the womb. Active management enables the time of birth to be predicted to within 30 minutes; this allows each woman to be allocated a student midwife.
The system excludes natural or non-interventionist birth. The midwife's role is to implement consultants' orders. "Military efficiency, but with a human face" is how its architects, Drs Kieran O'Driscoll, Declan Meagher and Peter Boylan, describe active management.