NICE have recently published draft guidelines which changes the advice around when women should be induced in pregnancy.
The draft guidelines recommend that women with uncomplicated single pregnancies should be offered induction at 41 weeks and that induction should take place as soon as possible. Previous guidelines advised induction between 41 and 42 weeks, with close monitoring after 42 weeks for women who chose not to be induced.
Recent research compared induction times with pregnancy outcomes, and showed higher infant mortality after 42 weeks if the woman had not been induced.
The new guidance also recommends considering induction of labour from 39+0 weeks in women with otherwise uncomplicated single pregnancies but who are at higher risk of complications associated with continued pregnancy – for example, a BMI of 30 or above, maternal age of 35 or above, or women from Black, Asian or minority ethnic backgrounds, or after assisted conception.
With almost 5,000 stillbirths and neonatal deaths a year in the UK, we welcome any evidence-based efforts to reduce these unacceptable numbers and make pregnancy safer. Early induction of labour could be particularly important in reducing the risks for some of the most vulnerable mothers, such as over-40s and those with existing health conditions or where the baby is failing to thrive.
However, doctors and campaigners have raised concerns over the recommendation that inducing labour should be considered at 39 weeks in women from an ethnic minority background, even if their pregnancies are considered uncomplicated.
Black women are 4 times as likely as White women to die in pregnancy or childbirth, and women from Asian ethnic backgrounds have a two-fold higher risk.
The NICE committee admitted that in order to reduce health inequalities in maternity outcomes, more research needs to be done, but advocate for earlier induction based on their experience: “As there was not evidence to identify the optimal timing of induction in these groups, the committee made a research recommendation”.
Our Chief Executive Jane Brewin said:
“Women from Black and minority ethnic groups have higher mortality rates during pregnancy and childbirth than White women, and their babies are more likely to be stillborn or premature. Induction has an important role to play in making pregnancy safer, but the NHS must take urgent action to understand why some mothers from Black and minority ethnic groups aren’t having the safe pregnancies and births they should – and put in place things we already know make a big difference to the health of mothers and babies, such as having one midwife throughout their journey to parenthood, with ongoing risk assessments and frequent check-ups if needed.”
All mothers should get a clear explanation of why they’re being offered induction of labour and be supported to compare the risks and benefits of their other options. It is reassuring that NICE specifically highlights the importance of mothers being involved in the decision-making process; this is a vital part of improving maternity care and making the UK the safest place in the world to give birth.
The consultation on the new guidance has now closed, but it is understandable that some people may be worried by these proposed changes by NICE. However, being informed and understanding the procedure and care can help you to make the best-informed choices for you.
Evidence shows that, in some cases, inducing labour is the safest thing for you and your baby and can help reduce the risk of stillbirth. If your doctor or midwife believes this is the case for your pregnancy, they will offer you an induction. It is important to remember that it is your choice whether to accept this offer or not.
We have an ‘Always Ask’ resource that lists out questions you can ask your health professional to help you make the best decision for you and your baby.
For more information about induction and labour visit our support pages.