The press and much of the world, or so it seems, has been on edge waiting for the Duchess of Cambridge to go into labor and finally that day has arrived. The historic event spawned a flurry of articles, some very concerned that the Duchess was post dates. Reporters have been camped out for weeks in front of St. Mary’s hospital in London in anticipation.
On the other hand, Kate and Prince William seemed quite content to wait, which is a lesson that all maternal providers and prospective parents should heed, especially in America, where it seems we have long forgotten that the due date is really an estimated date of confinement and not an expected date of confinement.
A term pregnancy is anywhere between 37 weeks (37 weeks 0 days) and 42 weeks (42 weeks and 0 days), although there is a convincing body of literature that babies do best when born between 39 and 41 weeks. Not every baby needs to be out by 41 weeks. Induction is certainly one option, but close monitoring and delaying induction to 42 weeks is also acceptable as most women go into labor by 42 weeks. The decision to induce at 41 weeks or wait to 42 involves many variables. However, once 42 weeks and 1 day rolls around the rate of stillbirth rises significantly.
Many hospitals in America have very high rates of labor induction. Particularly concerning are medically unindicated inductions and caesarean sections before 39 weeks. In one study, 28% of scheduled early-term deliveries were purely elective. These deliveries are a mix of impatience (providers, parents, or both), incorrectly calculated due dates, and a false sense of security that edging the delivery date forward is safe when it is exactly the opposite. Babies born between 37 weeks and 38 weeks and 6 days have a higher risk of mortality, serious health problems, and impairment in math and reading skills compared with their peers born at or after 39 weeks.
Many hospitals have initiated hard stops to curb unnecessary early inductions. These system wide efforts combined with educational campaigns directed at both maternal health providers and prospective parents can reduce medically unindicated early deliveries to 5%. It’s a great start, but that rate should really be 0%.
What we can take away from the great Kate wait is that a baby’s date of delivery is an estimate and that as long as things are normal the better part of obstetrical care is patience. The Queen may have been concerned about her holiday plans, but the future heir to the throne has a placenta with its own schedule and if everything is fine then the best plan is no plan. At least until 41 weeks.
If Kate who is carrying the future heir to the throne and is being watched by a billion or so eyes could wait, so can we.
“I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.”
Jen Gunter is an obstetrician/gynaecologist in San Francisco. She blogs on her personal site at drjengunter.com.