Interpretation
While there is good evidence that induction of labour from 41 weeks’
gestation reduces the rates of perinatal mortality22,
what to do prior to 41 weeks is less clear. The increasing rates of
induction of labour and early term birth are a growing global concern
due to their association with adverse neonatal23,
childhood24, neurodevelopmental and educational
outcomes25, 26. Induction of labour from 39 weeks’
gestation has been suggested as a solution to balancing these risks,
however this has yet to be demonstrated as
effective27. Evidence suggests that many women would
also prefer to wait for labour to start naturally28 or
regret their decision to accept an induction of
labour29. Observational data from the Netherlands has
suggested that over 3500 inductions at 39 weeks would be needed to
prevent adverse neonatal outcomes in African women, another group at
higher risk of stillbirth30. To our knowledge there
have been no studies examining the impact of earlier induction labour
for south Asian women. It is therefore not surprising that the new NICE
guidelines, recommending that Asian and Black women should undergo
induction of labour from 39 weeks have received widespread criticism due
to their lack of evidence, for being racist, discriminatory and for not
placing the desires and expectations of the woman at the
centre16, 31-33.
Our approach to offer earlier fetal monitoring for south Asian women
provides an alternative solution, using established clinical tools that
are already embedded in clinical care. The implications to maternity
care providers are that this change in practice can be readily
implemented. While a randomised controlled trial of earlier monitoring
would offer the best evidence, this may no longer be possible as
equipoise is lost. Future studies should therefore focus on improving
the sensitivity and predictive ability of fetal monitoring through the
addition of other ultrasound or serum biomarkers, determining the
economic cost to services associated with offering earlier monitoring
compared to earlier induction of labour and capturing the views and
experiences of south Asian born women on stillbirth prevention
strategies.