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.