You might be here because you’re nearing or past your due date and getting the pressure for induction of labour. In which case, I hope this helps to give you a non-biased, evidence based information so that you can make an informed choice about your pregnancy and birth.
There’s many myths surrounding pregnancy and birth. One being that your stillbirth rate increases dramatically increases as soon as you get to your due date because ‘the placenta starts to age and die’. The other, and most important one, is that you have no say in your pregnancy and birth, and whatever is suggested to you, you must do. Ever heard people say ‘I couldn’t go past 41 weeks’ ’they wouldn’t let me have a water birth as I had to be induced’ etc? The fear of the stillbirth rate being so high after your due date leads to the assumption that induction is necessary for so-called 'post date' pregnancies. However, it's crucial to understand the facts behind this controversial topic and dispel the misconceptions surrounding it.
What are post-term (or post due date) pregnancies?
This is where some issues come into play. A pregnancy that is ‘term’ is considered from 37-42 weeks. Yet pregnant people are pushed to induction at 40-41 weeks, sometimes sooner which are referred to as ‘post dates’ which is different to post term. Post dates is going past your estimated due date. Why, if term is until 42 weeks, are we pushing pregnant women and people into induction at 40 weeks? Consider the fact that more than 80% of pregnancies go beyond that magical due date, are all those women broken or are we calculating due dates totally wrong? It’s almost as if it’s a total estimate..
It's important to note that the duration of a normal, healthy pregnancy can vary from woman to woman, and even within the same woman for different pregnancies. Rather than focusing solely on the calendar, we must assess the overall health of both the mother and the baby using a combination of clinical assessments and fetal monitoring techniques.
Think about fruit. It doesn't all ripen at the same time, even if they've all been planted on the same day. The same tree, same orchard, the fruit is ready at differences times. If you tried to pick the apple too early, it'll be tough and sour. Not ready. Why do we expect this from fruit but when it comes to babies, they must all be ready by 40 weeks and not a day sooner! Induced labours also tend to be longer and more painful, because the baby isn't ready to be born. Forcing a baby to be born before they're ready is a challenge. The ripe fruit falls easily from the tree, but the unripe ones are much harder to claw off the tree.
The myth of increased risk
Contrary to popular belief, research in the field of obstetrics and gynecology has not established a significant correlation between stillbirth rates and pregnancies that go beyond the due date. While it's essential to monitor the well-being of both the mother and the baby, the emphasis on inducing labour solely due to the passing of the due date needs to be re-evaluated, as it’s not a good enough reason to end a pregnancy sooner than the baby is ready.
But what are the stats of stillbirth and gestation?
At 38 weeks, the risk of stillbirth was 0.12/1000, so 1 in 8333 or 0.012%
At 39 weeks, the risk of stillbirth was 0.14/1000, so 1 in 7142 or 0.014%
At 40 weeks, the risk of stillbirth was 0.33/1000, so 1 in 3030. Or 0.033%
At 41 weeks, the risk of stillbirth was 0.80/1000, so 1 in 1250 or 0.08%
At 42 weeks, the risk of stillbirth was 0.88/1000, so 1 in 1136 or 0.088%
(Muglu et al 2019 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605635/)
So you can see, that yes, the stillbirth rate does increase, but all numbers are incredibly low chance. When someone says that the stillbirth rate dramatically increases, it really puts that fear in to you and you imagine it’s a chance much higher than the numbers above. Take the look at the details and make your own decision based on that rather than pressure from outsiders, especially when they haven’t actually told you those details.
What you might be getting told in pregnancy is the relative risk (the risk doubles) rather than the absolute risk (0.5-1% for example). Relative risk doesn’t help you to make informed choices.
Should induction be offered?
Pregnancy is a unique experience for each woman, and the approach to managing post-term pregnancies should reflect this individuality. Induction, although commonly suggested, should not be the default response to every post-term pregnancy. Instead, shared decision-making between the pregnant person and their healthcare provider is crucial. No one can tell a birther whether they should or shouldn't have an induction - it is up to them alone to make that decision with ALL the facts. This process involves a thorough discussion of the risks and benefits associated with various options, including the potential implications of induction and the alternatives that could be offered if you decline induction. Although this is something that doesn’t tend to happen in your appointments, but it is something we talking about in my hypnobirthing courses. Decision making is something we go in to detail in my hypnobirthing courses.
Where do you go from here?
Let's acknowledge the uniqueness of everyone's pregnancy and birth and give the power and control back to them so that they can make informed decisions, coming out of their birth feeling empowered rather than feeling like a kid at school following arbitrary policies and guidelines. Let’s not take things at face value when being told that the risk of going past your due date is terribly dangerous and ask some questions so you can choose the right path for you.
If you would like to start your journey to feeling positive, confident and empowered about your birth and your choices, start that process with my hypnobirthing courses.
I'm Bea, hypnobirthing and antenatal teacher, breastfeeding counsellor and infant feeding specialist. I provide hypnobirthing and antenatal classes as groups or private courses in Leicestershire as well as antenatal and postnatal infant feeding support.
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