Pregnant women should be induced at 41 weeks – BEFORE they are classed as overdue, health bosses say


Pregnant women should be induced at 41 weeks to cut the risks to themselves and their baby, health bosses said today.

Healthy mothers-to-be were previously only offered an induced labour on the NHS when they were overdue — 42 weeks. 

But recent evidence shows that babies are more likely to die if the pregnancy goes beyond the 42-week mark and the chance of stillbirth increases the longer the wait goes on.

The National Institute for Health and Care Excellence, a body of the Department of Health that publishes guidance, today published new draft guidelines saying women should be induced as soon as they hit 41 weeks to make the birth safer for them and their child.

One in five labours — around 128,000 a year — are induced in the UK every year, according to the NHS. Doctors induce labour by inserting a gel or tablet into the vagina.

Labours are also started artificially if the pregnant woman’s waters break early or if she or her baby has a health problem. 

Those women who choose not to be induced at 41 weeks can continue with twice-weekly monitoring. But they should be informed that there is no evidence this can prevent poor outcomes for mother or baby, the draft guidelines say. 

Pregnant women should be induced at 41 weeks and not 42 to cut the risks to themselves and their baby, the National Institute for Health and Care Excellence has announced

Experts on the NICE committee looked at a range of evidence to support the shift.

The guidance is not yet formal, with the official recommendations expected to be published on October 14 this year after a consultation.  

INDUCING LABOUR A WEEK BEFORE DUE DATE ‘COULD REDUCE COMPLICATIONS’ 

Offering all pregnant women the chance to induce labour early would cut complications and reduce the number of emergency C-sections, a major trial found in 2018.

It showed that inducing labour at 39 weeks – a week before the due date – was safer than waiting for the pregnancy to run its course.

A trial of 6,100 women in 41 American hospitals revealed that triggering childbirth early cut caesarean sections by 16 per cent, pre-eclampsia and hypertension by 36 per cent, and breathing problems among newborns by 29 per cent.

The findings, published in the New England Journal of Medicine, were described as ‘game changing’ by the researchers. 

Lead author Professor William Grobman from Northwestern University said: ‘This new knowledge gives women the autonomy and ability to make more informed choices that better fit with their wishes and beliefs.

‘Induction at 39 weeks should not be routine for every woman, but it’s important to talk with their provider and decide if they want to be induced and when.’ 

It also only applies to ‘uncomplicated singleton pregnancies’, with different rules applied to mothers expecting twins. 

Evidence for the change included a large study in Sweden that was stopped early because more babies were dying or being admitted to intensive care when induction was carried out at 42 weeks compared to 41.

Research led by the Sahlgrenska University Hospital in Gothenburg compared how inducing birth at 41 weeks compared to the ‘wait and see’ approach of not inducing until after 42 weeks.

The study took place across 14 hospitals in Sweden between 2016 and 2018 and involved 2,760 women who volunteered to take part. 

It was stopped in October 2019 because six babies in the latter group died. No deaths were recorded in the other group. 

Other possible complications of allowing pregnancies to go beyond 41 weeks include the placenta breaking down and failing to provide the baby with adequate oxygen and nutrients, as well as the risk of womb infections.

NICE also called for more research on when induction should be offered in the groups of women who may be more likely to experience poor outcomes if their pregnancy continues beyond 41 weeks.

These groups include women of black, Asian and ethnic minority backgrounds, women with a body mass index (BMI) over 30, and those aged over 35.

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, welcomed the guidance update.

She said: ‘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.

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.

Source: NHS 

‘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.

‘Induction of labour is a common and safe procedure, with around one in five labours induced in the UK.

‘A woman’s individual needs and preferences should always be taken into account and she must have the opportunity to discuss the options with a healthcare professional so that she can make an informed decision.

‘We would also second calls for more research in understanding induction of labour for women from black, Asian and minority ethnic backgrounds who have a higher risk of morbidity and mortality in pregnancy outcomes.

‘This is so we can work to reduce health inequalities in maternity outcomes.’

The guidance also recommends that women who had previously had a caesarean birth and lost a child in the womb should be informed they are more likely to suffer tears to their uterus in future pregnancies.

NICE said women who had previously suffered intrauterine fetal death — the clinical term for the tragedy — and had caesareans are more likely to suffer uterine rupture. 

Women more likely to suffer this had previously been given prostaglandin to induce pregnancy but the committee found these drugs should not be used on women who have a uterine scar.

Dr Chrisp said: ‘It’s tragic when a woman suffers intrauterine fetal death and we need to make sure they are fully supported. 

‘We also need to make sure they – and healthcare staff – are fully aware of the risks of different interventions and can make informed decisions accordingly. 

‘However, it’s clear that more research should be done to establish the safest and most effective way to induce labour in higher risk women who have experienced intrauterine fetal death, which is why we’ve made the recommendation to this effect.’

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