Routine Induction at 41 weeks – the end of watchful waiting?

by | 5 Jun, 2021 | Guidelines | 0 comments

“Women should be offered induced labour earlier than previously advised to 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.” (NICE News)

The new draft NICE Guideline

The new draft guideline incorporating evidence from recent research into induction of labour is open for consultation until 6th July and stakeholders and individuals are invited to comment. Areas to consider include fetal macrosomia, methods, timing and also induction in the case of intrauterine death. Much discussion and debate has ensued within the maternity and birth world particularly around the recommendation for induction for all at 41 weeks, with those having additional risk factors such as BMI over 30, or from a black and ethnic minority background, from 39 weeks. Evidence that has been examined has concluded that induction of labour at these earlier gestations would reduce the stillbirth rate, whilst not increasing caesarean sections.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: “It’s vitally important that pregnant women faced with the possibility of induced labour are offered advice based on the latest evidence. By offering induced labour one week earlier, we can help ensure that women and babies are safer from harm and have the best possible outcomes during birth.”

Many midwives, women and birthing people have massive concerns around the curtailing of pregnancy for those deemed low risk with no medical concerns. It not only has considerable implications for the already full to capacity maternity services, but ultimately for the future health and wellbeing of women, birthing people and their babies.

We received over 100 comments on our Facebook page such as these:

“I feel deeply saddened and angry about these changes as ultimately it just means more interventions, more choice taken away, more pressure, more ‘fighting’, more birth trauma.”

“I currently work where we have an 11 bed induction ward, a 34 bed postnatal/antenatal ward and a 10 bed delivery suite. We have 7-8 women per day booked for induction. The maths, capacity etc just doesn’t work at all. Women end up waiting longer than optimal from point of being able to have an ARM to actual transfer to Delivery Suite. We need less inductions not more.”

“Having recently given birth at 40, I was told by midwives that I “would be induced at 39 weeks.” Luckily I had a good meeting with a consultant where I brought in detailed evidence about stillbirth rates- because it turns out my risk of having a stillbirth was lower at 40 for my second baby than it was for my first baby at 36, when this induction business was not raised at all. ”

I declined induction and had a very straightforward homebirth (against advice) at 40 +5, but most birthing people do not have the confidence, or access to academic research databases through work, to decline procedures that are presented as being necessary for the health of their baby, or even to ask about the evidence to inform their decision.”

Intrapartum interventions

A paper published today however has shown that intrapartum interventions and adverse outcomes for both mothers and babies are increased for low risk pregnancies at or near term, something which midwives have long been saying, witnessing the outcomes of inductions every day in clinical practice (Dahlen et al, 2021). And as noted in this study, women and birthing people are not being asked about their views and experiences, with 70-86% declining participation in induction of labour trials.

Following this the Steering Group has made a pivotal decision to change the previously advertised focus of the summer meeting to one of induction.

Speakers include:

  • Hannah Dahlen — presents the recent paper (Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study)
  • Florence Wilcock — obstetrician queries the evidence base
  • Margaret Jowitt — physiology of the onset of labour
  • Members of ARM Steering Group — key evidence

Join us to examine the evidence by booking your ticket for this online meeting via the website.

References

Dahlen HG, Thornton C, Downe S, et al. Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study. BMJ Open 2021;11:e047040. doi: 10.1136/bmjopen-2020-047040

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