Things for prospective mothers to think about(Contains scientific info on stillbirth)

Deleted User wrote: »

As regards induction, there is very good reason why doctors get pushy once a child is overdue. It is that the incidence of still birth skyrockets past ~40 weeks:



I am currently working on a research project investigating placental function in infants that suffer from neonatal asphyxia. It is possible to tell just from looking at the placenta whether the baby was overdue or not. These placentas are friable, calcified and generally very unhealthy looking. It is this decline in placental function, combined with a growing baby placing increasing demands on the degrading placenta, that causes fetal death in utero.

Does this only occur past 40 weeks?

I've also seen placentas from 'overdue' Mums which have been perfectly healthy and I've seen placentas before EDD with massive calcification due to other factors (smoking). Personally I would not look to US studies on neonatal mortality given the huge inequalities in antenatal care and preterm birth rates. There are some Swedish post term studies that I'm sure you're aware of that would contradict your theory.

Deleted User wrote: »

Because very occasionaly, and unfortunately, the two are mutually exclusive.

If it is very occasionally, then why should it be treated as if it is the norm?
Childbirth is a normal physiological event. We've all heard the phrase that childbirth can only be declared normal in retrospect, but for the majority of women, being allowed to go into labour spontaneously and being allowed to labour for as long as is normal for her will lead to the birth of a healthy baby. 40 weeks is the average gestation period and should not be taken as normal for all women. If a woman has a normal gestation period of 38 weeks, then at 40 weeks she is already significantly overdue and is of course at greater risk of placental deterioration and stillbirth. However for those women who would have a normal gestation period of 42 weeks, at 40 weeks their baby and placenta will be doing just fine. The problem with current procedure is that all women seem to be expected to conform to a norm that is not necessarily normal for them.

It is terrifying when you are expecting a baby and you are deemed to be overdue and you are told that you are putting your baby's life at risk if you don't agree to various interventions. I myself experienced this. There were no indications that my child was in anyway compromised but I was constantly told by doctors who had barely examined me that I was endangering him. In the event, I was induced at 40 + 10. After an intense and short labour I gave birth to a fine healthy baby boy and a perfect placenta. He nor it showed no signs of postmaturity or trauma of any kind. I, on the other hand, had torn very badly because of the speed of the induced labour - on the basis of my Bishop's score I was far from an ideal candidate for induction (no softening of cervix, no effacement, baby still very high) and I was lucky to have avoided a c-section.

I was also very lucky in that I had a team of midwives who knew I wanted as natural a birth as possible and supported me through it, and who seemed to keep the doctors at bay. Maybe that meant there were greater risks to my child and myself, but in any case, the trip down the birth canal is one of the riskiest journeys we take in life.

If I had to choose, of course I would rather have tearing and a healthy baby than no baby, but what if we had been allowed to progress normally? Why is admission and monitoring not an alternative to immediate intervention? It may be overly cynical on my part, but I have a strong suspicion that a lack of beds, staff and resources have more to do with the active management of labour than evidence-based research has.

In utero death is not only caused by placental degradation - congenital malformation is a much more common cause. Some stillbirths are due to infection, or accidents, or (very few) due to the process of birth itself. The majority are simply unexplained - life and death is a still a mystery after all.

Like some of the others, I feel your defence of current obstetrical practice complete with all of it's interventions is misguided and unnecessary. every pregnant woman in Ireland will run the gauntlet of 'birth management', arbitrary deadlines and routine interventions, unless she is lucky enough to have a hands-off care provider. Yes, women need to be aware of the risks, but they also need to be allowed to choose the level of risk they are comfortable with. Litigation-wary doctors are maybe not best placed to decide what is best for a normally progressing but overdue mother-to-be.

Cat Melodeon wrote: »

It is terrifying when you are expecting a baby and you are deemed to be overdue and you are told that you are putting your baby's life at risk if you don't agree to various interventions. I myself experienced this. There were no indications that my child was in anyway compromised but I was constantly told by doctors who had barely examined me that I was endangering him. In the event, I was induced at 40 + 10. After an intense and short labour I gave birth to a fine healthy baby boy and a perfect placenta. He nor it showed no signs of postmaturity or trauma of any kind. I, on the other hand, had torn very badly because of the speed of the induced labour - on the basis of my Bishop's score I was far from an ideal candidate for induction (no softening of cervix, no effacement, baby still very high) and I was lucky to have avoided a c-section.


If I had to choose, of course I would rather have tearing and a healthy baby than no baby, but what if we had been allowed to progress normally?

Why is admission and monitoring not an alternative to immediate intervention?


.

Just to say i tore very bad with my second guy a 3rd degree tear and he wasnt induced he was 5 weeks prem (the 3rd guy redid all the damage and did a little more) . inducement doesn't necessarily lead to tears and natural labour can result in a tear. Some natural labours are worse than induced labours, depends on the person.

Admission and monitoring would have to be 24/7 that's a lot of monitoring for a maternity hospital. The baby heart beat could stop at any time day or night it would mean a rush to get the c-section done and maybe resuscitation needed and pediatricians there. if the mother has a full stomach then there would be a risk during anesthetic. To me its still safer to induce at 41 weeks.


Im lucky ive had mine all early but i was always prepared to die for my baby's if needs be, if that meant emergency c-section or inducement Or anything else as long as baby was ok i didn't care about myself.

Squiggler wrote: »

My placenta was perfect, as was our baby, nothing "post dates" about either of them.

Three full scans in the space of 5 days, over a week of extreme pressure to agree to an induction that even the consultants agreed was not medically indicated (scan results were 8/8 on all three, chord was functioning perfectly, plenty of fluid, CTG were fine etc.)

Same as my brother in law sister inlaw, one day she was fine and healthy all going well, the next she was dead, seems no reason for it the heart stopped beating but it did.

That makes me wonder if an unborn baby could suffer with SIDS, a woman i know whos baby was 1 week old died from SIDS if that child had still been inside her would it have died? who knows, still very tragic.

grindelwald wrote: »

Better analogy would be ovarian cancer its more of a life death situation, you cant compare the risk of a stillbirth to risk of tonsillitis or risk of tooth decay!


I think the seat belt analgoy rings true, some will crash and die and others will crash and survive ( of those that survive some will be fine fit n healthy and some will have long term complications others short term) others wont crash at all. I think its a perfect analogy.

I'm not comparing tooth decay to stillbirth, I'm making the point that arbitrarily conducting interventions when they are not medially indicated simply because of an artificially imposed time limit should not be standard practice, just as in the past procedures were carried out routinely which seem barbaric now and which would never be considered by doctors today.

We all know that driving a car is one of the riskiest things we do each day. Wearing a seat belt is the sensible thing to do and it does not cause any harm to the wearer. Having a baby carries less risk (in terms of outcomes) than driving. Treating interventions such as induction or c-section as being a commonplace safety measure equivalent to wearing a seatbelt seems to denigrate the rights of the woman to physical safety and basic dignity. Interventions can be violent and scarring. They should not be commonplace.

I trust the evidence.

The evidence shows us that stillbirth increases from 42 complete weeks. Not 40 weeks. Many hospitals have brought their post date policy in line with this evidence.

ESRI states, "In 2008 approximately 1 in every 200 births were stillborn and 1 in every 470 live births died in the first week of life. ESRI States: Despite improvements in reducing perinatal mortality in recent decades, the perinatal period continues to be a time of relatively high risk. "

The same ESRI report indicates a concerning increase in medical intervention and Caesarean section rate of nearly 27%

The evidence also shows us that routine medical intervention and caesaren section contributes to perinatal and maternal mortality and morbidity.


* Only 43.5% of First time mothers will have a spontaneous birth. (WHO recommends 85%). Down from 50.7% in 1999.



* 7.2% of First Time Mothers will have a forceps delivery. This is down from 8.1% in 1999 BUT UP from 5.1% in 2004



* 21.4% of First Time Mothers will have a vacuum extraction. This is Up from 17.0% in 1999.



* 27.3% of First Time Mothers will have a Caesarean Section. This is UP from 23.2% in 1999.


Birth experience matters. The second highest contributor to maternal death is suicide following the first post natal year. This is widely believed to be down to an increase in PTSD, PND, birth related trauma and lack of services to evaluate a mother's mental health following birth.

Sqiggler, I am so very sorry for your loss.

James - you missed the key word in my post, "routine"

I have no problem whatsoever with medically indicated intervention or caesarean section. I can even understand certain arguments with regards to informed choice and maternally requested intervention/caesarean.

However, we know routine intervention does not save babies.

In fact, research shows that routine intervention is associated with significant increased risks to mother and baby.

We also know that new research has shown that levels of high intervention do not improve outcomes for infants.

http://www.sciencedaily.com/releases/2011/04/110413101916.htm

I would understand medical intervention if the dates were definitive and there was any indication that the baby or mother may be at risk. However, as in my 2 pregs, dates can very easily & commonly be miscalculated.

My first preg was 41 weeks, leading the docs to start talking induction, but when my daughter was born the midwife commented on the amount of white vernix she still had (apparently it's mainly gone at term, and certainly at 41 weeks). This would indicate that the preg may not have been 41 weeks afterall, and if I'd been induced...:(

The due dates of my second preg differed by 10 days...the EDD by missed-period calculation was 10 days before the EDD determined by the scan. So when I was "over" by 13 days by dates, I was only 3 days over by scan. They wanted to induce me then too, but it wound up not being necessary.

James, I think everyone here will easily support any effort to deliver a healthy baby safely. But at what point can you definitively define "overdue?" If, in my cases, the preg isn't really overdue, there's a risk to mom & baby by delivering under unspontaneous conditions.

Deleted User wrote: »

That's a U.S. study, not sure how relevant it is to obstetric practice in Ireland, given that their C section rate was 32% in 2007 as opposed to 18.9% here. I suspect a significant proportion of C sections there (as here) are elective.

These climbing C section rates are a worrying trend, as C sections have an increased risk of maternal complications.

This, however, is a completley different issue to non elective or emergency C section, which is only performed when there is a definite need for it.

Induction is a seperate issue again, and the risks of going post dates has been shown over and over again in countless large studies from around the world.

While induced labour is more likely to result in C section there is a confounding factor here:

A higher proportion of induced babies will be post dates, and thus on average bigger than their non induced counterparts. Also, being post-mature their skulls will be more ossified, less easily moulded, and more prone to obstructed labour.

James, Ireland's Caesarean section rate is nearly 27% (26.7%). Not 18%. A large proportion of these Caesarean Sections are indeed elective due to failure to provide breech clinics and a lack of VBAC options (some units rank in at only a 4.5% vbac rate as compared to guidelines of 70%) but a significant proportion come from induction of labour and effects of oxytocin. The fact is, our maternity services are becoming more closely in line with places like the US. Highly medicalised, highly obstetric, majority of women solely have access to consultant led care IE. birth becomes a medical event with a surgeon.

That research is not for electives alone.
Using statistical models, Glantz assessed the relationship between rates of induction and cesarean delivery and rates of the three neonatal outcomes. He found intervention rates had no consistent effect on newborns: Whether a hospital did a lot or very few interventions, there was no association with how sick or healthy the infants were.

Even after a second round of analysis that accounted for differences among pregnant women that could potentially impact the results, the finding was the same -- hospitals with high intervention rates had newborn outcomes indistinguishable from hospitals with low rates.

According to Glantz, "If higher intervention rates were preventing negative outcomes that otherwise would have occurred, and lower intervention rates led to negative outcomes that potentially could have been avoided, the data would have revealed these relationships, but there were no such trends."

On induction:

There is high quality internationally recognised evidence which shows us that stillbirth increases from 42 complete weeks. Irish maternity units (well some....) have come in line with this evidence and newer induction policies reflect this; ie induction at term+14.

There is a new phenomenon occurring in units who don't consult the evidence. Premature induction. Babies induced too soon and suffer adverse affects as a result. Ask any midwife, due to an over-reliance of technology babies are being born covered in vernix and requiring nicu following inappropriate uses of induction