In a perfect world, an expectant mother should go into labour at 40 weeks. Yet sometimes the process doesn’t proceed as smoothly as expected, and baby runs late. Certain medical problems can make an extended pregnancy risky for the mother and the baby. The National Institute of Health and Care Excellence (NICE) has advised doctors to induce pregnant women early in a bid to reduce stillbirths.
The guideline says instead of these expectant mothers having to wait for 41 to 42 weeks before doctors start inducing them, they advised that it should be done earlier than that.
Nice said the shift followed an examination of recent evidence showing greater risks to the baby if pregnancies reached 42 weeks.
One of the main studies examined (from Sweden and the Netherlands) was stopped early, because of the number of babies dying or being admitted to intensive care after late induction.
Medics and charities for those affected by stillbirth and infant deaths welcomed the move.
However, mothers’ groups warned that too many women were being pushed into stressful and traumatic inductions, without the right pain relief in place.
Until now, women have been offered induction on the NHS between 41 and 42 weeks, but recent evidence shows that babies are more likely to die if the pregnancy goes to 42 weeks or beyond.
The new guidelines say women should be induced as soon as possible when they hit 40 weeks in a bid to make birth safer for them and their child.
Those women who choose not to be induced at 41 weeks can continue with twice-weekly monitoring, but should be told that there is no evidence this can prevent poor outcomes for mother or baby.
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 advising 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.”
Dr Pat O’Brien, consultant obstetrician and vice president of the Royal College of Obstetricians and Gynaecologists, said: “We welcome an update to the NICE guidelines around inducing women’s labour.
“It’s been more than 10 years since the previous guidelines were introduced and it’s vitally important the new research published since then is acknowledged and the advice for women updated accordingly.
“This proposed update takes into account the increasing body of evidence that pregnancies that reach, or pass, 41 weeks are associated with a small increase in the risk of stillbirth and perinatal death and that induction of labour reduces this risk.
Justine Roberts, Mumsnet founder and chief executive, said women should be given an informed choice and adequate pain relief.
She said: “The consensus among Mumsnet users is that if induction at 41 weeks will save babies’ lives, this is great news.
“But inductions can be stressful and traumatic, especially if adequate pain relief isn’t in place, and some mothers spoke about agonising experiences of inductions when anaesthetists weren’t available to provide epidurals.”
Clea Harmer, chief executive of the Sands stillbirth and neonatal death charity, said: “Many bereaved parents have told Sands they believe earlier delivery might save their baby’s life. We hope this Nice review of the latest research evidence will help to get that judgement on timing right more often, avoiding more tragic baby deaths.
“We also hope this draft guidance will lead to better care and advice for parents whose baby has died, to minimise the chances of the same happening again in any future pregnancy.”
