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• You can also download the draft guidance (link in section 2) for a read.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

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

It's more than possible for both to be factors. Many medical things have physiological, systemic environment, and lifestyle factors.

Sadly, women's health is badly under funded in many ways and looking into women who are marginalized further even more so. I do get the concerns that these 'recommended to consider' might be used coercive as happens. I also have concerns that ignoring race and ethnicity-related risk factors in pregnancy and childbirth in the slowly growing research in this area will put more women at risk. We're risking lives by treating White women as the standard, but there are also a risk of these being used overzealously. It's difficult, and needs a lot more data and while working on that also working on helping hold medical professionals accountable when they do cross the mark. All these things things are part of trying to improve things.

I had placenta issues with 3:4 of mine. The research in this area is slim on the ground, but there have been studies which found higher rates for some ethnicities, as well as environmental and lifestyle factors. I'd really like to see a lot more research in this area as I did 100% feel that my physiology wasn't matching what is 'meant to happen'.

@BiBabbles

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

It's more than possible for both to be factors. Many medical things have physiological, systemic environment, and lifestyle factors.

Sadly, women's health is badly under funded in many ways and looking into women who are marginalized further even more so. I do get the concerns that these 'recommended to consider' might be used coercive as happens. I also have concerns that ignoring race and ethnicity-related risk factors in pregnancy and childbirth in the slowly growing research in this area will put more women at risk. We're risking lives by treating White women as the standard, but there are also a risk of these being used overzealously. It's difficult, and needs a lot more data and while working on that also working on helping hold medical professionals accountable when they do cross the mark. All these things things are part of trying to improve things.

I had placenta issues with 3:4 of mine. The research in this area is slim on the ground, but there have been studies which found higher rates for some ethnicities, as well as environmental and lifestyle factors. I'd really like to see a lot more research in this area as I did 100% feel that my physiology wasn't matching what is 'meant to happen'.

@BiBabbles

I had placenta issues in 2/3 of mine. The last being a planned cs due to those previous issues, one of which was life threatening.

I would welcome more research into reasons for this and any other causes of maternal or baby death or serious complications.

“This one is written 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.”

Why would we want to follow US recommendations with their over medicalisation and their statistically awful outcomes for mothers, babies and particularly BAME dyads.

The poster who mentioned the lack of informed consent and pressure to induce - sadly that’s often standard. If the outcome of this guidance isn’t the careful separation of groups and research into different categories to inform individual recommendations for different ethnic groups under different circumstances then generic BAME policy is no better then generic white policy when BAME isn’t one group. It also does nothing to address the other factors and the additional inductions will create more women who feel pressured, have difficult births, feel compelled to birth outside the system etc

Abuela Doulas are encouraging their members and followers to fill in the petition against this. A group of informed women for whom this is directly relevant.

@Belliphat

“This one is written 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.”

Why would we want to follow US recommendations with their over medicalisation and their statistically awful outcomes for mothers, babies and particularly BAME dyads.

The poster who mentioned the lack of informed consent and pressure to induce - sadly that’s often standard. If the outcome of this guidance isn’t the careful separation of groups and research into different categories to inform individual recommendations for different ethnic groups under different circumstances then generic BAME policy is no better then generic white policy when BAME isn’t one group. It also does nothing to address the other factors and the additional inductions will create more women who feel pressured, have difficult births, feel compelled to birth outside the system etc

Abuela Doulas are encouraging their members and followers to fill in the petition against this. A group of informed women for whom this is directly relevant.

There is some evidence that black women do proportionately worse in the UK, compared to their white counterparts, than in the US. This is quite a recent shift, and it's appalling in both countries, but it's not as simple as 'US awful UK good'.

I think you're misunderstanding why the research is talking about 'BAME' as a group. The research on what constitutes a term pregnancy has, until recently, taken white women as default. That is what treats everyone else as a lumped-together group. The new research does seek to differentiate, but the major intervention is to establish that white women are not the default.

If the outcome of this guidance isn’t the careful separation of groups and research into different categories to inform individual recommendations for different ethnic groups under different circumstances then generic BAME policy is no better then generic white policy when BAME isn’t one group.

Absolutely. I can’t see a generic policy lumping all non-white women (of which, as you say, there are several different ethnic groups) together with women who’ve had assisted conceptions, obese women and older women, with no evidence tying the groups together except the fact that they are all at higher risk of adverse outcomes (presumably for a diverse range of reasons) can really be called ‘person-specific medicine’.

I agree Chanandler broadly. But this guidance isn't saying (as I read it), 'treat all ethnicities under BAME the same', it's saying, this is a broad category that merits consideration of induction at 39 weeks.

The grouping also includes those over 35, those who have a high BMI etc.

It's advising to start the conversation about whether induction is a good option.

The decision comes back to individual cases I assume.

(On a broader note, I would be a bit concerned generally about induction being seen as a panacea for many issues & hopefully it would be approached in the true sense of these recommendations & not for less valid reasons eg hospitals wanting to manage births more etc.)

No OP, the current guidelines are racist because they are based on white women by default. This is acknowledging that women of a BAME background may be at higher risk of complications (there is a known higher rate of stillbirth and maternal death in BAME women). Obviously there needs to be further research into how better to support BAME women throughout pregnancy but this recommendation itself isn’t racist.

Just like how most medicine is based on men and male physiology. It’s only recently that there has been updated info about heart attack signs in women. Medicine is usually based on knowledge of white male physiology, when it comes to pregnancy it’s white females.

The guidance isn't 'lumping together' BAME women.

That 'lumping together' has already been done - when researchers used white women as the default, to establish the average length of a normal pregnancy.

The research I linked to discusses different BAME ethnicities. Why is it so hard to believe white women might be the outliers here?

@Belliphat

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.

How long does it takes to completely rebuild an system of institutional racism?

I'm pretty sure it takes longer than 40 weeks, whereas the guidance to consider offering induction will potentially help pregnant women identified as being higher risk for myriad reasons - now.

I’m gobsmacked (hate that word but it’s applicable here) that 23% of people have voted YABU.

Had to reread your question several times, thought I was missing something.

Why on earth do 23% of MN voters think it’s ok to induce a perfectly healthy pregnancy?

Insane.

@MrsSkylerWhite

I’m gobsmacked (hate that word but it’s applicable here) that 23% of people have voted YABU.

Had to reread your question several times, thought I was missing something.

Why on earth do 23% of MN voters think it’s ok to induce a perfectly healthy pregnancy?

Insane.

Have you actually read the thread? That's not what the vote says at all.

Why on earth do 23% of MN voters think it’s ok to induce a perfectly healthy pregnancy?

They don't. (I assume).

These recommendations are not in relation to 'perfectly healthy pregnancies'. They are saying that based on evidence, consideration should be given to inductions for a named number of groups of women.

Not that every 35+ woman, or black woman, or woman with a high BMI should be induced, or will be.

I can see the merit. I do have some misgivings as of course there's the potential for some hospitals to try & manage births by waving Nice guidelines about induction. But let's hope that's unwarranted cynicism.

Apologies: it seems I misunderstood (and still do 🤷‍♀️: re-read it several times. Obviously, I’m just a bit thick. Sorry)

Earringsandlipstick I really like the things assumed in your last couple of posts. I would love all that too. After along time working as a advocate and a decade and a half as part of maternity services I don’t recognise a climate where ‘consideration is given’. I don’t think the guidelines will be waved around but rather rolled up and used as cudgels.

At a time when PND rates are increasing, free birthing is increasing and some hospitals are involved or are facing serious investigation into catastrophic failures of care we have plenty of evidence that services are not working well for many mothers.

So sarahandquack I have no reason to see this as anything other than the lumping together of all BAME women because that is exactly what will happen irrespective of whether the mothers in front of clinicians belong to one of the identified research groups.

@MrsSkylerWhite

Apologies: it seems I misunderstood (and still do 🤷‍♀️: re-read it several times. Obviously, I’m just a bit thick. Sorry)

You're not thick. The issue is that a lot of posters (including me) don't think the OP is representing the situation honestly.

The OP is worried that the NHS wants to force BAME women to have unnecessary inductions, for no good reason.

Obviously inductions happen for lots of reasons, but one reason is that the pregnancy has gone beyond normal term. Being a bit overdue isn't a problem, but statistically, pregnancies that go very overdue carry high risks. Before modern medicine, they were a major cause of maternal and foetal death.

The problem is that when medics determined what counted as the normal length of pregnancy, they looked at white women. When researchers look at women from various BAME groups, they find something different. So, BAME women may be being put at risk, because they're treated according to a standard that applies to white women.

So sarahandquack I have no reason to see this as anything other than the lumping together of all BAME women because that is exactly what will happen irrespective of whether the mothers in front of clinicians belong to one of the identified research groups.

I think you've misunderstood me.

I understand that there's a serious issue with medics coercing women into unnecessary interventions.

But that doesn't change the fact that BAME women have already and demonstrably been lumped together by medical research that treats white women as default. Unless we are willing to de-centre white women in medicine, we can't progress.

I’m BAME, God I hate that term lumping us all together. I’m the same ethnicity as another poster upthread Chinese and I’m small. All I remember was them showing some concern about my teeny hips and pelvis and small feet and suggesting I may need a caesarean. But I’m articulate, asked questions etc and never felt let down in anyway. I remember the obstetrician commenting on where I worked, she had studied medicine there. I’m not saying there isn’t some truth for women of other races but this chucking everyone in the same category is just frustrating.

I understand what you mean - I think we just have very different visions of what the how looks like.

@MrsSkylerWhite

I’m gobsmacked (hate that word but it’s applicable here) that 23% of people have voted YABU.

Had to reread your question several times, thought I was missing something.

Why on earth do 23% of MN voters think it’s ok to induce a perfectly healthy pregnancy?

Insane.

You are missing something, starting with the fact that OP hasn't the first clue what she is talking about..

Why on earth do 23% of MN voters think it’s ok to induce a perfectly healthy pregnancy?

Perfectly healthy pregnancies are induced every day. What makes you think its not ok? Not that that is at all the issue here.

Isnt this in response to research about the poor outcomes of some BAME pregnancies?

I read some of these comments on here OP. and i disagree with everyone. I think this is disgusting and puts more BAME women at risk instead of tackling the real issue . Women and baby shouldnt have to be potentially put at risk to not deal with racism, they should not deal with it period

@Motherofking

I read some of these comments on here OP. and i disagree with everyone. I think this is disgusting and puts more BAME women at risk instead of tackling the real issue . Women and baby shouldnt have to be potentially put at risk to not deal with racism, they should not deal with it period

And you are scientifically/medically qualified to know what you are talking about? OR, like OP, you have just decided that it's racist with no basis in fact.

Yabu. And clearly haven’t done proper reading or research.

Out of curiosity @SarahAndQuack do you have any evidence that gestational length research was done on majority white women? Not being goady but you're presenting this as fact and I'm curious to see if it is in fact the case.

And while I accept there is clearly some kind of institutional issue resulting in higher rates of Black women dying during pregnancy and childbirth, do those who put it down to institutional racism have any stats on the ethnic make up of midwives and nurses? Because at my local hospital there was certainly around 50/50 split of Black/Brown and Eastern European midwives and nurses. And most maternity care is midwife led.

Perfectly healthy pregnancies are induced every day. What makes you think its not ok? Not that that is at all the issue here

Its very much the issue. Inductions are more likely to result in other interventions and more complicated births which benefit neither the child nor the mother unless actually necessary.

Do you not find it odd that three racial groups are listed as having on average slightly shorter pregnancies but the racial group showing longer pregnancies is made the norm by which the others are measured rather than a variant which needs assessing in its own context?

To me the problem is that one racial variant is taken as the default or appropriate model coupled with "BAME women have worse outcomes, we must do something, this is something". I'd like to see something better disagregated rather than yet again, all the ethnicities covered by "BAME" lumped into one pot whilst white women are treated as the default.

Its no different to treating women based on defaults created by researching on male bodies.