04 November 2021

Watchdog softens recommendation for pregnant women to be induced at 41 weeks

04 November 2021

An NHS watchdog has softened its recommendation that pregnant women should be induced as soon as they reach 41 weeks, rather than 42, to cut the risks to themselves and their baby.

Draft guidance in May from the National Institute for Health and Care Excellence (Nice) said women should be induced as soon as possible when they hit 41 weeks in a bid to make birth safer for them and their child.

Those women who did not want to be induced at 41 weeks could continue with twice-weekly monitoring but should be informed there was no evidence this can prevent poor outcomes for mother or baby, Nice said.

The guidelines also advised healthcare professionals to consider induction of labour from 39 weeks in women with otherwise uncomplicated pregnancies who are at increased risk, including those aged 35 and over, those with a body mass index (BMI) over 30, and those from Black, Asian and minority ethnic backgrounds.

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

In new guidance published on Thursday, the recommendation to offer induction to some groups at 39 weeks has been scrapped, while health professionals are told to give women with uncomplicated pregnancies “every opportunity” to go into spontaneous labour at term.

It says the risks of early or late induction should be discussed with woman and they should be informed of the 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”.

The guidelines added: “Discuss with women that induction of labour from 41+0 weeks may reduce these risks, but that they will also need to consider the impact of induction on their birth experience when making their decision.”

The guidance also says staff should be mindful that the 2020 MBRRACE-UK expert report showed that, across all births, the stillbirth rate is more than twice as high in black babies and around 50% higher in Asian babies compared to white babies.

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 routinely offer induction at 41 weeks, and to single out Black and brown women, alongside other groups more likely to face adverse outcomes, for induction even earlier at 39 weeks.

“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.”

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