Going pat 41 weeks...really dangerous?

[songbird516]

Originally Posted by canadianbakers It sounds like his death wasn't caused by being 42 weeks, though, but instead by the long induction and the cord issues. If it was to do with his cord, it may have occured at any gestational age with labor and birth. If he had passed away before the induction I would be more likely to put some blame on him being 42 weeks, but not with the other stuff going on. Again, I can't imagine the issues Levi would have had if we had induced early - 39 weeks would have been 2.5 weeks early for him... that is scary to me. Yes, true.

I agree with this. My second was born at 41 weeks and he was little! My placenta with him looked healthier at 41 weeks than my daugher's did at 40 weeks. Also his gestational age assessment was 38 weeks even though I knew date of conception, so he really was 41 weeks. I think that most of the time babies come when they are ready, and medically managing everything really can't take the risk out of life or childbearing/childbirth.

[UmmKira]

I pray you have a wonderful birth experience! I went over for both of my girls, and neither showed any signs of having issues from going over. I think i may just take longer to bake by little buns in the oven.

[Sabra]

I was actually researching this just the other day. The conclusion I was seeing was that inducing at 41 weeks vs 42 improves outcomes...BUT here's the thing: the rate of still birth at 40 weeks is 4 in 1000. If you wait until 42 weeks, the rate of still birth nearly doubles...to 7 in 1000. And yeah, that sounds scary, but here's the thing. Put it into percentages: 4/1000 = 0.004 = 0.4%; 7/1000 = 0.007 = 0.7% Now, flip that around...at worst, there is a 99.3% chance of your baby NOT dying. It is a small risk.

This is a good (if dense) read: http://archive.ahrq.gov/clinic/epcsums/prolongsum.htm It's a meta-analysis of studies, which means it has done the number crunching for you. A few relevant bits:

* The risk of antepartum stillbirth increases with increasing gestational age. Data from several large studies in the United Kingdom show that, when calculated as deaths per 1,000 ongoing pregnancies, antepartum stillbirth rates begin increasing after 40 weeks, with estimates of 0.86-1.08/1,000 between 40 and 41 weeks, 1.2-1.27/1,000 between 41 and 42 weeks, 1.3-1.9/1,000 between 42 and 43 weeks, and 1.58-6.3/1,000 after 43 weeks. *Although not statistically significant in most individual trials, there is a consistent finding that perinatal mortality rates are lower with planned induction at 41 weeks or later compared with expectant management, a finding confirmed by formal meta-analysis. Based on the observed absolute risk difference in the meta-analysis, at least 500 inductions are necessary to prevent one perinatal death. Whether this is an acceptable trade-off at either the policy or individual level is unclear. *There is a remarkable lack of data on patient-oriented outcomes, such as quality of life or measures of patient preferences for different outcomes or for different processes to achieve those outcomes.

Here's another quote from a different part of the article which is also relevant (note the numbers given here are different than what I mentioned earlier, and what I found last time I looked into this, but the conclusion drawn is the same):

In some cases, these risks appear to be due to uteroplacental insufficiency, resulting in eventual fetal hypoxia. Data from large registries show that the risk of perinatal death, especially of antepartum stillbirth, increases with advancing gestational age. If risk is calculated based on the number of ongoing pregnancies, gestational-age-specific stillbirth risk reaches a nadir at 37-38 weeks and then begins to increase slowly. Risks increase substantially after 41 weeks; however, the absolute risk is still low (between 1 and 2 per 1,000 ongoing pregnancies between 41 and 43 weeks).

[calleiah]

To my knowledge the only study actually done on still birth and timing was conducted in the 50's. It is the study most quoted. *To my knowledge* there has been no comprehensive study on the subject since that study. It's possible something has come out recently, but if it has, I haven't seen it, and Im kind of a research freak. You are absolutely within your rights to ask her to site her sources and backup her statement. You have the the right to read and draw your own conclusion. If you BPP looks good, sono says your placenta is doing fine, I see zero evidence for induction.

Additionally, conditions in utero for one mamma at 41 weeks can be totally different than another. Making blanket statements without taking specifics into account is irresponsible and leads to "standard of care" treatment. I personally dont want "standard of care". I want evidence (based on ME and MY situation) based treatment.

[mariamommy]

I did not read the whole thread. Just wanted to throw in my 2 cents/experiences.

I carried three of my babies to 42 weeks and my last baby to 43 weeks. All healthy. But all cesareans. I only labored with my third hoping for VBA2C, she made it through 5 days of labor well.

[Sabra]

Originally Posted by calleiah To my knowledge the only study actually done on still birth and timing was conducted in the 50's. It is the study most quoted. *To my knowledge* there has been no comprehensive study on the subject since that study. It's possible something has come out recently, but if it has, I haven't seen it, and Im kind of a research freak. You are absolutely within your rights to ask her to site her sources and backup her statement. You have the the right to read and draw your own conclusion. If you BPP looks good, sono says your placenta is doing fine, I see zero evidence for induction.

Um, the meta-analysis I quoted looked at roughly 700 papers published from 1980-2000. That's certainly past the 1950s. Most of the scholarly articles (which are accessible fairly readily by Google search, even if you can only read the abstracts of most of them) I've looked at--and I restricted my search to articles published from 2008 forward--have study cohorts in the tens of thousands. The information is not difficult at all to come by.

[TwinKristi]

Originally Posted by canadianbakers It sounds like his death wasn't caused by being 42 weeks, though, but instead by the long induction and the cord issues. If it was to do with his cord, it may have occured at any gestational age with labor and birth. If he had passed away before the induction I would be more likely to put some blame on him being 42 weeks, but not with the other stuff going on. .

I've read that the cord can lose its elasticity as it ages and doesn't do as well with compression? I don't remember there being any complications prior to the pushing stage. They also thought size played a roll. Just too squished in there.

Originally Posted by songbird516 I've heard this story before and I took away a very different message. What if the induction contributed to the stillbirth? A woman in my doula training course lost a baby during an induction at 42 weeks, and felt strongly that her baby would have been alive if she hadn't been forced into the induction. I don't think that I would schedule a c-section if my baby died during an induction, but that's just me. I know a local mother who lost a baby during a homebirth; baby was breech and the cord was compressed in some way during the end of the birth. For their second they chose a hospital birth, but still allowed labor to start on it's own, labored naturally at home for almost the entire labor, and didn't make decisions based on the fear that the same thing would happen during the birth of the second baby. OP, here is an article from a midwife that discussed inductions and addresses some of your concerns. http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/

We can all say what we "think" we would do but until you're there in those shoes I don't think anyone can really say. Her OB discouraged her from a planned c/s but imagine the anxiety and stress she would be in most likely in the same room she gave birth to her son in and the sadness she felt. Same nurses, same drs, induction, etc. I don't blame her at all for choosing a c/s. And yes the induction may have contributed to it, but it could have been his size combined with the age of the cord and whatever else on top of the induction. They would have induced at 39wks to avoid the size concern but she didn't want to go there and I respect that. I had considered a homebirth for DS6 and had planned to before he was ever conceived, but after she lost her baby I let fear take ahold of me and just couldn't risk it. I understand the POV you have, I just don't share it.