A major new study, which could make childbirth safer around the world, has been launched by Trinity College Dublin (TCD).

The study will focus on tests of foetal wellbeing during labour, with the aim of making monitoring less intrusive and potentially reducing the need for unnecessary interventions, such as caesarean sections.

The researchers explained that hypoxia in labour, which occurs when a baby does not get enough oxygen to its brain before, during, or after delivery, can lead to irreversible brain injury and death.

In order to monitor this, doctors use cardiotocography (CTG) in high-risk pregnancies to monitor the foetal heart rate, allowing early intervention if necessary.

CTG abnormalities are relatively common and can lead to the decision to deliver the baby by emergency caesarean section. However, in as many as 60% of cases, the foetus is subsequently found to have been compensating for the stress of labour and was not actually compromised. In other words, a caesarean section was not actually needed.

Foetal blood sampling (FBS) is a more invasive secondary test that requires a blood sample to be taken from the scalp of the foetus. This provides information on the acid-base status of the foetus, reflecting hypoxia.

It is used to provide either reassurance that labour can continue, or more objective evidence that delivery needs to be expedited. Clinical guidelines in Ireland and the UK treat FBS as a gold standard test. However, recent studies have questioned the validity and reliability of FBS, not to mention the logistical challenges of achieving a result in a timely manner.

Foetal scalp stimulation (FSS) is an alternative test of foetal wellbeing in labour, in which the examiner stimulates the foetal scalp with the index finger over a period of 30 to 60 seconds. It is less invasive, gives results quicker, which is key in emergency scenarios, and can be incorporated into a standard vaginal examination performed by a midwife or obstetrician.

It has been highlighted as an alternative to FBS in new Irish guidelines, but there is a lack of evidence to support one test over another.

This new study aims to compare FBS with FSS to determine their impact on caesarean section rates, as well as a range of other things, such as low Apgar scores and admission to special baby care units.

If the findings of the study show that FSS is as good as or superior to FBS, then this have the potential to change and improve the way labour is managed across maternity services worldwide.

According to the study's lead researcher, Prof Deirdre Murphy of TCD, almost 70,000 babies are born every year in Ireland and adverse birth-related events include cerebral palsy, perinataI death, and maternal morbidity and mortality.

"These outcomes impose a huge physical, emotional and financial burden on affected families, the health service and society in general.

"The overall objective of this project is to make childbirth safer while reducing unnecessary intervention in labour. This is a landmark clinical trial for midwifery, obstetrics and neonatology that has the potential to have a positive impact globally," she explained.

The project recently received almost €1 million funding from the Health Research Board (HRB).