Birthing study reveals 39 weeks is the optimum time to have a baby
Research has dispelled women’s fears around induction of labour as experts declare 39 weeks the ‘optimum time to have a baby’.
When Kiara Raffa was offered a planned induction of labour at 39 weeks with her fifth child, she was in floods of tears as she grappled with fear and anxiety.
“I was absolutely petrified,” the 36-year-old Perth mother says.
“I’d been told numerous times how painful labour after an induction was. I was very against having an epidural. I was petrified of the medication that they put in the drip with the induction. All of those fears created so much anxiety for me.”
Ms Raffa’s four previous pregnancies had all gone an average of a week overdue but were not induced, with difficult labours and traumatic births, the last two very quick. With the reassurance of her obstetrician, and despite her fears, Ms Raffa decided to opt for induction of labour with her fifth.
Baby Alaska was born six weeks ago after what Ms Raffa describes as a smooth, controlled labour that was worlds apart from her previous births. “I honestly don’t have words that can describe how healing it was for me,” she says. “This labour was when I felt the safest. I look back at it now and sort of have a little giggle to myself, why was I so scared?”
Like so many aspects of birth, induction of labour is subject to divergent perspectives between obstetricians who, on average, tend to more commonly induce labour or schedule planned caesarean sections, and midwives who generally prefer nature to take its course in low-risk women via spontaneous labour.
Now a large dataset, comprising almost half a million births in Queensland over 21 years, has found planned births at 39 weeks in low-risk women, compared with expectant management, are associated with lower rates of peri-natal mortality and stillbirth, and lower rates of neurological disability in babies and severe adverse maternal outcomes.
Planned births include both induction of labour and planned caesarean section, and C-sections were associated with the biggest reduction in risks to mother and baby. But the paper, by the University of Queensland’s professor of obstetrics and gynaecology Sailesh Kumar with colleagues, also found that planned birth by induction of labour was associated with a reduction in risk of severe perineal trauma and shoulder dystocia, a high-risk complication that leads to babies getting stuck in the birth canal.
The paper, published in the Lancet, confirmed previous studies that found induction of labour was not associated with a higher instance of emergency caesarean section.
“Even in low-risk women, it’s clear that planned birth reduces the risk of peri-natal mortality,” Professor Kumar said.
“It is a very safe time to have a baby if you’ve got no other risks until that point.”
“But death in childbirth in Australia is such a rare event. This data shows that in low-risk women, if you are induced between 39 (weeks and 39 weeks and six days), you have a 32 per cent lower odds of having a baby with a severe neurological outcome and about a 20 per cent lower odds of a severe non-neurological outcome. You have about a 6 per cent lower odds of severe maternal outcome. You have about 10 per cent lower odds of your baby being separated from you, and you have about a 47 per cent lower odds of having severe perineal trauma.
“Your baby is less likely to get stuck at the time of delivery and you have about 46 per cent lower odds of needing an emergency caesarean.
“I think that there is now robust data that suggests induction of labour at 39 weeks is safe and is potentially associated with benefit for a variety of serious adverse outcomes.”
The Lancet data follows evidence from a US randomised trial known as the ARRIVE study, which found induction resulted in a lower risk of C-section and a reduction in adverse peri-natal outcomes. The results of that trial are already changing practice in Australian hospitals towards more frequent inductions of labour, but the Australian College of Midwives does not regard that as a positive development. Midwives point to alternative studies showing higher intervention rates as a result of induction and insist there is evidence to support inductions resulting in more difficult labours.
“I think there is evidence to support those findings, and I think also we need to look anecdotally at what women are saying,” says ACN’s chief midwifery officer Alison Weatherstone. “There’s a lot of consumer evidence now … that women don’t necessarily have all of the information from an antenatal perspective, and it potentially may have influenced their decision on whether or not they had an induction of labour.
“I think we need to look at evidence-based information that we provide women in that antenatal space so that they can make an informed decision.”
Australia’s first woman professor of obstetrics and gynaecology, Caroline de Costa, former editor-in-chief of the Australia New Zealand Journal of Obstetrics and Gynaecology, says the Lancet paper gives good grounds for Australia to adopt widely a more proactive approach towards induction in public hospitals.
“The results of the Lancet paper are clear,” Professor de Costa said. “This is a study across a large population, it’s been very well conducted, and it shows quite strong evidence for the safety of both induction of labour and planned caesarean section in the 39th week. This may, in fact, be the optimum time for delivery in low-risk women. It is a very safe time to have a baby if you’ve got no other risks until that point.”
Professor de Costa says women should not fear a more painful labour, a longer labour or higher risk of birth interventions if they are induced. Professor Kumar agrees and says the most definitive study on the issue says women report less pain if they are induced, as well as a greater sense of control and satisfaction during labour.
That accords with Ms Raffa’s own experience. “They say natural is best a lot of the time. But the medical science is there. It’s there to help women, and if it’s going to result in your baby being born safer with less intervention in the long run, I one hundred per cent recommend it.”
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