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).
We are heading towards the care that women receive in USA! A very slippery slope.
I am truly horrified and appalled that this is the recommendation from NICE to deal with the disproportionate mortality of black women in childbirth. There is nothing wrong with our bodies. We just need you to listen to us and look after us, just like you do for middle class white women. This recommendation clearly demonstrates the issues that can arise when there is a lack of diversity in decision making. To say it’s wide off the mark and disappointing doesn’t go far enough to convey my shock.
Appalling …. Clearly no diversity among those reviewing this policy . This is a racist attack on black and brown women … we know induction can be harmful and is not without risks so why would you wish to increase the risks…. There should be a public outcry about this
This is an outrageously obscene response to a crisis situation, lacking evidence and so it seems, contribution from those with lived in experience of having black or brown birthing bodies.
Blaming black and brown bodies, pathologising them. Suggesting they are inferior or incapable of birthing successfully. It is truly appalling.
This must be stopped and the spotlight must be shone on the system not on those it has and continues to fail so massively.
As both a midwife and a mother of two who has been induced twice (and had relatively successful “normal” deliveries on paper, I am concerned that women will be coerced into induction because they want to do what is safest for their baby. Despite criticism we are still seeing the result of the term breech trial in everyday practice with vaginal breech birth being often not even considered as an option for discussion alongside ECV and LSCS for women.
Will this be the same? Induction becoming the normality at 39 weeks for a wide range of women without due consideration of individual circumstances?
What about the increased pressures on an already stretched maternity service? Surely pushing the service further with increased inductions will just increase the risk of incidents?
As a final student midwife about to embark on the beginning of my career I was absolutely shocked and saddened to read this NICE recommendation. No evidence to base this guidance on and it feels like a knee-jerk reaction without actually counselling the women of whom this will affect. All too often we see “recommendations” turn in topart of the norm and it just isn’t good enough. Where is that individual, woman-centred care? Where is that belief that a woman’s body can birth their babies? And where is the support to reduce the risk of mortality to black and brown women in childbrith, without a quick fix solution?
Must do better NICE- these women are our women in arms and deserve to be treated as such.
As a retired consultant midwife in public health, I am opposed to this proposal from so many angles. Women need individual care, we need to get this right. Women need equal access to care regardless of the colour of their skin, we need to get this right, we need more midwives and midwifery skills and continuity of care: ie Better Births recommendations
Instead of investing in more midwives and equal access for women, the proposal to intervene with a medical approach is not acceptable. All the interventions such as CTG monitoring, elective CS , inductions have not reduced the mortality rates of women or babies significantly for a while. Why should this proposal make any difference? The obstetric interventions should occur only when indicated or a woman/birthing person makes that a preferred choice.
This is a completely reductionist view which fails to address the root problems in provision of care; especially for those birthing people already disadvantaged by the system. To propose that induction of labour should be recommended to those depending on their melination is completely unacceptable and completely dismisses the very clear evidence associated with risks of induction of labour in itself, not to mention the bigger picture contributing to institutionalised systemic racism.
This guideline is highly likely to cause more harm than good, listen to birth workers, listen to service users, listen to people of colour and don’t propose to see the solution as increasing the number of people pushed into following a guideline which routinely offers highly medicalised birth associated with more pain, longer stay, greater intervention and less satisfaction.
I was induced twice with my eldest as it didn’t work the first time (funny that). As a result when I was induced the second time it had an almost immediate response and I was in full blown labour. My midwife didn’t believe me and wouldn’t transfer me to the labour ward until I started screaming blue murder (in between contractions). In the meantime my blood pressure had sky rocketed and my baby was at risk, they then had to give me an injection to stop my labour and eventually, after being in labour for 2 days, I ended up having an emergency cesarion. Even though I knew something was very wrong my midwife would not listen to me after I repeatedly told her that something was wrong. I am just grateful that I am a loud mouthed Australian who did speak up, as so many women would feel like they couldn’t in that situation and would be uncomfortable, and argue with a medical professional which was difficult enough but throw it a tonne of pain, no sleep and dangerously high BP and it was just about impossible. I thank god I did though because otherwise both of us might not have made it…
So sorry to hear you were not listened to Belinda. Did you make a complaint? If you would any help to do so please contact us…
It’s absolutely shocking that women giving birth are not listened to. All women’s bodies basically work the same and all women, regardless of skin colour need the same care. The fact that the outcomes for black and brown women are so much poorer in my mind only emphasises the need to listen to those women even more surely? There’s a myth that black people have a higher pain threshold, but if that’s so, then when they’re saying they’re in pain and something isn’t right, you should be taking it even more seriously, so it makes no sense to ignore them or disbelieve them. Pay more attention, treat people with equity & don’t ignore someone’s pain based on the colour of their skin. The only difference between their and our DNA is 0.01% – that’s what makes up people’s skin colour! In every other way they are the same as us.