MNHQ here: new NICE advice recommending induction at 41 weeks - what do you think?

[RowanMumsnet]

Hello

NICE has today published a new guideline on the use of induction in labour, and one of the changes they're making is to recommend that induction should be undertaken one week earlier than has previously been advised.

NICE says (bolding added by MNHQ):

"Inducing women in labour earlier than previously advised will make birth safer for them and their babies, according to draft guidelines published by NICE today (25 May 2021). The updated recommendations strengthen previous advice in the light of new evidence on induction timings."

"The draft guideline, an update of the 2008 version, recommends that women with uncomplicated singleton pregnancies should be offered induction at 41 weeks and the induction should take place as soon as possible. Previous guidelines advised induction between 41 and 42 weeks, and that women who had chosen not to be induced should be monitored after 42 weeks. If women choose not to have induced labour their decision should be supported and their care options discussed with them."

"Recent research which compared induction times and outcomes showed higher infant mortality after 42 weeks if the woman had not been induced."

You can read the full draft guideline [https://www.nice.org.uk/guidance/indevelopment/gid-ng10082/consultation/html-content here]]

We're being asked by the media what you all think about this - so do let us know - we know induction is a topic that concerns a lot of you.

Thanks
MNHQ

I welcome this and I think an ELCS should be offered instead of an induction if preferred.

I do a lot of charity work for stillbirth and neonatal deaths as a result of my own baby dying. I meet far too many women who have a grave or place where ashes were scattered to visit instead of a child to hold and it wouldn’t be the case if their baby had been born at 41 weeks.

If the recommendations change then there needs to be more done to stop the coercion going on already around induction.
Induction has a place clearly and can save lives but it seems the default and pushed option rather than a choice. The "dead baby card" is used so often by consultants and midwives now and I experienced it a lot with my first when only 40+4 and then again when my waters broke. I wish I knew O had a choice as it certainly didn't feel like it at the time.
Guidelines are good but they are used to force.

Thanks so much - really interesting and informed responses as ever. Thank you

Having just gone through their consultation they talk about inducing suspected big babies but their evidence review doesn't find clinical significance of reducing any of the risks with induction if the mother doesn't have gestational diabetes. But then they conclude they can offer induction. Seems really odd.
They also note that induction of labour increases the risk of 3rd and 4th degree tears in the induced women...

This is a draft guidance out for consultation at this stage.

There are some good discussions on
evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/?fbclid=IwAR39b4otLzmqJQ39IMAUsJiKiahk5yUOyUFlW_XsWI714_tlwIoAjImsl5w

www.aims.org.uk/journal/item/induction-care-bundles?fbclid=IwAR1tuHrypS_LSFpgmjo8Zt3DeyC2QhBQveupcs8XXo-L_HtKYbUeOq_c9CA

www.aims.org.uk/information/item/induction-and-caesareans?fbclid=IwAR2aO0wUmHSo85xpSIfuLboxSoxn6RgBsC0ucEJWpUF5WBFMVQdp38ibcLM

Many induced births involve synthetic oxytocin.. it is worth considering the effects of this on the mother and baby.. www.ncbi.nlm.nih.gov/pmc/articles/PMC3947469/?fbclid=IwAR0AWZe_xqPbEsLW1AhbCtofIwER8g4oexWJvYDw6fhjKlHO82y5JRSE88I not least 'Neurodevelopmental risk for the offspring also was suggested by the finding that the occurrence of attention deficit disorders was twice as likely in children exposed to Pitocin® during birth.' but also it's impact on breastfeeding, stress reactivity and maternal mood.

It is possible that still birth deaths could be reduced by understanding the reasons why this disproportionally affects the BAME community or by improved understanding of the risk factors and screening for those.

These guidelines require up to 25% of all births to be induced, interfering with the natural birth process of somewhere between 300 and 600 women for each still birth. How do we weigh up the long term harm done to those mothers and babies against the risk of the worst possible outcome.

And finally, the thoughts from Midwife Sara Wickham
'It feels like there's a new childbirth-related news headline every week. And no matter whether it's on the web, in the papers or on TV, it’s highly likely that it will be scary and focused on risk. It may instil fear and undermine women’s confidence in their own bodies and babies.
Here are a few things that you should bear in mind when reading these headlines and the associated stories.

1. Both the originator of the research and the people who turn it into a story want to get the headline and the story to spread as far and wide as possible. Their job isn't to help you make an informed decision about what is right for you.
2. The goal of getting maximum publicity for a research finding or story is sometimes achieved by taking a sensationalist stance. Sometimes, key facts are glossed over, shared in a misleading way or left out completely.
3. Risk and fear sell news very quickly. There are many, many studies showing that birth is safe and that women's bodies are marvellously good at growing, birthing and feeding babies. But these don't make exciting headlines, and they don't make nearly as many people read, click and share, so they are often ignored.
4. There is almost never any discussion of the bigger picture or the wider context, either of the study itself or of other work that has been done on the same topic. We need more information than can be found in the headlines.
5. In reality, research findings are never certain. All studies have limitations. Sadly, the complexity and the uncertainty gets compromised in favour of those risk-filled headlines which make you want to click, read and share.

Stay calm. Remember that the job of the media is to sell headlines, not to help people making pregnancy and birth decisions. Breathe. Get informed. And then make the decision that's right for you. If you'd like to see more of my work on this topic, you can find me at www.sarawickham.com/wrfm'