The decision to accelerate labour during childbirth is often performed without women’s informed consent, a new study by Trinity College Dublin (TCD) has found.

The team from TCD’s School of Nursing and Midwifery set out to explore women’s views and experiences of augmentation (speeding up) of labour with synthetic oxytocin (AOL).

Augmentation with AOL is an intervention that aims to accelerate labour which has begun spontaneously. It makes contractions longer, stronger and more frequent and is usually performed with an oxytocin drip after spontaneous or artificial rupture of the membranes.

It is indicated in the management of labour dystocia (difficult or obstructed labour). However, the World Health Organization has expressed concerns about its overuse. For example, more than 50% of first-time mothers have their labour accelerated in countries such as Norway and Finland.

The TCD research assessed 25 studies from 14 countries that had been conducted between 2004 and 2021.

The researchers found that the decision to speed up labour was often performed without women’s informed consent. Furthermore, women often described their experiences as atypically painful. In fact, the use of AOL was described fundamentally in negative terms, with words such as “traumatic” and “disempowering” used.

“Perhaps another surprising finding was that the vast majority of studies that we found did not focus specifically on AOL. However, women wanted to and talked spontaneously about AOL when recalling their childbirth experiences, suggesting that this was relevant for them.

“It is striking that AOL, one of the most commonly performed interventions that women may undergo during childbirth, has been given very little attention by researchers. Basically, we have been using AOL for more than 50 years without asking women their opinion about it,” commented the study’s lead author, Silvia Alòs, a PhD student at TCD’s School of Nursing and Midwifery.

She noted that books, data sheets and healthcare providers “usually describe that AOL causes similar contractions to those observed in spontaneous labour, but that is not what women recounted”.

The researchers concluded that clinical guidelines and hospital policies for augmentation need to be informed by research that includes women’s views and experiences as a main outcome.

“Access to information is key. When discussing the risks of AOL with women, healthcare providers should incorporate the potential implications that AOL may have on their childbirth experience. Looking ahead, we hope that clinical guidelines and hospital policies on AOL benefit from considering our findings,” Ms Alòs added.

This research is published in the journal, Midwifery, and can be viewed here.