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Proposed guidelines on childbirth ‘rushed and racist’, midwives say

Medics will be encouraged to offer inductions to all pregnant women of colour, if NICE’s draft proposals go ahead

Adam Ramsay
Adam Ramsay
13 July 2021, 12.01am
Marley Hall, @midwifemarley, https://www.instagram.com/p/CQ8LJ4xgxre/?utm_medium=copy_link

Proposed new guidelines that would see all pregnant women of colour in England offered interventions to speed up birth have been criticised as ‘racist’ by midwives and experts.

The draft advice, published by the National Institute for Health and Care Excellence (NICE), suggests that medics should ask all pregnant women of colour to consider being induced at 39 weeks.

Inducing labour can involve inserting a tablet into a woman’s vagina, or putting her on a hormonal drip, which accelerates and often intensifies contractions.

“There is no evidence to suggest outcomes will improve if these groups are offered earlier induction” a spokesperson for the Royal College of Midwives told openDemocracy. She said: “Each pregnancy is unique, and suggesting that a whole group of women should be offered an intervention […] could itself be considered discriminatory.”

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At the time of writing, 22,000 people had signed a petition opposing NICE’s draft recommendations.

“The draft recommendations highlight that women from a Black, Asian and minority ethnic background are at higher risk of adverse events in a pregnancy that is continued beyond term,” a NICE spokesperson said, in response to questions from openDemocracy.

“It’s clear there are still significant health inequalities in maternity outcomes which need to be addressed, and we hope the final recommendations will go some way towards doing that,” they added, saying the proposals are “subject to change”.

However, while induction is sometimes necessary, it also comes with problems, according to Marley Hall, a midwife in London. Describing the proposed guidelines as “rushed and racist”, she said they “will reduce choices”. And because induction usually means contractions are more painful, the advice will “increase the rate of [other] intervention, including C-sections, forceps and suction deliveries”.

I was taught that ‘Asian women behaved like princesses’ when in labour – always overreacting because they’re ‘wimps’, basically

Speaking to openDemocracy, Hall described how significantly higher maternal mortality rates among women of colour in the UK are the result of structural racism, including racial stereotypes that have long rebounded through neonatal units.

“I was taught that ‘Asian women behaved like princesses’ when they were in labour – always overreacting, because they’re ‘wimps’, basically.” That Scandinavian women “are the best at giving birth, built really great, did really well” and that “Black women have got pelvises that make them labour for a long time,” Hall said.

The result of these attitudes, she explained, was that Asian women were taken less seriously when they described being in pain, while “Black women are left to labour in pain for longer.”

Women of colour experience significantly worse outcomes from pregnancy than white women in the UK, including being much more likely to die in childbirth. However, one expert (who wished to remain anonymous) told openDemocracy that the proposed guidelines amount to “taking a problem with the system, and society and racism, and blaming it on the individuals”.

“Most women in the world are people of colour,” she added. “The idea that they all need to be induced is absurd.”

‘A lot of coercion’

Although NICE’s draft guidelines only suggest that women should ‘consider’ inductions, “people will pretty much feel under pressure, [they] will just do it,” said Maria Booker from the campaign group Birthrights, which works to protect human rights in childbirth.

“We all know what ‘offer’ looks like in practice,” added Hall. “In practice, if you offer a woman [an intervention], they’ll think ‘I should take it’. People are going to end up going for it. There is going to be a lot of coercion.”

And once women have been induced, it “significantly reduces their choices”, she said, pointing out that women who have been induced often can’t safely give birth at home or in more comfortable midwife-led units, and are instead confined to hospital wards, which many find a more stressful experience.

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NICE’s report on its proposed new guidelines notes: “there was a lack of direct evidence available” for its proposal and so its recommendations are based on the “knowledge and experience” of the committee that drafted it.

“I think it’s worrying that the committee didn’t see that this was problematic,” said Booker. “There were all those people in the room, and nobody thought, ‘Is this going to be racist?’ That we single out all these groups, with no evidence for it?”

Hall argues that “they clearly haven’t thought through the long-term impacts of this”.

One of the biggest risks to maternal health is postpartum psychosis, a serious mental health illness that can sometimes lead to suicide, said Hall. More inductions are likely to lead to more interventions, and often more traumatic experiences, which can contribute to that problem, she argued.

As well as affecting women of colour, the guidance also suggests offering inductions to women with a high body mass index (BMI), to women aged over 35, and to women whose conception was medically assisted – the latter includes a high percentage of lesbian mothers.

If agreed, the proposed guidance, which will be published in October, will have “a lot of implications for other countries too”, said one expert, as many countries around the world follow NICE guidelines closely.

“The draft recommends healthcare professionals consider offering induced labour to this group of women from 39 weeks. However, healthcare professionals must discuss the risks and benefits of induced labour with the woman and take her preferences into account. They should respect and support her decision if she chooses not to have labour induced,” NICE’s spokesperson added.

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