The truth about stillbirth in post term pregnancy.
If you saw my last email, you'll know that I've been writing a guide on how to naturally induce labour. Near the beginning of the book, I write about the main reasons Medical Inductions are recommended.
The most common reason to induce is because you are "post term." Technically, post term means 14 days overdue. Physicians change what post term means all the time, here in Saskatoon, we often hear that induction should take place at 10 days overdue and going any longer is dangerous.
If a mother desires to wait and delay medical induction beyond the (average) 7-14 days overdue, she is faced with a daily battle of fighting for what she wants.
I can't tell you how many times medical professionals have told my clients, "It's time to induce because of the "huge" risk involved in being post term." So what is the true risk that we face at the end of pregnancy? Let me shed some light on the subject.
True Risk of Still Birth
A study conducted in 2013 revealed the true risk of stillbirth compared to the risk of infant death during delivery:
At 40 weeks: 4.2 of 10,000 (0.00042%) stillbirths will occur vs 9.5 out of 10,000 (0.00095%) deaths during delivery.
At 41 weeks: 6.1 of 10,000 (0.00061%) stillbirths will occur vs 10.8 out of 10,000 (0.00108%) deaths during delivery.
At 42 weeks: 10.8 of 10,000 (0.00108%) stillbirths will occur vs 11.5 out of 10,000 (0.00115%) deaths during delivery.
The study concludes that, "Child delivery between 39-40 weeks seems to have the most stable rates of stillbirth and infant death during delivery," however, they also state that, "It is difficult to make recommendations for clinical policy based only on retrospective data," since it uses generic data from the years 1997 and 2006. They also felt there were discrepancies due to the fact that all estimated due dates were based on the mothers last menstrual cycle (irregular cycles are not uncommon among women).
Another study conducted in 2019 used a database of birth records from 1990-2018 which included 15 million pregnancies within that time frame. The results showed that stillbirth increased from .11 per 1,000 (0.00011%) at 37 weeks gestation to 3.18 per 1,000 (.00318%) pregnancies at 42 weeks gestation. So although this newer study did reveal an increase in stillbirths at 42 weeks gestation, is a .00318% chance of stillbirth worth a medical induction over waiting for natural labour to begin?
I have yet to see an article showing the difference in going overdue until the body naturally induces labour vs going overdue with medical induction. I'd love to see that study and find out if the stillborn rates are still the same.
We should also take note of the rate of induction in the study periods while comparing the rate of stillborn births. You may recall that the 2013 study used a birth database from the years 1997-2006. The rate of induction was at 12.5% in 1997–2001. Whereas in the 2019 study, they used a birth database from the years 1990-2018 where the rate of induction rose to 23.9% in 2014–2018. This information should absolutely cause us to wonder if medical induction plays a role in increasing the rate of stillbirth at 42 weeks gestation.
Conclusion
I think the greatest thing we can take away from these studies is this: although there is an increase in risk of stillbirths and infant deaths during delivery, to project that the risk increase is "substantial" or "significant" is an over-dramatization of the truth.
We understand that there is always a risk in pregnancy and birth, but to manipulate mothers into having medical inductions because there is a minuscule increase in risk just doesn't add up.
Typically, the longest a practitioner will "let" you go overdue is 14 days. As you near the end of your pregnancy, understand that, yes, there are risks, however, we must trust our body and our baby and follow our birth goals closely. It's easy to be swayed when we are tired from many months of pregnancy and when someone is repeatedly pushing their opinion on you.
My goal today wasn't to tell you to NOT get medically induced, but rather to give you the information and the true rates of stillbirth so that you can make an informed and confident decision that best suits you and your growing family.
Below is a comparison of reasons why you should or shouldn't get a medical induction, I hope it helps you decide what to do if you are faced with making such a decision.
Coming soon, we will dive into the topic of placental calcification. When a physician is unsuccessful in convincing a mother to induce labour within 10 days overdue, they typically turn to the "aging" of a placenta to scare mothers into inducing labour.
Although I don't believe that manipulation is always the root of recommending induction, it does become a method used to convey the fear that the physicians carry. There is so much fear in the medical world when it comes to the topic of birth. Frankly, it isn't their fault, it's what they were taught for 8+ years and it can be difficult to realize those fears and overcome them. Doctors never want to lose a baby on their watch, I get it. However, I always recommend taking time to figure out if fear is being projected onto you or if there is a true reason to be afraid. It's okay to ask the questions, "Is my baby in distress?" "Show me the signs of increased risk other than being overdue?" These direct questions should always be asked with gentleness and kindness, but they can get to the root of the recommendation to induce.
Thanks for reading! I'll see you next time for more info on the risks of placental calcification.