On May 16, the American Congress of Obstetrics and Gynecology met to discuss several matters with regards to their practice. One of the topics that were discussed was recommending routine induction at 39 weeks for all women. The birth community was rather in an uproar about several of their more controversial statements, including
“This is a no-brainer. Why are we even having this debate?”
“Nature is a lousy obstetrician.”
“39 weeks is the solution. Rescued by birth.”
“Think like a fetus. There is no benefit to staying in after 39 weeks.”
The general conclusion of the meeting was that recommending induction across the board at 39 weeks was a good idea, though no official recommendations have been made as a result of their discussions. Many in the birth community are now nervous about what may happen to the field of obstetrics and how this recommendation if made official, is going to change the way obstetric practice is done.
There are a few things to note about ACOG. It is merely a private member organization, though indeed a LARGE one. It is not a government entity, though its name would suggest such. The recommendations that are put out by the organization do not dictate the way a member practice. (Hospitals and insurance companies do that). Furthermore, if a physician recommends a procedure just because ACOG recommends it, that does not mean that it is good practice. Only one-third of the recommendations put out by ACOG are based on sound evidence. The other two-thirds are based on either limited evidence or “consensus and opinion.” See here to read about this review of ACOG practices.
Evidence has shown time and time again that waiting until a baby is ready to be born, while carefully monitoring the mom and baby in the final weeks is generally the safest route. In addition, a woman is not clinically considered to be “post dates” until she is 42 weeks. An induction performed at 39 weeks could potentially cause a baby to be born three weeks before they were ready which can be dangerous for a baby. Due dates can be wildly off, and a 39-week induction could be very risky to a baby whose lungs are not yet developed. Induction itself also carries many risks for both mom and baby and those too numerous for this post.
One thing that evidence is clear on is that a baby should gestate for at least 39 weeks. That does not mean that 39 weeks is the magic date that a baby should be evicted from the womb. Stillbirth risks go up after a baby has reached 42 weeks, and most care providers consider the 39 weeks to 41 weeks time frame to be an optimal window for birth. Still, even though the stillbirth risk rises, the incidence is still extremely low, and a baby may still have crucial development happening at 39 weeks. You may read a great Evidence Based Birth (R) article detailing the research on due dates and stillbirth here.
So what is a woman to do if she finds herself with a provider that recommends induction at 39 weeks – just because?
First, understand that you can always change your care provider. ALWAYS. Women have changed doctors or midwives in the final days of pregnancy. It can be done. If your care provider is not practicing with the standard of care that you desire, or they are not answering your questions to your satisfaction, switch right away. In general, midwives tend to practice with a more hands off approach. Simply switching from a doctor to a midwife may change the entire outcome of your birth. Learn the difference between active management and expectant management and find a provider that lines up with the one that fits you best.
Know that you have the right to informed consent, but you also have the right to informed refusal. Informed refusal is not a term that is widely known, but it should be. Informed consent usually amounts to “I inform you and you consent.” Informed refusal simply asks the question, “What may happen if I choose not to move forward with this plan?” That is a viable option for you.
Hear the advice of your providers. Do your own research. Take an independent childbirth class. Make what you feel is the best decision for you and own it. At the end of the day, you are the one that deals with the results of decisions about you and your baby’s health, not your care provider.
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