It was a weekend in January when an expectant mother knew she needed to attend hospital. She had been experiencing contractions for 24 hours, staying at home during this time because “they tell you to wait as long as possible before going into hospital”.After a night of no sleep due to the pain from her “freight train contractions”, she attended a Dublin maternity hospital. She wasn’t dilated, she was told, and was encouraged to go home.“I asked them what they could give me to help with the pain because it was so excruciating. She said paracetamol, a hot water bottle or a hot shower. But I said I had them at home so we went home,” the mother said.While at home, the mother said she was “incapacitated” by the pain. After another sleepless night, she went back to the hospital the following morning.“I went in and I was begging for pain relief, but they said I still wasn’t dilated enough. I remember jumping up and down between contractions to try and open things up,” she adds.Eventually, she was admitted to hospital and was given gas and air, followed by an epidural. Her son was born six hours later.“Everybody knows a birth is not going to be easy. But the system feels very rigid, and there needs to be some flexibility,” she said.“I don’t think anyone would say paracetamol is sufficient when it comes to real, genuine labour pain. It’s like bringing a paper knife to a gun fight.”The issue of how labour is managed in the Irish health system has come to the fore following an article published by The Irish Times earlier this month in which Peter Boylan, a former master of the National Maternity Hospital, called on the HSE to revise the National Clinical Practice Guidelines on Labour “without delay”.Boylan 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.Describing the concept of latent phase of labour as “dangerous”, Boylan said women were lying in antenatal wards or being sent home in pain while getting regular contractions.He argued that if a woman has 1cm dilation and is getting strong contractions, then she is in labour and that the phrase “latent phase” should be removed from the guidelines.However, the HSE has disputed Boylan’s evaluation of the guidelines. Cliona Murphy, clinical director of the HSE National Women and Infants Health Programme, said he 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 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 told RTÉ.She said it was “absolute nonsense” to suggest that someone might be refused pain relief. However, some women have come forward with stories of their labour, describing the fear, anxiety and “unnecessary, prolonged pain” they have experienced.One woman, who did not want to be named, gave birth in a Dublin maternity hospital eight weeks ago. When she attended the hospital, she said her contractions were three minutes apart and were 30 to 40 seconds long. However, the midwife said she was only 1cm dilated and that she could go home or wait in the waiting room.“A room with 15 people in it. I was in visible pain [and] this felt utterly embarrassing to me. Nonetheless, I know my body, and I opted to stay given I lived 45 minutes away,” she said.When she was in too much pain to put her clothes back on, she asked her husband to help. He too was concerned about the extent of pain she was in. They asked the midwife to reassess her.“To her surprise, I was 3cm and progressing quickly. I was brought to the labour ward and my baby was born four hours later.”Another mother said she attended a Dublin maternity hospital when she was 2cm dilated, after more than 10 hours of contractions. They arrived home at 11pm, but the pain became so intense, they returned to the hospital at 2am.“We weren’t being admitted; they wanted to send us home, but I was refusing,” she said, stating that while in the triage area she began vomiting profusely, experiencing dehydration and crying out for help and pain relief.It was 4am before she was admitted, but she experienced a stressful two hours in the meantime.“If I didn’t get turned away in the first instance, I would have got the proper care. By the time I was actually admitted, it was an hour and 15 minutes later when she was in my arms. A lot of things were rushed that led to a stressful birth that didn’t need to be stressful.”According to Krysia Lynch, co-chair of Aims Éire, a maternity advocacy group, this is not a new phenomenon, and if the HSE admitted every woman who was having contractions they “wouldn’t have the resources”.“If they stay, they’re put wherever there’s space for them. Sometimes it’s better for women to go home because the waiting space leaves a lot to be desired. Many women will be told there is no pain relief in these spaces,” she said.“Women do report they were screaming for epidural. Then they feel guilty that they came in too late and can’t get it. But then they don’t want to be too early and sent home. It is such a difficult decision to know when to come in. If people are concerned in the first part of their labour, it colours the whole thing.”Lynch said there is a need for more community-based midwives who can attend women in their homes to assess and reassure them.“Our maternity system is not designed for early labour. So much stress would be removed if there were these midwives who can give guidance on next steps.”In a statement, the HSE said it has “full confidence” in its labour guideline, which was 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.