NICE induction guidelines are updated

What has changed and why? 

These new guidelines cover the circumstances for inducing labour, methods of induction, assessment, monitoring, pain relief, and managing complications. It aims to improve advice and care for pregnant women who are thinking about or having induction of labour. Earlier this year, draft guidance earlier this year was criticised for being racist, suggesting ways to improve outcomes for Black and Asian families was to recommend blanket induction of labour earlier than is offered to white women and birthing people.

What has changed? 

Having conversations about induction much earlier in the pregnancy with your care provider, rather than waiting until 38 weeks. This is suggested to give the pregnant person time to process the information and do independent research on induction outcomes; benefits, risks and alternatives. . 

Induction of labour is also advised from 41 weeks, as opposed to the previous between 41 and 42 weeks. Over 80% of spontaneous births start after 41 weeks, so the new guidelines will reduce many birthing people’s chances of experiencing labour that starts naturally. The primary reason for induction is stillborn birth, the figures change from 0.04% in week 41 to 0.06 and in week 42 goes back to 0.04 in week 42. 

Another alteration to the guidelines are that every pregnant person will be recommend to have a  routine membrane sweep from 39 weeks of labour (with no evidence to support this recommendation).

A membrane sweep is a form of induction and has benefits and risks.

Benefits:
Can shorten pregnancy
Can start labour within 48 hours

Risks: 
You can have water rupture
Can cause infection
Can be painful
It might not work
Longer labour
Can cause bleeding

A lot of practices give membrane sweeps routinely so if you’re having an internal examination, it is important to ask what it’s for and why you’re having it. And if it is for a membrane sweep, you have decline or have time to think about it. 

It is important that you’re not put under pressure to have an induction as there are many benefits of spontaneous birth. 

Benefits like: 
30% less likely to have a c-section
40% less likely to tear
Shorter births by up to 8 hours
Increased infection risk for baby and birth person
Lung development problem like asthma
60% increase in the need for pain release 
Less risk of PPD

Risks of spontaneous birth: 
Still born statistics: 0.04% in week 41 to 0.06 and in week 42 goes back to 0.04 in week 42. 

Other things to consider: 

One of the most important things to consider is your “due date” and how it is calculated. “Due dates” are calculated from the last date of your period, but you do no ovulate until 10-14 days after your last period, this this is when you fell pregnant.
Birth works. The human body was not designed for fail when it comes to birth. 

Women and mammals have giving birth for millions of years, it has only been the past 100 years we have been interfering with the process of birth. 

But the number one thing to remember is that it is your decision. 

If at any point during your pregnancy you feel less movement or experience anything you feel is abnormal, to contact your health provider. 

Some helpful links: 

New NICE guidelines: https://www.nice.org.uk/guidance/ng207

References:

Mittendorf et al 1990: www.ncbi.nlm.nih.gov
MBRRACE-UK Perinatal Death for Birth from Jan to Dec 2016: www.npeu.ox.ac.uk

The latest details from MBRRACE have shown that the stillbirth rate decreases after 42 weeks:*

  • At weeks 37 to 41 (+6) the risk of a stillbirth is 1.52 per 1000 births
  • At 42 weeks onwards the risk of stillbirth is 1.04 per 1000 births
  • Stillbirth rate declines progressively throughout a women’s pregnancy
induction statistics