Premature Birth and Induced Labour | Action Medical Research | Children's Charity

Premature birth and induced labour: boosting understanding gives new hope

First published on 22 November 2011

Updated on 9 November 2016

What did the project achieve?

“We’ve improved understanding of how a naturally occurring hormone called oxytocin helps to prepare a pregnant woman’s body for childbirth,” says Professor Andrés López Bernal of the University of Bristol.

The researchers believe their findings may one day lead to better ways to control labour, which may benefit women who go into labour prematurely and women who need to have labour induced (meaning labour is started artificially).

At the moment, if a woman goes into labour prematurely, little can be done to stop her baby from being born too soon. Over 61,000 babies are born too soon each year in the UK.1-4

One in five pregnant women has to have labour induced – if, for example, her baby is overdue or isn’t growing properly in the womb.5,6 Induction isn’t always successful and, when drugs are used to start labour, around 22 per cent of women have to have an emergency caesarean.5,6

“Oxytocin stimulates contractions of the uterus (womb), prevents bleeding after delivery and stimulates the production of breast milk,” says Professor López Bernal. “We have improved understanding of how oxytocin works, by revealing interactions with special proteins called growth factors and transcription factors. We plan to investigate this further in the hope of finding ways to improve women’s chances of having a successful delivery.”

References

1. National Institute for Health and Care Excellence (NICE). Preterm labour and birth final scope April 2013. http://www.nice.org.uk/guidance/gid-cgwave0660/resources/preterm-labour-and-birth-final-scope2 Website accessed 15 August 2016

2. Office for National Statistics. Statistical bulletin: Birth Summary Tables, England and Wales: 2015. Live births, stillbirths, and the intensity of childbearing measured by the total fertility rate. http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2015 Website accessed 15 August 2016.

3. ISD Scotland Data Tables (2015 data). Maternity and Births. Table 5 - Live births (all, singleton and multiple) by birthweight and gestation. http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/data-tables.asp?id=1543#1543 Website accessed 15 August 2016.

4. Northern Ireland Statistics and Research Agency. Births. Live births 1887-2014. http://www.nisra.gov.uk/demography/default.asp8.htm Website accessed 15 August 2016.

5. NICE. Clinical guideline [CG70] Inducing labour. July 2008 http://www.nhs.uk/Planners/pregnancycareplanner/Documents/NICE_induction Website accessed 25 October 2015.

6. NHS Choices. Inducing labour. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx Website accessed 25 October 2015.

This research was completed on 12 December 2015

Around one in 20 pregnancies worldwide ends with the mother going into labour too soon and having her baby prematurely.1 In contrast, one in every five pregnant women has to have labour induced.2 A dire lack of understanding of the natural processes that control labour and childbirth is limiting our ability to help. Professor Andrés López Bernal at the University of Bristol believes boosting understanding could eventually benefit women and their babies.

What is the problem and who does it affect?

Many pregnant women anticipate childbirth with a mixture of excitement and trepidation – hoping for an easy labour and healthy baby. Much attention focuses on the baby’s due date.

If a woman goes into labour too early or too late, her own or her baby’s health can be put at risk. Sadly, it is not always possible to help.

“When a woman goes into labour prematurely, there is little we can do to stop her baby from being born too soon,” says Professor López Bernal. Premature birth can have devastating consequences. Tragically, around 1,500 babies die in the UK each year after being born too soon.3-5,a,b Many others who survive a very early birth develop lifelong problems such as cerebral palsy, blindness and learning difficulties.

“If a baby is overdue, inducing labour is fraught with potential problems,” continues Professor López Bernal. “The need to use forceps is higher with inductions,6 for example, and about 22 per cent of inductions end with an emergency caesarean section.7” Labour can be induced for several reasons – if the baby is overdue or isn’t growing properly in the womb, if the mother’s waters have been broken for a while and if the mother has pre-eclampsia.

What is the project trying to achieve?

“A remarkable feature of the uterus – the womb – is that it remains relatively relaxed for the nine months of pregnancy, carrying the baby safely, and then, during labour, it contracts forcibly and the baby is born,” explains Professor López Bernal. “The biological processes that control this switch from relaxation to contraction are largely a mystery. We are hoping to boost understanding by studying the role of a naturally occurring hormone called oxytocin.”

Oxytocin is an ancient hormone, which can be traced back through 500 million years of evolution in creatures as diverse as mammals, marsupials and sharks.8 It is already used, with varying and unpredictable degrees of success, when attempting to induce labour.

“We are exploring a newly discovered action of oxytocin, which involves turning genes on,” explains Professor López Bernal. “Improving understanding could eventually lead to better control of labour, whether stopping or starting it, with potential health benefits for mother and child.”

What are the researchers’ credentials?

Professor Andres López Bernal, who has been studying childbirth for over 30 years, is an international expert on signalling pathways within the womb. He is collaborating with Professor Craig McArdle, an expert in how oscillating calcium levels within cells can turn on genes, a process that might occur during labour.

Project LeaderProfessor A Lopez-Bernal
Project team
  • Professor C A McArdle
LocationSchool of Clinical Sciences, University of Bristol
Duration3 years
Grant awarded22 August 2011
Start date1 January 2012
End date12 December 2015
Grant amount£195,773.00
Grant codeSP4612, GN1797

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References

  1. Beck et al. Bull World Health Organ, 2010, 88:31-38
  2. NICE guidelines for induction of labour, 2008 http://www.nhs.uk/Planners/pregnancycareplanner/Documents/NICE_induction...
  3. Office for National Statistics. Health Statistics Quarterly 35 (Autumn 2007), Table 2.1
  4. The Information Centre, Community Health Statistics. NHS Maternity Statistics, England: 2003-04, 2004-05, 2005-06
  5. ONS: Health Statistics Quarterly 28 (Winter 2005), 32 (Winter 2006), 36 (Winter 2007)
  6. Roberts et al. Paedriatic and Perinatal Epidemiology 2002; 16: 115-123
  7. Thorsell et al. Acta Obstet Gynecol Scand 2011; 90: 1094-9
  8. Gimpl & Fahrenholz, The Oxytocin Receptor System, Physiological Reviews 2001; 81: 629-683
    a. For England and Wales, deaths listed as due to “immaturity related conditions”.
    b. For Scotland and Northern Ireland, deaths listed as due to “disorders related to length of gestation and fetal growth”.
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