To think the proposed NICE guidelines on induction are blatant racism?

[NotSoNice75]

A midwife friend of mine has alerted me to this.

There is currently a proposal by NICE to 'recommend' induction of labour for all BAME women at 39 weeks of pregnancy (ie a week before they are due), even if they are perfectly healthy and the pregnancy has no complications.

As you probably know, induction of labour significantly increases the chance that a woman will need further interventions, and that she will end up with a forceps/caesarean delivery.

While that has its place (I was induced myself for medical reasons),
I believe that this policy takes away choice (it is a brave woman/couple who refuse when their obstetrician is presenting death as a viable consequence) and lets us off the hook for the real problem.

Women and babies are not at risk because of their physiology, they are at risk because of systemic racism and inequity in maternity services.

If you agree that this policy is blatantly racist, please please submit a comment form. Feedback from individuals doesn't usually carry much weight but we're hoping for power in numbers. This seems to have gained momentum very late, and the deadline is 5pm today.

• Go to: www.nice.org.uk/guidance/indeve ... ml-content

• Download the comments form (link in section 3) and complete.

• You can also download the draft guidance (link in section 2) for a read. The relevant bit is highlighted in the extract below. And yes, that means that any single one of those factors is justification for induction.

Also, this is on Twitter with the hashtag #notsonice

Sorry if I’ve missed it, but what is the reasoning behind this?

It’s shit guidance as it isn’t evidence based. It appalls me actually and can only see it as another facet of the racism that has seen poor outcomes for BAME mothers and babies.

Please excuse me for asking, but is this related to findings about differences in pregnancy length in different populations? There is research indicating that 40 weeks is only the average term pregnancy for white women, not for all women, and there is also a some evidence of increased risk of stillbirth after term.

OP have you posted the wrong link? What you have there doesn't say 'recommend' it says 'consider' and also says while considering you should take into account a long list of things including history and patients wishes.

I think in a lot of cases, doctors will refuse requests for induction before term. This seems like it gives more freedom to practitioners and women to decide what to do. I agree a blanket 'recommend' could be problematic but I don't think 'consider' is in the same way.

Unless what you've shared is the previous versions rather than the draft I think you post is misleading: its very clear the advise is practitioners are to consider previous history and wishes before making a recommendation either way.

The recommendation is based on scientific findings and is literally the opposite of racism.

The guidance may indeed be flawed. However you are not presenting the facts, with your screenshot at least.

A range of conditions / situations are presented, of which BAME is one (being over 35, or overweight are examples of others).

The text begins with 'consider' and provides a list of potential criteria to address, but your screenshot cuts these off.

You say 'recommend' but in your screenshot the term is 'consider' which is very different.

It may be used elsewhere, I haven't taken a closer look.

But the guidelines says, ‘offered’, women can still say no, thanks. I can’t imagine the NHS is drawing up new guidelines to force ever BME woman to have induced labour at 39weeks and this isn’t it.

I don’t know enough to comment tbh.

Are NICE saying there are actual biological differences between different race women that mean longer gestation is more dangerous for BAME women?

Or is it (as you suggest) that overdue women are treated with worse care if they are BAME? And so have statistically worse outcomes?

If it’s the latter then I agree with you - this is covering up the real problem - but I just don’t know enough.

Could you explain a bit more about where it says induction will be recommended at 39 weeks for all BAME women? Because the screenshot you have posted says "consider" induction, and take into account the woman's preferences. Isn't this recommendation aiming to address the health inequality that leads to poorer outcomes for BAME mothers and babies?

I guess it depends what the research is behind this - the research @sarahandquack mentions would be pertinent . It also says 'consider' not 'recommend' in your screenshot so you're a bit unreasonable for misrepresenting that aspect.

If it’s racist it’s also ageist and discriminating against women who don’t conceive naturally.

There is no scientific finding that BAME women are less capable of good birth outcomes than white women. In fact there is excellent evidence that this is not the case. There is equally good evidence that our uk care for BAME mothers and babies has led to a much greater likelihood of poor outcomes. Induction carries its own risks and to recommend that rather than to challenge the inequalities that have led to these failures is racist.

@minipie

I don’t know enough to comment tbh.

Are NICE saying there are actual biological differences between different race women that mean longer gestation is more dangerous for BAME women?

Or is it (as you suggest) that overdue women are treated with worse care if they are BAME? And so have statistically worse outcomes?

If it’s the latter then I agree with you - this is covering up the real problem - but I just don’t know enough.

There are certainly observable differences in average pregnancy length across different ethnicities.

I would think that imposing a definition of 'full term pregnancy' that only really applies to white women would also be pretty racist.

If you read the actual draft guidelines on the link, it refers to "recommendations".

Are NICE saying there are actual biological differences between different race women that mean longer gestation is more dangerous for BAME women?

No.

However it is a fact that women of BAME ethnicity face more adverse outcomes than white women in childbirth & immediately after.

However more research is needed to ascertain the reasons.

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0657-2

@cindarellasbelly

OP have you posted the wrong link? What you have there doesn't say 'recommend' it says 'consider' and also says while considering you should take into account a long list of things including history and patients wishes.

I think in a lot of cases, doctors will refuse requests for induction before term. This seems like it gives more freedom to practitioners and women to decide what to do. I agree a blanket 'recommend' could be problematic but I don't think 'consider' is in the same way.

Unless what you've shared is the previous versions rather than the draft I think you post is misleading: its very clear the advise is practitioners are to consider previous history and wishes before making a recommendation either way.

This.

Sorry, link not working properly. Here it is: www.nice.org.uk/guidance/GID-NG10082/documents/draft-guideline-2

@DuggeeHugs

I guess it depends what the research is behind this - the research *@sarahandquack* mentions would be pertinent . It also says 'consider' not 'recommend' in your screenshot so you're a bit unreasonable for misrepresenting that aspect.

Oh, sorry, I cross posted, but here's a couple of abstracts. I literally just googled (I had a hunch this was the case but I am not a medic).

pubmed.ncbi.nlm.nih.gov/15075154/

pubmed.ncbi.nlm.nih.gov/2292982/

• Go to: www.nice.org.uk/guidance/indeve ... ml-content

OP I just clicked your link as it was in your post - it's no longer leading to the draft? Do you want to post an up-to-date link?

ANd here's the full thing: www.nice.org.uk/guidance/indevelopment/gid-ng10082/consultation/html-content

@NotSoNice75

If you read the actual draft guidelines on the link, it refers to "recommendations".

Thanks for the updated link.

I read the relevant section, and you're wrong.

It still says 'consider'. It is also prefaced by a lengthy section on communication, patient preference & consent, and decision-making.

The 'recommendation' refers to the recommendation of the report, one of which is 'consider induction at 39 +0 weeks in certain situations'

It's also supplemented by a whole raft of evidenced-based research which can be consulted.

Talk about utterly misrepresenting a situation, and being quite lazy about it too. 🤨

Googled avg length of natural term labour of black and Asian women, and research comes up saying it is 39 weeks on avg vs 40 weeks in white women. I still think there are too many inductions done early, because women are told they won’t be allowed to go over the hospitals preferred no. of weeks.

Page 24 explains why this consideration has been included, based on audit data. Evidence based for the safety of mother and baby, absolutely not racist.

Are you looking for things to be offended by?

Personally I was delighted to see the phrase woman and mother littered through the document :)

Having wanted to be induced and had to talk midwives into planning to be induced at 10 days over, I’d be shocked if this language ‘consider’ isn’t just trying to support mothers and medical staff to consider inductions earlier for good reasons instead of the blanket why are you wasting my time no one is going to induce you you're only a week overdue attitude I’ve seen across multiple babies and midwives.