The case for inducing at 37 weeks

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While we often think of pregnancy as a nine-month or 40 week affair, experts agree that 37 weeks is actually "full term". So is there an argument for inducing all births at 37 weeks?

Researchers in Denmark brought this debate to the table last week when they published a new study investigating possible links between inducing labour and improved birth outcomes.

They found that inducing at or after 37 weeks corresponded with a halving of stillbirths (down from 1.9 deaths per 1000 births to one in 1000, between the years 2000 and 2012.)

Likewise, the risk of asphyxia dropped by 23 per cent from 2003 to 2012, and the risk of cerebral palsy fell 26 per cent between 2002 and 2010.

The researchers concluded that the increase in inductions at or around 37 weeks could explain some of the improved perinatal outcomes.

So does this mean that inducing labour at 37 weeks would reduce the incidence of stillbirth in Australia? Professor Michael Permezel, president of the Royal Australian & NZ College of Obstetricians and Gynaecologists (RANZCOG, says that in theory, yes it would.

"It is very likely that induction of labour earlier rather than later would reduce the risk of stillbirth," he says.

"Approximately one in 3000 will have a perinatal death between 37.0 and 37.6 weeks, increasing to about one in 1000 by the week beginning 40, and one in 500 in the week beginning 41.

"Of all those women pregnant at 37 weeks, about one in 400 will have a perinatal death," Dr Permezel explains.


However, while he acknowledges that inductions could reduce incidence of stillbirth, Dr Permezel is not in favour of routinely inducing women once they get to 37 weeks. He notes that there are several potential problems.

"Birth at 37 weeks has an increased likelihood of the baby needing admission to the special care nursery - most often because of breathing difficulties. Although this almost invariably resolves completely within a couple of days, it is an added cost for the health system, and the separation from the mother is obviously undesirable."

Dr Permezel also notes that a policy of routinely inducing women at 37 weeks would lead to an increase in caesarean sections. "This is because many women will be having the induction of labour before the pregnancy is ready for vaginal birth – for example if the baby's head is high or the cervix tightly closed," he explains.

"In most cases where the head is high, it's not safe to induce labour, and an elective caesarean section would be recommended."

Midwife Nicole Grant agrees, saying that in her opinion it would be unwise to routinely induce women at 37 weeks.

"Pregnancy, labour and birth are a natural body process, not medical procedures. That fact should be honored by women, and women should be empowered to make decisions that reflect that they are going through a normal body process," she says.

In terms of reducing the incidence of stillbirth, which currently sits at six babies a day in Australia, Grant says that it is really important for pregnant women to be aware of the movement of the baby.

"The best and most effective way to reduce stillbirth is to educate pregnant women on fetal movements. When women know when their babies are most active, and their usual rest periods, they can call their midwife and get checked if something is wrong."

Grant says that it is important that pregnant women are taken seriously and that care providers should be assessing them whenever they are concerned about a lack of movement.

"Care providers need to see a woman every time she says her baby hasn't moved as much as usual. The baby's heart rate should be checked and if there are any concerns she should be referred to obstetrics for an ultrasound," she explains.

While Grant is not in favour of medical inductions at 37 weeks, she sees no harm in pregnant women trying some natural induction techniques. "There are two techniques that literature support: firstly, antenatal breast expression i.e. getting milk from the breasts by hand stimulation. I encourage all my first-time mums to do this from 36 weeks, because it increases their milk supply, gets them used to the feeling of breastfeeding, and decreases the risk of a postdates induction."

And secondly, according to Grant, the other natural induction technique that is known to work is sex. "Sex works because semen has a natural form of prostaglandins which can change the cervix and make it more 'ripe'," she explains.