Risky or Rubbish? The real stats on going "overdue"
I was 41 weeks pregnant, and both myself and my baby were healthy. When I went to my antenatal appointment, the doctor at the hospital told me that if I didn't get an induction soon, my placenta would fail and my baby would die.
This story is common amongst women and birth parents whose pregnancy progresses beyond 40 (or in some cases even 39) weeks.
Interestingly, these words often come parallel to us being told that if we don't deliver the baby soon, it will grow too big, so perhaps our placentas aren't so useless after all!
Those of us whose babies like to cook for longer are often branded by medical professionals as "irresponsible" for allowing pregnancy to continue with a view for waiting for spontaneous labour, rather than scheduling an induction. These same professionals often avoid giving actual risk numbers though, or present them in relative terms, e.g. 3x more likely, making it hard to make informed decisions about our care.
So what are the actual stats?
- 38 weeks - 1 in 8333
- 39 weeks - 1 in 7142
- 40 weeks - 1 in 3030
- 41 weeks - 1 in 1250
- 42 weeks - 1 in 1136
For all pregnancies, including "low", "moderate" and “high risk” pregnancies (i.e. multiples, women with medical conditions and babies with congenital abnormalities), the chance of stillbirth was calculated as follows:
- 38 weeks - 1 in 6250
- 39 weeks - 1 in 2380
- 40 weeks - 1 in 1450
- 41 weeks - 1 in 602
- 42 weeks - 1 in 315
(Muglu et. al, 2019, as cited in Wickham, 2021)
Yet even these figures need to be considered with caution. Some of the included studies are 40+ years old, and rates of stillbirth are lower now than they were then.
We know that although the stillbirth rate is lower amongst each group at 38 weeks above, babies born at 39 weeks and beyond have fewer health complications in the neonatal period, and extracting more babies from the womb as a means to reduce stillbirth before they are ready to be born is likely to be counter-productive.
We also need to consider that most of this data was collected from with countries that favour obstetric-led and medicalised birth models (e.g. US, UK) over physiologic birth, and no breakdown is given between risks by provider, birth location, induction/spontaneous labour/c-sec, or medications and interventions used during birth, etc.
Finally, we must also be aware that induction as a means to reducing stillbirth does not have robust evidence to support it until after 42 weeks gestation, but strong evidence to suggest that induction significantly increases the likelihood of unplanned caesarean section.
When the doctor was giving me the rounds to book an induction, I reminded myself that if there was a necessity to get my baby out ASAP, they would've been prepping me for a c-sec, not recommending a 3-day long induction process starting in 3 days time.
This is not to say that for every baby "all will be well" and to ignore the advice of medical providers as a blanket rule, but it is worth understanding whether there is valid concern for your baby's individual safety, or if practitioner/institutional preference and policy is coming into play.
Stillbirths do happen, every single one is a tragic loss, and it isn't possible to predict who that most unlucky "1 in ..." will be. That said, some stillbirths are preventable, and we can reduce the risk for some babies.
Here is what I would like to see happen:
- Risks presented as actual numbers, like the presentation of those on previous slides, without fear-mongering or coercive tactics;
- A thorough discussion of the pros and cons of "watchful waiting" vs induction according to your individual situation, and the likely outcomes of each at each particular hospital;
- Information and education provided to pregnant women and parents that can help reduce risk of stillbirth rather than practitioners only focusing on gestational age, as this is currently not a common feature of standard antenatal care.
- Decreased/irregular foetal movement compared to the baby's normal patterns;
- Erratic or increased foetal movements that feel out-of-control or wildly energetic compared to what is normal for your baby;
- Medically-identified risks - foetal growth restriction, low amniotic fluid, placental blood flow restriction;
- Male babies and families from some ethnic or racial backgrounds at higher risk.
- Getting to know an monitoring your baby's movements each day using their "Daily Actions" steps;
- Acting on your intuition and getting checked out immediately if something seems out of he ordinary for your baby;
- Sleeping on your side from 28 weeks pregnant;
- Reducing other risk factors wherever you can (e.g. avoiding cigarettes, alcohol and illicit drugs, avoiding or managing diabetes and high blood pressure).
As always, education and respecting the capacity of pregnant women and patients to make the best decisions for themselves and their babies is paramount. We can't simply intervention-away pregnancy loss and stillbirth, or pretend neonatal death or maternal death don't happen. Each and every one of us needs to be informed, respected and supported, whichever path it is we choose to take.
This, rather than coercion, is the pregnancy and birth care we really need.
Muglu et. al, (2019) as cited in Wickham, S. (2021). In Your Own Time: How western medicine controls the start of labour and why this needs to stop. Birthmoon Creations.
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