Birthrights has published its response to NICE’s draft guideline on induction which recommends that all women and birthing people should be offered induction at 41 weeks. It also recommends that groups at increased risk of complications, including black and brown women, those aged 35 or over, women with a high BMI, or after assisted conception, should be offered induction at 39 weeks.
Birthrights argues that the proposed guideline takes no account of the fact that many women and birthing people already feel pressured or even coerced into having an induction and that the quality of choice conversations around induction is generally poor.
In addition, the proposals downplay the fact that many individuals experience induction as being more painful, and that it closes down options such as giving birth at home or in a birth centre.
Birthrights argues that, given the current evidence base, whilst induction should be available to those that want it, waiting for labour to start is an equally valid choice. Organisations such as NICE and clinicians should not presume to make the decision on behalf of an individual and their family, when the absolute risk of an adverse outcome remains low. The role of healthcare professionals is to help explain all the risks and benefits of the various options to enable the person who is pregnant to make an informed decision.
We are particularly concerned about the proposal to single out black and brown women for earlier induction given the lack of evidence that induction improves outcomes for these women and their babies. Given the evidence we have received in response to our racial injustice inquiry about how particular ethnic groups are stereotyped and “othered” we are very concerned about the impact this could have on the trust black and brown women have in maternity services. Through the inquiry we have heard numerous examples of black and brown women not being offered any choice at all, having their choices denied or consent overridden, and being ignored or dismissed when they raised questions or concerns about care. We realise the NICE committee is constrained in its terms of reference to look at induction only but the needs of black and brown women, and other groups who have worse outcomes need to be addressed holistically.
The NICE consultation closes at 5pm tomorrow (6th July) and we would encourage as many individuals and organisations as possible to respond. If you are not registered as a stakeholder and would like us to include your comments in our response please send your comments to us by 4pm today (5th July).