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• You can also download the draft guidance (link in section 2) for a read.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

The underlying analysis would have separated by ethnicity, and not lumped BAME in together, not until they had to summarise the results. They would have also kept age continuous or separated 30-35, 35-40, 40+ before summarising "above 35," because both the 35-40 and 40+ group were associated with increased risk.

Statisticians are also not complete idiots that don't consider factors such as socioeconomic status, language barriers, increased rates of gestational diabetes etc. The analysis takes these factors into account, it would never get through peer review otherwise.

I suspect the risk cut-offs for BMI are different across different ethnicities, but that is the kind of research that takes time and a larger sample, without ethically allowing anyone to face adverse outcomes.

I think this is a step in the right direction in removing the template of "white women as the default."

@ThatsNotMyNameEither don’t know don’t care. It’s not relevant to her experience and you can suggest you were a victim of anything you want. We are talking about black women dying 5x more in childbirth than white women. You having to put your own story that to invalidate theirs is a prime example of white women believing their experiences are more than non white women’s. We are not discussing you here.

I think there might be an issue with combining the TIMING and the MODE of delivery in 1 paragraph.

I suspect that many people would not object to considering earlier delivery of baby (eg 39wks vs 41wks) for people at higher risk (bame, >35, assisted conception). After all, one option is to wait (vs elective c section vs induction)

However many people have a reaction to induction specifically I feel. Having the conversation early (eg 39wks) and having the option of elective C section at 39-40wks if no spontaneous labour +/- sterilisation (if desired) should be available to people at higher risk (though this option won’t be for everyone and some may suit induction better. Complex discussion that should be held with an expert).

academic.oup.com/ije/article/33/1/107/668109

The median gestational age at delivery was 39 weeks in Blacks and Asians and 40 weeks in white Europeans.

www.ndph.ox.ac.uk/news/report-on-baby-deaths-in-the-uk-highlights-increased-risk-for-bame-and-deprived-women

Stillbirth rates for Black and Black British babies were over twice those for White babies, whilst neonatal death rates were 45% higher.
For babies of Asian and Asian British ethnicity, stillbirth and neonatal death rates were both around 60% higher than for babies of White ethnicity.
The stillbirth rate was 1 in 295 for White babies; 1 in 188 for Asian babies and 1 in 136 for Black babies.

It’s evidence based and no more racist than the hard facts it’s based on. Will you say it’s racist to prove that BAME pregnancies are higher risk and therefore something should be done to address this?

I don’t know about this issue specifically, but I do know that NICE guidelines are very robust and inequalities and quality in health a key consideration for them. They are developed by clinicians, tested with clinicians, governed by clicians and for clinicians. They are absolutely and only informed by careful consideration of the clinical evidence. As you are not a clinician OP, and even if you were and disagreed for non evidential reasons, YABU.

@FightingtheFoo

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.

That was my best understanding of what the research I already linked to was saying? I don't have a direct study, but I do know that people have been using 40 weeks as standard for centuries in Western Europe and it pre-dates Western Europe having extensive populations of people who weren't white, so I just can't see where they'd have got the data from except white people. I would also be guessing that US-based rigorous studies (not just 'folk wisdom says that ...') would have been done on white populations because of the racist exclusion of people of colour from healthcare.

I didn't think you were being goady and appreciate the question - I ought to find more solid evidence.

Omfg.

Claralara42

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

You’re right. I was induced myself with our first, at 42 weeks, 26 years ago.

I just worded it badly. I meant healthy pregnancies that aren’t overdue.

Seems I got entirely the wrong end of the stick with the OP anyway so please, just ignore me