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• You can also download the draft guidance (link in section 2) for a read.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.

It only says “consider”, and it also says “take into account the risk of complications”. I don’t see anything wrong with that.

People please, I'm not misunderstanding at all. Have a look on the #notsonice hashtag on twitter if you don't understand why this is a pretty horrific thing to propose.

Anyone who has been through Mat services recently will know that if this is presented as is currently suggested then the bulk of BAME women will be pressured into inductions. There is no research to suggest that all BAME women need inductions, there is no evidence that induction will Improve the stats for black women when other care factors haven’t even been explored. It’s not a nuanced reading of recent evidence it’s a knee jerk response that doesn’t seek to provide the individual and responsive care all women deserve.

@NotSoNice75

People please, I'm not misunderstanding at all. Have a look on the #notsonice hashtag on twitter if you don't understand why this is a pretty horrific thing to propose.

You really are. So is the creator of that OTT post who is concerned with taking headlines & making inferences that aren't there.

@SarahAndQuack posts on institutionalised racism are very well-made (such an interesting point re 'skin turning blue') so I'm not saying racism isn't an issue.

But it's not here in this document, with a raft of evidence-based supporting information.

There is no research to suggest that all BAME women need inductions,

That's good. Because the draft recommendations do not say that all BAME expectant mothers need inductions.

Just as not all women over 35 don't, or all women who have a high BMI.

You should read it.

@NotSoNice75

People please, I'm not misunderstanding at all. Have a look on the #notsonice hashtag on twitter if you don't understand why this is a pretty horrific thing to propose.

Please can you pull out the relevant evidence and references from the NICE draft guidelines?

@Belliphat

Anyone who has been through Mat services recently will know that if this is presented as is currently suggested then the bulk of BAME women will be pressured into inductions. There is no research to suggest that all BAME women need inductions, there is no evidence that induction will Improve the stats for black women when other care factors haven’t even been explored. It’s not a nuanced reading of recent evidence it’s a knee jerk response that doesn’t seek to provide the individual and responsive care all women deserve.

Exactly, thank you.

@NotSoNice75

People please, I'm not misunderstanding at all. Have a look on the #notsonice hashtag on twitter if you don't understand why this is a pretty horrific thing to propose.

But you are. You have seriously misunderstood this, you have misquoted and misrepresented. You may have found other people who have also got it as wildly wrong as you have, but that makes no difference.

It literally and totally does not say what you said it does.

Women of Afro Caribbean descent are more likely to have twins - (much more likely?) Are they also more likely to have diabetes or high blood pressure? Asian women links to diabetes & blood pressure issues?
Is age & weight (or low weight) in mothers, more or less likely?

You have seriously misunderstood this, you have misquoted and misrepresented. You may have found other people who have also got it as wildly wrong as you have, but that makes no difference.

Exactly this.

I thought the recommendation was actually based on the fact that induction of labour is suggested too late for BAME mothers and is currently based on the needs of white women.

That might be the case but I can’t see that the guidance actually says that, or makes any reference to it. There’s a section on page 24 about why the recommendations have been made and it makes no reference at all to the needs of white women vs. BAME women. It just identifies a number of at-risk groups - BAME women, obese women, women who had assisted conception, and older women - and says they’re all at higher risk of adverse outcomes if a pregnancy goes ‘beyond term’.

As I’ve said on this thread already, I think it’s very plausible that BAME women have poorer outcomes at least in part because white women are treated as the default. But I really can’t see that this guidance represents evidence-based recommendations for care tailored to the needs of BAME women vs. white women. It would be great if it did.

Bloody hell!

Post this in the Black Mumsnetters forum and ask them!

I suspect that many of them have been involved in the campaigning, maybe even the research, for requiring the NHS to treat BAME women according to their pregnancy specifics rather than applying the stabdard gudileines that are based on white women.

This isn't discrimination, FFS. It's person specifc medicine - a fiucking good thing!

Oh, and there is a fuckton of recent research into the differences in pregnancy for BAME women - death rates and possible causes. Which is why this is being recommended - that is that a gynea should consider induction more than he would for a white woman!

This one is wrutten quite simply, based on US data with US centric recommendations, but ias being followed here, some of the reaserach being duplicated - leading to this change in recommendations.

www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html

And here, an easily read round up on UK based info

www.womenshealthmag.com/uk/health/a33323338/black-maternal-care/

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

Recommendations to consider.

[quote EarringsandLipstick]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]][/quote]
So is it a knee jerk reaction to recent activism?

I wouldn’t know how to weigh medical research evidence up properly even if it was put in front of me and annotated, so I’m loathe to form an opinion without more information, but it requires an explanation, surely?

#notsonice is an inspired hashtag.

My anecdotal experience of the "consider induction" policy as someone who had 3 risk factors in my last pregnancy (hypertension, aged 40 with a BMI over 30) is that the consultant told me they would induce me at 37 weeks. Not for me to consider it or talk through the options. Just that it was what was going to happen, and at 37 weeks not 39 (since that's considered 'term'). I have seen this amongst my friends and family too, a real push for inductions (including my sister who had zero risk factors and was 39+5 when they decided to indice her leading to a horrendous forceps delivery, haemorrhaging and blood transfusions).
Has the research actually taken into account ethnicity in isolation as opposed to BAME women more likely to have poorer health outcomes on average due to level of education/poverty/language barriers/being taken seriously (the experience of black women having their pain dismissed in health care settings is well documented)?
I refused the 'offer' of induction, not an easy thing to do but being educated and on my third baby I had the confidence to request details of clinical research and evidence to back up the policy and came to the conclusion the difference in risks was negligible and did not justify the risks associated with being induced early so they agreed to monitor me (and mention induction again at every appointment) and baby came when he was ready at 41 weeks (spontaneous, although I had agreed to be induced that day if nothing happened by then as 41 weeks was definitely well cooked).
Lumping everyone non-white into the same grouping is essentially racist, there are significant physiological differences between women of Chinese descent, Arabic, Indian, African and so on. There just isn't the resource to look at individual circumstances, same as as everyone lumped into the same group if their BMI is over 30 regardless of height, build, waist circumference, ethnic background etc despite this all having a significant impact on risk and despite BMI over 30 not being anywhere near as high risk as BMI over 35.

Out of interest, what extra factors would you recommend HCPs consider for BAME women, OP?

Bearing in mind these recommendations to consider are in the wider context of addressing the appalling disparity in outcomes for these groups of people?

I am a bame woman who has had children and is currently pregnant. I don’t think the guidelines are racist - if they are followed correctly - eg all the options are discussed with all women along with the pros and cons in each situation.

Being aware that there may be a higher risk if pregnancy is allowed to continue beyond a certain period is not racist and is sensible.

However there may be a danger IF the guidelines are NOT properly implemented and induction is pressed vs other options.

I think an issue one could take with the guidelines is that they put induction as the default and first choice vs elective c-section. But they do this for all women not just women at higher risk (it’s just that women at higher risk are asked to consider it at 39 vs 41 wks). Perhaps there should be a bigger discussion of elective C section vs induction - complex decision and may depend on many factors?

How have we ended up in 2021 with medical professionals believing that “female pain” is less serious or credible than “male pain” by so many medics? On top of that, that “black pain” is less serious or credible than “white pain”.

It’s almost incredible. Like folk superstition instead of science based medicine.

Is the long-term fix into make big changes in medical schools? It is so peculiar and appalling that I can’t quite get my head around it. It’s not as though BAME groups are very tiny minorities in the UK any more. This isn’t the 1950s.

@RickiTarr

How have we ended up in 2021 with medical professionals believing that “female pain” is less serious or credible than “male pain” by so many medics? On top of that, that “black pain” is less serious or credible than “white pain”.

It’s almost incredible. Like folk superstition instead of science based medicine.

Is the long-term fix into make big changes in medical schools? It is so peculiar and appalling that I can’t quite get my head around it. It’s not as though BAME groups are very tiny minorities in the UK any more. This isn’t the 1950s.

There was an interesting talk on the radio about that last week. It's fascinating. It's not just doctors, we all do it, apparently! There's a long history of research ito it. The radio piece was about a study where Patient A was called James and a range of people rated his pain from symptoms, facial expressions etc.

When Patient A was called Jane everyone perceived her pain to be markedly lower than when Patient A was called James!

All sorts of biological and sociological resons for it. People are just weird!

www.ncbi.nlm.nih.gov/pmc/articles/PMC3690315/

www.practicalpainmanagement.com/pain/gender-pain-experience

Thanks @CuriousaboutSamphire, I’ve bookmarked the links for my bedtime reading.

I’ll have a search for the radio programme too. Was it BBC radio?

[quote RedMarauder]@Watermelon221

Do you have any data to back up the above, because it’s a pretty damning statement?

Explain why there have been lots of reports and no action then.[/quote]
I don’t deny the poorer outcomes.

I was asking about the reasons being due to systemic racism in the nhs and not related to other physiological , socio economic or language barrier factors or related to increased risk of co-morbitities?

@Belliphat

Anyone who has been through Mat services recently will know that if this is presented as is currently suggested then the bulk of BAME women will be pressured into inductions. There is no research to suggest that all BAME women need inductions, there is no evidence that induction will Improve the stats for black women when other care factors haven’t even been explored. It’s not a nuanced reading of recent evidence it’s a knee jerk response that doesn’t seek to provide the individual and responsive care all women deserve.

I think this is the point that many pp are refusing to recognise.

@Watermelon221

That's the point - there is no research and no action. There are just reports saying there are issues that need to be researched so the appropriate actions can be taken.

Racism isn't just name calling it is also systems, structures or expectations that lead to unequal treatment due to someone belonging to an ethnic group.

This is why I can understand the OP raising an alarm over this consultation.

This is not racism. It is based on the audit data so it is trying to address inequalities in healthcare and poorer outcomes for BAME women and babies.

There needs to be more research and more support during BAME women's pregnancies to get to the root cause of this but the NICE guidelines are intended to REDUCE differences in morbidity and mortality between white women and BAME women. Racism would be making recommendations based on what suits white women best.