Updated induction guidelines

[FamilyStrifeIsHard2Bear]

I went to my 4 days overdue midwife appointment today to be told, with no other mention of any changes before now, that induction guidelines have been updated since I had my first a few years ago.

Apparently now women should be offered induction from 41 weeks instead of between 41 and 42.

I appreciate it doesn't sound like a big change, but I was 10 days overdue with my first and expected I had a little bit more time before interventions started being discussed and am not very happy.
I know it is still my choice etc etc, but I don't like that interventions are being promoted even earlier than they were previously.
It sounds pathetic but I am not one for unnecessary medical intervention, am hoping for a natural as possible birth, and this info being sprung on me made me so wound up the midwife had to do three sets of blood pressure readings before mine went down enough to be at a reasonable level.

Reading the NICE guidelines there are some studies and recommendations still to be looked in to e.g whether different guidelines for specific demographics should be considered, so it doesn't sound like they've given a significant amount of consideration, checks or research before introducing these updates which also doesn't instil a lot of confidence.

I think there was a study done where it was found that babies born at 39 weeks gestation were statistically the healthiest and that the incidence of stillbirth increases significantly at 42 weeks or more... I don't remember the name of the study sorry. Given you've had a similar length of gestation previously I wouldn't worry about it (I think it's dangerous to assume that all pregnancies should be x number of days). Can you agree to ultrasound monitoring and ask for the evidence base (rather than just their protocols) behind their advice?

It's a subtle change of wording but it's going to ultimately result in a lot more women being offered / pressured into and given inductions.

There's a really good discussion on The Midwives Cauldon podcast about it: https://themidwivescauldron.buzzsprout.com/1178486/9545341-an-interview-with-dr-sara-wickham-no-2

The midwife they interview for that episode also has a detailed blog post about it: https://www.sarawickham.com/research-updates/the-2021-nice-guideline-on-inducing-labour/

More generally, this is a good look at the pros/cons of induction of labour for dates and nothing else: https://midwifethinking.com/2016/07/13/induction-of-labour-balancing-risks/

"It sounds pathetic"

It absolutely does not. There is nothing pathetic about wanting to aim for a physiological birth when possible. Your experience of birth matters profoundly.

FWIW, I had my first at 40+10. I was told at 41 weeks they would book me in for an induction later that week and I politely but firmly declined it. The midwife was surprised but respectful and I would do the same again this time, should I find myself in the same circumstances.

Thanks @moregarlic that's really helpful. I didn't know these things had changed

@Lardolader Not a problem - nor had I until recently!

Thanks all for your replies so far, particularly @moregarlic for all the evidenced information and helpful reading.
All these options, choices and decisions certainly don't help with keeping down stress and blood pressure - I bet NICE didn't include that in their assessments when deciding to change guidelines..!

@FamilyStrifeIsHard2Bear absolutely! It's incredible when you think about the impact of stress during pregnancy and also what's required to start spontaneous labour. I hope you come to a decision that's right for you!

Or your baby decides to be a due date baby and save you the stress :)

We’ve found out recently that DS1 actually has mild cerebral palsy due to not being induced in time. We were around 42 weeks.

With subsequent babies, we paid and my placental blood flow checked as I got to term. With both it had dipped after 41 weeks and I was induced.

there are a lot of studies which suggest induction after 41 weeks if the best course of action, but obviously it increases your risk of an even more medicalised birth.

There's evidence that from 39 weeks,the very small risk of stillbirth (if everything is well otherwise) increases as time goes on. I think one of the reasons the date has been brought forward is because of this trial
https://www.google.com/amp/s/amp.theguardian.com/lifeandstyle/2019/oct/28/post-term-pregnancy-research-cancelled-babies-die-sweden

What would worry me wouldn't too much be the day they recommend induction but more when it will actually happen. I hear so many stories from women and midwives saying that when induction is planned for a certain day, women are only actually induced 1, 2, 3 days and sometimes more later than the agreed date. I would really ask about their waiting times for induction.

I hope it all goes well 🙂