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• You can also download the draft guidance (link in section 2) for a read.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

I can see nothing racist in this at all.

@BarbieJ

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

This

I can see nothing racist in this at all

Really? You see nothing racist about making one racial group the default and classifying all others as one lump outliers against that default? No differentiation between other racial groups, just white taken out as the default?

If there are differences in normal gestational experience influenced by ethnicity then have a section saying what those differences are for each group individually rather than "white default" and "other".

Are you also ok with taking male bodies as the default and classifying female bodies as abnormal or outliers when treatments developed for male biology don't work? Or do you expect that knowledge to be applied in context to each sex?

As PP said - "consider" tends to become "do" in overcrowded maternity units and anxious first time mothers being told "its for the baby" are rarely in a position to challenge.

Is it ageist too?

Or is it just making appropriate clinical recommendations for groups based on their differing risk profile?

To have NO amendments to rules for BAME mothers which left them at increased risk compared to others - now that would be racist.

This thread actually makes me want to scream. It is laden with white supremacy.

Posters seem very quick to defend NICE without thinking about their own internal biases.

In my view, before beginning to comment you need to acknowledge two very important things:

1. 5x as many black women (compared to white women) die in childbirth and no-one knows why
2. public sector organisations can be steeped in systemic racism and/or misogyny; they can also give batshit recommendations- look at the WHO with their recommendation against women of childbearing drinking alcohol

I've not read the full report yet, but the reference to BAME is implicitly saying "white as default". This is an area where it is KNOWN black women die frequently more than for example Asian women (according to BMJ 34 per 100,000 cf 15 per 100,000). Black women need and deserve recommendations that make real changes to address the underlying issues. Not to be lumped in a "high-risk" category with older mums etc.

I've not read the full report yet,

So maybe you should, or even just that section of the recommendations.

Your post is ridiculously uninformed.

These recommendations are designed to address the very problems you are posting.

The use of BAME is not saying 'treat everyone woman of any ethnicity that falls under that umbrella term in the same way' (no more than it's saying 'treat every woman over 35 the same'.

It's saying that if a patient belongs to a range of ethnicities, research has shown that considering induction at 39 weeks of their pregnancy may result in better outcomes for mother & baby.

@BeBloodyBold

This thread actually makes me want to scream. It is laden with white supremacy.

Posters seem very quick to defend NICE without thinking about their own internal biases.

In my view, before beginning to comment you need to acknowledge two very important things:

1. 5x as many black women (compared to white women) die in childbirth and no-one knows why
2. public sector organisations can be steeped in systemic racism and/or misogyny; they can also give batshit recommendations- look at the WHO with their recommendation against women of childbearing drinking alcohol

I've not read the full report yet, but the reference to BAME is implicitly saying "white as default". This is an area where it is KNOWN black women die frequently more than for example Asian women (according to BMJ 34 per 100,000 cf 15 per 100,000). Black women need and deserve recommendations that make real changes to address the underlying issues. Not to be lumped in a "high-risk" category with older mums etc.

Yep. And the report does reference some of that.

This is, as far as I can see from a quick Google about current maternity research, the beginning of trying to put that right.

assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/942480/Maternity_high_impact_area_6_Reducing_the_inequality_of_outcomes_for_women_from_Black__Asian_and_Minority_Ethnic__BAME__communities_and_their_babies.pdf

Lead by Professor Jacqui Dunkley Bent, a black woman, England’s first Chief Midwifery Officer for the NHS.

Being 'lumped in' is cohort identification, not a bad thing in itself.

To have NO amendments to rules for BAME mothers which left them at increased risk compared to others - now that would be racist.

BAME != homogenous mass of other-than-white. There are observable differences between teh groups lumped into BAME. You are demonstrating the problem.

Typical example is seeing racism that isn't thereat all, and trying to incite others to think the same.

Awareness of racism is to be highly raised, but this doesn't mean looking for it everywhere and then raise outrage.

[quote CuriousaboutSamphire]And here, an easily read round up on UK based info

www.womenshealthmag.com/uk/health/a33323338/black-maternal-care/[/quote]
I read this with interest. However the birth stories held up as examples of racism mirror examples of birth stories from me and my white friends. All women have tales of having to push to get pain relief or to be admitted to the ward. I was refused a water birth twice. I was refused an epidural. I was refused my husband being with me pre covid as I miscarried in accident and emergency at 5 months. Yet I'm white.

Well, the term itself is problematic. BAME cannot be understand as not white. White people happened to have ethnicity (lol) and be the minority too. From Irish Travellers to half of Asia that is white.
If they mean black women why they are not clear about that?

@ThatsNotMyNameEither ‘I’m white and it happened to me so it could not have been racism.’ Some black people are murdered and some white people are. In some cases the white person was murdered for one reason such as drugs and the black person was murdered due to the race. As you can see these two things can exist at the exactly the same time. I have seen this on MN, so many times. White women constantly suggesting that because something happened to them it cannot be racism. It’s infuriating.

I don't think it's racism?

It also mentions obese women and those having used assisted conception which is predominantly older women so is it also fattist and ageist??

It's based on risk profiles - it only says induction should be considered not enforced!

So what is it when it happens to white people then? Perhaps my midwife didn't like me for some other reason? Because I'm from Wales? Because I'm over 35? Also very wrong, no?

Point one says it takes into account the woman’s preferences and point 2 mentions previous obstetric history. As well as suggesting inducing BAME women, they are suggesting the induction of women who have had assisted conception, therefore not limited to BAME. Stop getting hysterical and looking for racism where there’s none to be found. I will absolutely not be submitting any comments calling this racist.

Cinnamon, I also didn't say it WASNT racism, just that the examples given do also happen to white women, but it is written as though it's a collection of examples of unique behaviour.

@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.

So you’re insisting you’re correct based on a Twitter hashtag instead of NICE guidelines?

It's not racist. It's been well documented that BAME women have significantly poorer outcomes during pregnancy and childbirth in comparison to Caucasian women.

The key word is 'consider'. It's not saying do it, it's saying be aware of the potential complications and then use your professional knowledge to risk assess the situation. It'd be down to an obstetrician to offer it anyway, not a midwife.

They're not going to start inducing labour willy nilly. It wouldn't be practical.

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?

Do I find it odd that the "norm" is white in a country that is almost 90% white? No, of course I don't. Would you be surprised to find that black is the norm in say, Nigeria?

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.

This! I had an OB who planned to induce me at 36wks when I was 20 wks because baby “looked” small to her, other than that baby was healthy. She decided it was likely a chromosomal defect because baby was mixed race (husband is white and I’m black) and an amnio was needed. My husband and I are slender and average height, smaller than average as babies, children, and as adults. She knew the history of our mums and the biggest baby out of all of them was husband at 7.5lbs. Got a second opinion from a fetal specialist and told us that an amnio was highly unnecessary and invasive after he did an ultrasound and looked through my notes. Next appointment, sonographer told us baby was once again healthy, no issues. OB asks why we didn’t do the amnio, we said we were advised not to. She says ok, looks at what he wrote and then says baby is now too big at 24 wks. Cue “baby is absolutely healthy” from every sonographers and midwife and OB and her consultants who kept running tests to find an issue other than size and coming back normal. She even took over my care from the CM. I was told by CM and asked why, and she said to talk to them. It ramped up even more when 36 came around and I refused induction because other than looking a certain size, there was no other evidence to suggest its necessity. Head sonographer, 20 years experience, tells me baby was absolutely fine and she didn’t see why the consultants were so concerned. Had almost 3 weeks of OB and her consultabts telling me stillbirth stats and that I was endangering my baby, killing him despite another test they ordered coming back normal. Gave in, 3 day induction failed miserably, em-cs and baby was 6lb 13oz and not breathing. I reported them and hospital admitted there was no medical reason for induction and it shouldn’t have been done but no reason on why it was and no apology from her or her team. My son is special needs and I’m reminded every day of what they put my family through and the impact it still has on us. What makes it even more hurtful are the people who tried to excuse such actions because they’re doctors and baby and I were fine in the end. 🙄

It’s a known fact that inductions are risky and dangerous when they are done unnecessarily like with any other medical procedure that is not necessary yet when it comes to pregnant women its not that bad as long as you and baby survive, ime.

The recommendation is to consider.....
No blatant racism, no need for outrage, no need for a campaign.
It is an evidence based draft guidance open for public scrutiny and feedback to inform a final guidance....

Surely it would be more racist to say "treat every delivering woman as if she were caucasian"?

Tailoring womens deliveries according to scientific discovery should be celebrated.

@ThatsNotMyNameEither did anyone say it’s not wrong. I said it was frankly stupid to use your experience to imply that when it happens to black women it isn’t racism. Jog on.

Tailoring womens deliveries according to scientific discovery should be celebrated

It would be if that were happening.

All groups other than white are being lumped into one bulk category of BAME. This is despite significant variance between the groups put into that category and subject to the blanket "BAME" advice.

Cinnamon, jog on yourself and don't be so rude! Stupid, indeed! If the woman in that article was a victim of racism because she was advised as a first action when presenting in labour, to take a bath, what was I a victim of when I was advised the same thing?