NICE Inducing Labour Guideline - Consultation on Draft July 2021

AIMS is pleased that the majority of our 65 comments have resulted in positive changes in the final NICE Guideline for Inducing Labour which were published on 4 November 2021 . Here are some of the things we lobbied for successfully.

We are particularly glad to see much stronger recognition of the principle of autonomy. This guideline now includes a specific recommendation to “recognise that women can decide to proceed with, delay, decline or stop an induction. Respect the woman’s decision, even if healthcare professionals disagree with it, and do not allow personal views to influence the care they are given.” This principle is now emphasised throughout the guideline.

We also welcome the inclusion, as we requested, of data on the actual risks of pregnancy lasting beyond 41 weeks, and of induction of labour compared with expectant management of a pregnancy where there is a suspected large baby. We hope that this will better support informed decision making about induction in these situations.

Although the Guideline Development Group have amended many of their references to ‘shared decision-making’ in favour of a focus on informed decision-making, we regret that they have not removed the term ‘shared decision making’ completely.

We are also concerned that the Guideline Development Group is failing to communicate clearly what they intend to convey by using the word ‘consider’ in situations where the evidence for a recommendation is not strong. AIMS believes that ‘consider’ could be taken to imply to healthcare staff that the action is for them to consider and therefore for them to decide.

AIMS and others raised concerns about the recommendation to consider offering early induction purely on the basis of race, age, BMI or method of conception. We drew attention to the fact that this was a non-evidence-based recommendation, with no justification for inclusion. We are therefore pleased to see that this non-evidence based recommendation has been removed and has been replaced with a comment that “women from some minority ethnic backgrounds or who live in deprived areas have an increased risk of stillbirth and may need closer monitoring and additional support.” AIMS feels that this ‘additional support’ could best be achieved by the rapid roll out of a culturally-sensitive Continuity of Carer model of care to women in these groups, as called for in the NHS long-term plan.

There are also two research recommendations relating to the gestational age at which induction should be offered: one about groups of women who may be at higher risk of stillbirth and one on identifying more precisely “the optimal timing of induction of labour in the low risk population of pregnant women”. We welcome this approach, which meets agreed NICE principles about how Guideline recommendations should be developed.

We would also like to see research into the role different factors play in driving the observed higher stillbirth risk for certain groups, including both individual health and socioeconomic characteristics, and the role of racial discrimination, bias, stereotyping and culturally-insensitive care.

Overall, however, AIMS remains concerned about the likely effect of the new Guideline. We will be reviewing the implications of the individual recommendations in more detail. We are concerned that this update may have the effect of increasing unnecessary and unwanted interventions. In practice, however, much will depend on healthcare professionals taking to heart the recommendations on providing full information, including information on the potential impact of induction, and respecting women’s decisions.