Trinity researchers examine medical intervention in maternity care

Two teams have reviewed different rates of childbirth intervention across various countries

Two Trinity led studies have investigated how a reduction in rates of caesarean section births could benefit maternity care services, and identified a significant variation in amounts of birth inducing drugs used in different countries.

The first study examined the cost implications of reducing caesarean sections (C-sections) rates among first-time mothers, along with improving rates of vaginal births after caesarean sections.

The funds saved could then aid the development of better maternity resources in Ireland, the study said.

The first study was led by Professor Patrick Moran, a senior research fellow in Health Economics in the School of Nursing and Midwifery in Trinity.

C-section rates throughout Europe have risen significantly over the last two decades. As well as being an important clinical issue, these changes in modes of birth may have substantial resource implications.

The study included women of the most active childbearing age (18-44), from Ireland, England and Wales.

The possibility of a 5% reduction in the number of c-section births was investigated, and it was found to lead to an economic saving of €1.1 million and £9.8 million in Ireland and England/Wales respectively.

If C-section levels were to reach a level comparable to that of “best performing” Scandinavian countries, a saving of €3.5 million per year in Ireland and £23.0 million per year in England/Wales would result.

Moran explained that these savings could be then used to improve maternity care services.

“Our results show that in addition to the reported clinical benefits, there is a significant economic benefit of reducing caesarean section rates among those for whom it is safe to do so in Ireland.”

“This can free up vital maternity care resources to strengthen maternity services in Ireland and improve outcomes for women, children and families.”

Trinity Professor Deirdre Daly has led a second study that reviewed and analysed the use of the labour inducing drug oxytocin across regimes used in 12 countries.

Oxycontin is used during induction (starting) and/or augmentation (speeding up) of labour; it causes stimulation of the uterine muscles, signalling contractions. Even after 70 years of its widespread use, there is still no agreement on an optimal infusion regimen during childbirth.

The drug can be potentially harmful, with serious consequences for mother and baby. Therefore, it’s vital that the appropriate rates are identified and administered.

The study analysed 16 regimes across 11 European countries and South Africa. Considerable variations were noted between rates of the drug used in different countries, and it was found that national regimens are only present in a handful of the countries.

It was found that just five of the countries analysed have a national oxytocin infusion regimen, (there is coherence in the use of the drug on a national level). Ireland has a national regimen, however one hospital uses an alternative regime.

The study also identified that over the 16 regimens, the total amount of oxytocin used over an 8 hour period ranged from 2.38 IU to 27.00 IU (International Unit, unit of measurement in Pharmacology).

In Ireland, the total amount infused in one regimen was 4.08 IU, just slightly above the lowest of the 16 regimens. In the hospital that does not follow the national regimen, the total amount infused was found to be 13.05 IU. This was the second highest amount in the regimes investigated, but very close to several of the other international regimens.

Daly said: “In the era of evidence-based health care, the fact that such widespread variation exists in the use of infused oxytocin, and in the total amount infused, reflects potential overuse in many settings.”

“All maternity care professionals are driven by the need to reduce avoidable maternal and neonatal morbidity and mortality, but it is crucial that intrapartum interventions designed to reduce risk for some who have complications are not used routinely for others who are healthy.”

Both Trinity studies prompt investigation into the use of intervention techniques during childbirth, to try and achieve some level of coherency internationally  in rates of caesarean section births and oxytocin administration.

Niamh Tiernan

Niamh Tiernan is the deputy SciTech Editor, and a Senior Sophister student of Zoology.