The use of a drug which speeds up labour is cited in a substantial number of medical negligence claims against maternity units, according to a new report.
However, there is still no national guidance on the use of this drug, Syntocinon, even though one of the greatest risks to patient safety is having different practices between hospitals.
The warning has been issued by the State Claims Agency which handles compensation cases brought against health staff.
A HIQA report is due on standards of care in the maternity unit in Portlaoise Hospital. It emerged in 2013 that four babies died there over six years in similar circumstances after foetal distress was either not recognised or acted on during the mother's labour.
The women were given the drug Syntocinon to accelerate labour but it can potentially lead to a further drop in oxygen.
The State Claims Agency found that the lack of a national guideline on its use is a deficit.
It found that one maternity unit had no guidance on its use; 13 had guidelines; six had local policies; five had protocols; three had procedures; one had a checklist. "No service obtains explicit written consent from women prior to starting them on the drug," it found.
When it comes to monitoring a woman in labour who has been given the drug, the majority of units said they provided guidance for staff.
But two of the units said they had no guidance on monitoring available.
Most of the units said they had explicit guidance on the dosage to be given but one had none.
The State Claims Agency's clinical risk adviser Mary Godfrey said this was of particular concern given that the drug is listed as one of 10 high-alert medications.
The report said there is now a real opportunity to put this information to use in drawing up a national guideline, which maternity hospitals should follow in giving the drug.
Ms Godfrey said that standardisation is the key to improving outcomes for women and their babies while also reducing the number of claims.