Pregnant women will be offered induction when they are just one week overdue under new medical guidelines to cut the risk of stillbirths.
Babies are due at about 40 weeks, and currently women are offered induction on the NHS if they do not go into labour naturally by 42 weeks.
But the health watchdog yesterday said that this should be decreased to 41 weeks to cut the risk of death and complications.
The National Institute for Health and Care Excellence (Nice) said discussing inductions at an earlier stage is likely to ‘increase the number of women who undergo induction’.
But they stressed that the ultimate decision should still rest with individual women, and they will be given ‘every opportunity to go into spontaneous labour’.
Currently about one in five labours in the UK are induced, which is when contractions are started artificially through drugs.
Evidence suggests induction can cut death rates, as pregnancies which go beyond 41 weeks carry an increased risk of complications.
Pregnant women will be offered induction when they are just one week overdue under new medical guidelines to cut the risk of stillbirths
The guidelines say NHS staff should inform women of risks associated with a pregnancy continuing beyond 41 weeks including ‘increased likelihood of Caesarean birth, increased likelihood of the baby needing admission to a neonatal intensive care unit and increased likelihood of stillbirth and neonatal death’.
However, they said there is not enough evidence to support a blanket policy in favour of inducing pregnancies at 41 weeks and women should be able to discuss all options.
Women who choose not to be induced should be asked if they wish to have additional fetal monitoring from 42 weeks, the guidelines said.
Nice added that staff should be aware that stillbirths are twice as high in black babies and around 50 per cent higher in Asian babies compared to white babies.
However, the watchdog has backtracked on earlier proposals that women who are most at-risk of pregnancy complications should be offered induction from 39 weeks.
Draft guidelines published in May had recommended that induction be considered from 39 weeks in women who are from black, Asian and minority ethnic backgrounds, as well as those who are obese or over-35.
But was scrapped in the final guidelines published yesterday – a move welcomed by campaigners who stressed ‘one size does not fit all’.
Amy Gibbs, chief executive of the charity Birthrights, said: ‘Birthrights is delighted that Nice has listened to our concerns — shared by so many women and birthing people, healthcare professionals, and birth workers — and removed the draft proposals to single out black and brown women, alongside other groups more likely to face adverse outcomes, for induction even earlier at 39 weeks.
WHAT IS INDUCED LABOUR?
An induced labour is one that’s started artificially. Every year, 1 in 5 labours are induced in the UK.
Sometimes labour can be induced if your baby is overdue or there’s any risk to you or your baby’s health.
This risk could be if you have a health condition such as high blood pressure, for example, or your baby is not growing.
Induction will usually be planned in advance. You’ll be able to discuss the advantages and disadvantages with your doctor and midwife, and find out why they think your labour should be induced.
It’s your choice whether to have your labour induced or not.
If your pregnancy lasts longer than 42 weeks and you decide not to have your labour induced, you should be offered increased monitoring to check your baby’s wellbeing.
‘We are pleased to see Nice acknowledge the lack of evidence that induction improves outcomes for these women and their babies, and that one size does not fit all.
‘Conversations around induction must be balanced, evidence-based and respect each individual’s right to make their own choice about what is best for them and their baby.
‘This is well reflected throughout the new Nice guideline, so we now need urgently to close the gap between these principles and what happens in practice.’
Sarah Siguine, from pregnancy charity Tommy’s, said: ‘With almost 5,000 stillbirths and neonatal deaths a year in the UK, this new guidance is a welcome step forward in efforts to change these unacceptable statistics and save babies’ lives.
‘However, the Government won’t reach its goal to halve these rates by 2025 without urgent action to understand and address the disproportionate risks facing some mothers who come from minority ethnic backgrounds or live in deprived areas.
‘Earlier induction of labour could play an important part in reducing the risks for some of the most vulnerable families, alongside other things we already know make pregnancy safer, like having the same midwife throughout the journey to parenthood with ongoing risk assessments and frequent check-ups if needed.
‘Mothers should always get a clear explanation of why they’re being offered induction, and be supported to compare the risks and benefits, so it’s reassuring that NICE guidelines emphasise the importance of such open communication and decision-making.’
Elizabeth Duff, senior policy advisor at the National Childbirth Trust, said: ‘It’s good news that NICE has dropped its draft proposal to offer induction at 39 weeks of pregnancy to groups at higher risk of complications, including Black, Asian and minority ethnic women.
‘This followed NCT and other bodies representing maternity service users pointing out the lack of evidence to support such a recommendation. It’s positive that voices have been heard and action taken.
‘However, induction of labour is still an intervention that has been used much more frequently in recent years and as yet there is inadequate information about longer-term impact on babies and parents.
‘While the current guidance states: ‘ensure women have the opportunity to ask questions’, it is highly questionable whether staffing levels in maternity care allow time for this to happen.
‘At NCT, we feel it is extremely important that pregnant women and their partners feel in control of decisions about their care. Induction in itself, while it may often be an appropriate course, removes the option of spontaneous labour.
‘In addition, as the guidance states, choices of a home birth and/or a water birth will be ruled out. Parents’ feelings of confidence and autonomy can be severely impacted by such restrictions.’
Health minister hails fertility revolution which means number of same sex female couples having IVF has quardrupled in a decade
By Minister for Women’s Health, Maria Caulfield, and Senior NHS consultant and Medical Director at CREATE Fertility, Professor Dr Geeta Nargund
One of the greatest joys is bringing new life into the world. But the path towards a family, while filled with hope, can often be bewildering and for some fraught with despair. Infertility can affect 1 in 7 couples – it almost certainly will affect someone you know.
This National Fertility Awareness Week, it’s crucial we continue to talk about fertility, to raise awareness about its challenges, and ensure everyone who needs support can access it.
We have made great strides in fertility treatment – in fact, IVF birth rates have tripled in the last 20 years.
We are also seeing the creation of more diverse families as a result of IVF. In 2019, we saw a four-fold increase from 2009 in IVF cycles involving a female partner.
Not only is treatment more successful, it’s also safer. The multiple birth rate is the lowest it’s ever been and advances in freezing technologies have given patients the same chance of success when using frozen embryos compared to fresh embryos in their treatment.
And people have greater choice on when to start their family.
The government recently announced the intention to increase the storage limits for eggs, sperm and embryos to 10-year renewable periods up to a maximum of 55 years. This removes the ticking clock of storage limits giving women more freedom as well as providing equality, as the storage rules will apply to everyone regardless of medical need.
While we have come a long way, we know there are inequalities that still exist, acting as barriers to some families accessing treatment and support.
According to the Human Fertilisation and Embryology Authority’s (HFEA) recent report, just 3% of patients undergoing IVF were Black, and they started treatment more than two years later compared to the average patient. Starting treatment earlier can lead to more successful outcomes and fewer complications in pregnancy. Everyone should be able to access NHS services so it’s crucial we continue to level up services across the UK.
When levelling up in health is spoken about, it means your race, or gender, or where you live shouldn’t determine your experience of, or access to, services. This is what the government is – rightly – committed to changing.
For the moment, the National Institute for Health and Care Excellence (NICE) is reviewing the fertility guidelines and we continue to have conversations in our clinics, with partners and stakeholders, and across government.
And looking to the future, this government is working to push women’s health to the top of the agenda, with the first ever government-led Women’s Health Strategy. As a clear priority for women in our recent call for evidence, fertility will be a key component of this strategy.
It’s clear we have made great strides already and as the technology and services continue to advance, we must make sure legislation and guidelines are in line with these advances in technology to ensure the NHS continues to offer world-leading services.