The perfect timing for birth

The risk of stillbirths for pregnant women who are aged above 40 is quite high. And to avert the risk, there is increased number of caesarean sections. Researchers are saying that both of these can be avoided if such a pregnant woman is given the option of being induced early. And this would save many babies’ lives. Induction is the artificial way to stimulate childbirth.

Data shows that at 39 to 40 weeks of pregnancy, women aged above 40 double their risk of stillbirth when compared with women who are under 35. But the risk at 39 weeks is reduced for older women: same as that of women in their late 20s. And that shows that if the older women are induced at this stage, the risk gets reduced. According to Dr. Anna Kenyon of the University College London Hospital, “It is justifiable for experts to conclude that inducing labour at an earlier stage of gestation (39 to 40 weeks) in older mothers (40-plus years) could prevent late stillbirth and any maternal risks of an ongoing pregnancy, without increasing the number of operative vaginal deliveries or emergency caesarean sections.”

Medication is a common method of inducing childbirth. Intravaginal, endocervical or extra-amniotic administration of prostaglandin, such as dinoprostone or misoprostol is part of the procedure. In the few controlled trials that have been done, extra-amniotic administration appears to be more efficient than intravaginal or endocervical administration of prostaglandins in induction, with no differential effects on other outcome measures. A woman can be administered intravenous synthetic oxytocin preparations, such as Pitocin, as well. 

There are processes such as membrane sweep, artificial rupture of the membranes and extra-amniotic saline infusion in which a Foley catheter is inserted into the cervix and the distal portion expanded to dilate it, and to release prostaglandins.

Experts, however, have warned that such induction can be risky if done before 39 weeks. It increases the risk of complications and premature death, from factors including underdeveloped lungs, infection due to underdeveloped immune system, problems feeding due to underdeveloped brain, and jaundice from underdeveloped liver.

Moreover, induced labour can be more painful. This in turn leads to increased use of analgesics and other pain-relieving pharmaceuticals. These interventions have been said to lead to an increased likelihood of caesarean sections. Research published in the Journal of Perinatal and Neonatal Nursing showed that elective induction in women, who were not post-term, increased a woman’s chance of a C-section by two to three times.

Reasons for Induction

Post-term pregnancy, i.e. if the pregnancy has gone past the 42 week mark.

Intrauterine foetal growth retardation (IUGR).

There are health risks to the woman in continuing the pregnancy (e.g. she has pre-eclampsia).

Premature rupture of the membranes (PROM); this is when the membranes have ruptured, but labour does not start within a specific amount of time.

Premature termination of the pregnancy (abortion).

Scheduling concerns.

Foetal death in utero.

Twin pregnancy continuing beyond 38 weeks.

Pregnancy at 37 to 40 weeks

The Baby: In these last weeks, some time before birth, the baby’s head may move down into your pelvis and is said to be ‘engaged.’ Sometimes the baby’s head doesn’t engage until labour has started. The amniotic fluid now turns into waste, called meconium, in the baby’s intestines, and the soft hair (lanugo) that covered your baby’s body is now almost all gone.

The Mother: When you are around 37 weeks pregnant, if it’s your first pregnancy, you may feel more comfortable as your baby moves down ready to be born, although you will probably feel increased pressure in your lower abdomen. If it’s not your first pregnancy, the baby may not move down until labour.