No one should be exulting about lowering late preterm births until we figure out who died as a result

Baby Tombstone

Imagine that I published a paper crowing that the US had reduced the use of chemotherapy.

Chemotherapy is expensive, arduous and has a plethora of terrible complications up to and including death. We would save lots of money and prevent lots of serious complications. A victory, right? Wrong!

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lowering death rates is an achievement; lowering intervention rates is not.[/pullquote]

You don’t have to a rocket scientist to understand that simply reducing the use of chemotherapy is meaningless in and of itself. It might be meaningful be but ONLY if the death rate from cancer held steady or dropped. If the cancer death rate rose, the reduced use of chemotherapy wouldn’t be an achievement; it would be an indictment of skewed priorities. At worst, it would reflect an appalling eagerness to save money instead of lives.

There’s a principle being illustrated here: chemotherapy is a process not an outcome. Improving outcomes is an achievement. Changing process is not.

The same thing goes for rates of intervention in childbirth. That’s why I despair when I see papers like the one published today in JAMA, Temporal Trends in Late Preterm and Early Term Birth Rates in 6 High-Income Countries in North America and Europe and Association With Clinician-Initiated Obstetric Interventions.

The authors found:

Between 2006 and 2014, late preterm and early term birth rates declined in the United States, and an association was observed between early term birth rates and decreasing clinician-initiated obstetric interventions. Late preterm births also decreased in Norway, and early term births decreased in Norway and Sweden. Clinician-initiated obstetric interventions increased in some countries but no association was found with rates of late preterm or early term birth.

ABC News reported:

The rate of cesarean sections and induced births in the U.S. has declined, reversing a decades-long trend of increased rates of obstetric interventions, according to a study published today in the Journal of the American Medical Association.

Researchers from multiple institutions … found measurable drops in the amount of obstetric interventions taking place in babies delivered both late pre-term (34-36 weeks of pregnancy) and early term (37-38 weeks of pregnancy). Researchers found there was a decrease in obstetric interventions from 33 percent in 2006 to 21 percent in 2014 for early-term infants and a slight decrease — from 6.8 percent to 5.7 percent — for infants born in late pre-term births during this time period.

Dr. David Hackney is quoted:

It always feels good to have a long-standing public health and educational campaign [of decreasing medical interventions],” he said. You “can actually see the change in … public health findings.”

Wrong, wrong, wrong!

No one should feel good about anything until they determine how many babies were injured or died to reach those lower intervention rates. I find it utterly appalling that no one even looked. Crowing about process while ignoring outcomes reflects two deeply disturbing trends: the pressure to save money and the obsession with “unhindered” birth.

The pressure to save money is at least understandable; we don’t have unlimited money to spend on healthcare. But the glorification of birth without interventions has no basis in science. It reflects the values of the midwifery and natural childbirth communities who demonize interventions they cannot provide because that is how THEY profit.

Dr. Jennifer Spong wrote an editorial accompanying the JAMA piece. The title, Improving Birth Outcomes Key to Improving Global Health, sounds promising. Our goal should be improving birth outcomes and thereby improving global health. Sadly Dr. Spong barely mentions outcomes and only in the last lines:

However, physicians cannot become too devoted to decreasing late preterm and early term birth rates. For pregnancies in which there is a complication and when delivery will optimize the pregnancy outcome, delivery should occur and will require an obstetrical intervention.

That’s because decreasing early birth rates is NOT an appropriate outcome. The outcome of childbirth can only be measure by death and injury rates and no one has bothered to do that here.

It saddens me that I have to repeat the obvious:

Any birth that results in a preventable injury or preventable death is a failure REGARDLESS of whether it is a vaginal birth at term without interventions.

Obstetricians have a legal and ethical obligation to maximize health in mothers and babies; they have no obligation to minimize interventions or maximize term births.

67 Responses to “No one should be exulting about lowering late preterm births until we figure out who died as a result”

  1. CaresForSomeReason
    July 28, 2016 at 10:24 pm #

    I wholeheartedly agree. I had a child who was diagnosed with IUGR at 36 weeks at a major university hospital. They started twice weekly non stress tests in the hospital and the at practice. Despite the fact that she failed the very first one at 37 weeks in quite dramatic fashion, leading to hours of monitoring in labor and delivery, and the ACOG recommendation was induction at 37-38 weeks, the whole hospital was infected with a “baby-friendly” 39 week standard. The hospitalist even told us that 37 weeks used to be term, but not anymore. Thus, we were released when she finally showed a response.

    After she had an okay NST later the same week, our follow-up 38 week NST was actually cancelled, since we could obviously go to term (they never even did another growth ultrasound). On the Monday of the cancelled NST (38 weeks), she stopped moving regularly, and went back to L & D as an emergency. After failing the NST again, and more hours of monitoring, they were ready to send us home and wait. It was only a stubborn L & D nurse, likely with way too much experience, that forced them to give us an induction. Despite failing to react appropriately and showing possible distress on the monitors for periods of hours during the two days of induction, including periods where they put me on all fours on oxygen, they let it go on. Can’t let that C-section rate go up! All the while, my doctor insisted there was no way she was growth restricted, the ultrasound was wrong, and she would come out big.

    Miraculously, she came out with no apparent problems, but weighing less than 5 pounds (way under the ultrasound estimate of 7th percentile). This was caused by fetal thrombotic vasculopathy, leaving her with a placenta a third the size of normal and rapidly failing. There was no good reason to leave her in and I feel we played Russian roulette. Indeed, my doctor handled a term stillbirth from the exact same condition the same week. To the authors of this study, my delivery at 38 weeks would be a failure, while the stillbirth at 39/40 is a victory.

    • lawyer jane
      July 29, 2016 at 11:21 am #

      Wow, that is sobering. So glad your baby was ok!

  2. CanDoc
    July 28, 2016 at 6:29 pm #

    Hmm… agree that there needs to be analysis to determine what is contributing to this trend. Although inductions and CS may have decreased, other interventions that wouldn’t be captured in delivery room data may have actually increased. Here’s what we see in my (Canadian) centre that has decreased our late prem/early term birth rate through increased use of OTHER interventions:
    1) More accurate gestational dating using new SOGC guidelines (date by earliest US, try to get US on all moms in first trimester if possible)
    2) More sensitive and, more importantly, more specific fetal surveillance in the third trimester of our 10-15% of patients with fetuses measuring small-for-gestational-age, including middle cerebral artery dopplers; as a result, we’re safely waiting until 38-39 weeks or more for many of these fetuses rather than delivering at 37-38 weeks.
    3) Far more aggressive glycemic control in gestational diabetics, with less need for early induction for uncontrolled sugars. (Fifteen years ago, 11-pound babies from diabetics were common in our area, now they’ve become very rare).
    4) More liberal use of induction of labour at 39 weeks for “soft” indications (discomfort, suspected macrosomia) – we tracked our own numbers, and this group has the lowest rate of CS of ALL patients, about the same as our spontaneously labouring women in spite of generally being slightly higher risk.

  3. BeatriceC
    July 27, 2016 at 9:52 pm #

    OT Charlotte Update: Vet gave her a clean bill of health. He made some suggestions for her cage, giving her a shelf to rest on and wider, flatter perches to help with her balance issues (the missing wing makes it hard for her to balance). He also suggested upping my timeline for training. I was going slow with her, but as she’s stepping up on both of us now, and completely unafraid of us, he suggested we “keep her busy” by teaching her tricks. So I started this morning with just target training (when you teach the bird to touch her beak to the end of a stick), thinking just that would take a couple days. I was wrong. We’re now up to “touch the *blank*” where I show her what an object is, name it, and then put it in a bowl and tell her to touch it. She does that by licking it. Here’s a short video (7 seconds) of “touch the ball”. There’s a ball in that bowl and she does, in fact, lick it, though you can’t see that on the video.

    • Platos_Redhaired_Stepchild
      July 28, 2016 at 12:51 am #

      Charlotte is lovely. Good luck with her training.

  4. BeatriceC
    July 27, 2016 at 5:36 pm #

    I’m frustrated. I have a friend who’s had terrible swelling in her legs, but one about twice the size of the other, elevated-for-her blood pressure, terrible headaches, reduced fetal movement and other assorted discomforts. And she’s 40, so AMA. She’ll be 38 weeks in a couple days. Her normal BP runs too low and she was sent to L&D with a bp of 149/?, even more increased swelling and a terrible headache. Her BP went down to 127/? while she was there so they sent her home with a 24 hour urine test and a an appointment to follow up on Friday. Pretty much the only risk factor she doesn’t have right now is that this is not her first baby (first baby is 3). This insanity with the “39 week rule” might well kill the baby. Her doc claims to be “current on all the research”, but apparently didn’t get the memo regarding the studies presented in the ACOG debate regarding routine induction or all the data pointing to increased risk of stillbirth starting at 37 weeks (says that only counts for first pregnancies). She’s literally on the far corner of the country from me (I don’t think you could put more miles between us and stay in the contiguous US), so there’s absolutely nothing I can do except talk to her on the phone/text/fb.

    • Montserrat Blanco
      July 27, 2016 at 5:49 pm #

      Did she got at least a blood test? At that point mine had elevated liver function tests and I got admitted with that, it is true that I had a 24 hour urine test with enough proteins to get the pre eclampsia diagnosis the day before but it was the liver function that got me admitted and everybody running.

      • BeatriceC
        July 27, 2016 at 5:52 pm #

        Yes. They did blood work and an ultrasound to check the placenta, so they aren’t doing absolutely nothing, but I’m still frustrated. There’s literally nothing to gain by waiting at this point and all sorts of reasons to induce. But that stupid rule is keeping them from doing it. I’m really hoping she just goes into spontaneous labor in the next few hours.

        • Empliau
          July 27, 2016 at 7:45 pm #

          Did they check her for DVT? IANAD, but isn’t one swollen leg in perilous circumstances (airplane, late pregnancy) bad stuff?

          • BeatriceC
            July 27, 2016 at 8:00 pm #

            She said no blood clots, so I’m assuming they did.

    • demodocus
      July 27, 2016 at 6:35 pm #

      Aw, jeez. Good luck to her. My symptoms were less severe and they induced me, although little miss was a couple days past 38 weeks.

      • Kelly
        July 27, 2016 at 7:58 pm #

        My friend was 38 weeks and was induced too. The doctor and nurses loved them because she did not fight them about the epidural in case she had to have a c-section and because she was willing to supplement with formula until her milk came in. I am so glad that I have friends who are not freakin crazy.

    • Erin
      July 27, 2016 at 7:18 pm #

      Fingers crossed for her and the little one.

      • BeatriceC
        July 28, 2016 at 2:44 am #

        Picked this one to reply to:

        Looks like it’s possible she might not have to wait any longer. In a “that’s what you get for being 3 hours behind the pregnant lady” moment (her words) she texted me to let me know that her membranes may have ruptured (small amount of clear, colorless fluid) and she’s starting to have some contractions. She’s going to monitor for a little while and go in if either more fluid happens or the contractions get stronger/longer/closer together.

        • July 28, 2016 at 6:21 am #

          If she thinks membranes have ruptured, tell her to go to the hospital and be checked, regardless of whether she has contractions or not. Please. (Reading this late; by now she may have delivered.)

          It’s not just the risk of amnionitis but a prolapsed cord can happen as well. And she should be checked for possible early pre-eclampsia (altho you did not give the second BP measurements — diastolic — which are the important ones to note.)

          • BeatriceC
            July 28, 2016 at 11:03 am #

            Thanks. There’s only so much I can do from over 3000 miles away, but o did convince her to wake her husband and go in. She is in fact ruptured and contracting, but progressing slowly. But she’s in the hospital, so I’m less anxious.

            Edited to add: I didn’t know the diastolic measurements, which is why they were question marks. She told me but I forgot what they were. And they were doing the 24 hour urine test. I’m not sure if they are continuing it now.

    • The Computer Ate My Nym
      July 28, 2016 at 7:02 am #

      More swelling in one leg than the other could be a sign of a blood clot. That needs to get checked right away. (Sorry-I know I’m writing 13 hours later. I just saw this.)

    • Karen in SC
      July 28, 2016 at 8:38 am #

      “I’m not comfortable with waiting any longer. The risks are too high. I’ve made my lawyer aware of all my risk factors for a poor outcome, including still birth. “

    • CanDoc
      July 28, 2016 at 6:37 pm #

      I’m happy things have happened on their own! Hope everything goes well for her.
      I think it is easy from far away and with partial information to make judgements about what’s happening and what should happen.
      I would urge caution: The truth is, most OBs in the US and Canada are well-trained, prudent, up-to-date, and very aware of the balance between waiting/delivering. As much as we judge “birth workers” who get their information from the internet and claim they know more than other care providers, I think it’s preferable to try to avoid falling into the same trap – which is difficult when worrying about someone you care about.
      Yes, it’s true that risk of stillbirth slowly climbs throughout gestation, and is higher in the case of any major pregnancy complication – but that’s a reason for fetal surveillance, not necessarily urgent delivery (for example biophysical profiles are the standard of care in Canada for women over 40 starting at 36-37 weeks, twice weekly after 38 weeks, with elective delivery at 39-40 weeks depending on your centre).

      • BeatriceC
        July 28, 2016 at 7:57 pm #

        I was a tad bit frustrated because these same doctors ignored some warning signs with her first and he would up in the NICU for a couple days, so to watch them being even less proactive with this one was frustrating me.

        But, it ends well, with the world’s most boring labor and delivery story. She did finally go in to the hospital in the middle of the night. Her membranes were definitely ruptured but she was barely 2cm and the baby wasn’t engaged. The contractions were barely uncomfortable. Late afternoon, they went ahead and did the epidural just in case failure to progress caused the need for a CS. Shortly (less than two hours) after that she texted me “the nurse is here to check again”, and 30 minutes after that I get a text with the baby’s weight. When the nurse checked, baby was already crowning, and just a couple pushes and he was out, safe and sound. (Some details obscured)

  5. Jessica
    July 27, 2016 at 4:43 pm #

    Somewhat OT, but for those who are familiar with Oregon midwife Sherry Dress, the Walla Walla Union-Bulletin published two stories today on the recent criminal case brought against her in Washington State for practicing midwifery without a license as well as the disciplinary action brought by the Oregon Health Authority. Seems ol’ Sherry lied about the location of five births – certifying that they occurred in Oregon rather than Washington, where she was prohibited from practicing. She came to the authorities’ attention when she managed to kill a baby during labor in June 2015. That couple is now expecting another baby but thinks Sherry should do jail time.

    • July 28, 2016 at 6:27 am #

      This is a classic example of why the legal situation of midwives needs to be NATIONALLY regulated and supervised.

      • Daleth
        July 28, 2016 at 11:46 am #

        I’m not sure it can be. Professional licenses for everyone–doctors, lawyers, nurses, architects, etc.–are granted, withdrawn, regulated, etc. by the states, not the feds.

  6. Madtowngirl
    July 27, 2016 at 1:59 pm #

    But, but, but….we can feel good because we changed things, even though they had no basis in science, and changed nothing!!!! Last week I moved a few books from one shelf to another. There was no reason for it, and it didn’t change anything, but damn, I feel good because CHANGE!

  7. Heidi
    July 27, 2016 at 1:12 pm #

    I’ve never understood this sentiment that inductions are always bad and should be avoided like the plague. I’ll be honest, I was relieved when I knew I’d get an induction at least by 39 weeks, and was thrilled when I got one at 37 weeks 6 days. It was only my personal observation, but belonging to some pregnancy subreddits, stillbirths were not unheard of. I think most, if not all that I read about, happened after 40 weeks. It seems like most of them, they could never find a definitive cause. It’s so tragic and so heartbreaking.

    • Daleth
      July 27, 2016 at 1:28 pm #

      I know!!! I was frantic to get my babies out because they were mono-di twins, which meant that if I stayed pregnant into week 38 the risk of stillbirth would skyrocket to ONE IN FIFTY. And on top of that, mono-di twins often have some connections between their circulatory systems (via their shared placenta), so if one goes the other one is often killed or brain damaged too, since the survivor’s heart pumps blood into the other one and if the other one’s heart isn’t beating anymore, the blood doesn’t come back. So unlike with fraternals, there’s a high risk of losing them BOTH.

      I pleaded to schedule the CS around 36w4, based on some studies I’d seen on PubMed (apparently week 36 is the sweet spot where the risk of stillbirth hasn’t gone up yet but the risks of prematurity are basically gone), but my hospital’s policy was to wait until 37w0–and since that fell on a weekend and the Monday was booked up, they scheduled me for 37w4! That was pushing it way too close to 38w0 for my comfort, so I was truly relieved to suddenly develop rapidly progressing pre-e at 36w6 and get sent upstairs for a CS.

      A school friend or mine, or really friend of my friends, had lost a baby at 36 weeks, and unlike mine she didn’t even have a high-risk pregnancy.

      That possibility was so scary that in recovery after my CS, when I slipped into hypovolemic shock and saw the team of doctors hovering over me, working frantically to save my life, in the last moment before a wave of ice-cold panic took hold I felt what can only be described as SHEER BLISS that my babies were OUT so the only person still in danger was me.

      • Heidi
        July 27, 2016 at 1:38 pm #

        I don’t even feel like 36 weeks was that controversial just a couple of decades ago either. My mother had my sister by planned c-section at 36 weeks. She had an abdominal cerclage. I don’t know what would happen today, but I wouldn’t be surprised if they don’t make women in similar circumstances wait longer. Both my sister and I were born at 36 weeks and didn’t need any interventions in regards to being born “early.”

        • Megan
          July 27, 2016 at 2:39 pm #

          It was made out to be a big deal that my babies were delivered at 37 weeks because of my BP. I think it’s a result of the 39 week rule. It’s like suddenly anything before then is “too early” no matter what. Irritating.

          • Jules B
            July 27, 2016 at 5:29 pm #

            I was induced at 38 weeks for BP issues and after baby’s heart rate did not recover fast enough after a Braxton Hicks contraction (they saw this during an Non-stress test). Plus I was a basketcase because I had an anterior placenta and was unable to do reliable kick counts (in certain positions, I just could not feel her at all, even at that stage).

            Anyway, despite all that, when I told certain “friends” I was being induced at 38 weeks, they acted like I was doing something evil to my baby. Like, really??

          • Kelly
            July 27, 2016 at 8:06 pm #

            I got the same thing when I wanted to be induced at 38w days due to a previous precipitous labor. The one person who really told me I was being ridiculous is now complaining that she wants the baby out as soon as she hits 37 weeks.

          • Charybdis
            July 27, 2016 at 8:14 pm #

            This would be when you tell her that she’s being ridiculous.

          • Kelly
            July 28, 2016 at 12:58 pm #

            I have refrained because I am trying to model being a good friend. At the same time, I will probably explode at some point and point it out to her.

          • guest
            July 29, 2016 at 9:23 am #

            My daughter was born at 36 weeks through spontaneous labor. The hospital I delivered at treated it as a higher risk labor with NICU nurses at the delivery and she was assigned a special care nurse after delivery. I was given tons of pamphlets about how this was considered pre-term and what I needed to look for with her when we got home. Also got a home nurse visit a few days after discharge. I was told this was because late pre-term babies with no issues at birth were falling off the radar and being readmitted more often at this hospital. My daughter was 6 lbs and had no issues and was still heavily monitored. I think the hospital was just being overly cautious. I know for me, I was happy she was out because we were having weekly ultrasounds and I just had a bad feeling the whole pregnancy about her so I was happy to not be fighting to get her delivered before something bad happened.

        • guest
          July 27, 2016 at 2:52 pm #

          On the other hand, I had my twins at 36 weeks and the spent 8 and 9 days in the NICU with bills of 50 – 60,000 dollars. They needed CPAP breathing assistance, and this was even though I had gotten steroid shots around week 30.

          • Daleth
            July 27, 2016 at 3:46 pm #

            Wow, that must have been rough. I got steroid shots at 29 weeks due to what they thought might be preterm labor, and I seem to recall them saying that the effects of the steroids wear off after some period of time–maybe two weeks?

          • guest
            July 27, 2016 at 4:29 pm #

            I think the optimum time for the steroid effect is 48 hours after the last shot is administered, but the benefit doesn’t go all the way back to zero, as far as I know.

            It wasn’t entirely unexpected as I had pre-eclampsia, and my insurance picked up the lion’s share of the bill. But 36 weeks does still carry a risk of breathing problems. Fewer babies will have them than 35, 34, 33, etc. weeks, but I wouldn’t push for an elective induction at 36. 38 or 39, though, definitely.

          • Heidi
            July 27, 2016 at 4:46 pm #

            That definitely sounds scary and very much of a struggle.

            In my mom’s case, though, I think 36 weeks was the most ideal time. I was born without a c-section or induction. My mom went into labor early and her cerclage didn’t hold me back. She had me within half an hour of going into labor. There was no planning for me. She lost two other children from very premature labor. If they hadn’t planned my sister when they did, I really do think they would have seriously risked her going into labor and doing further damage to her already very incompetent cervix.

          • guest
            July 27, 2016 at 5:04 pm #

            Sure, in that situation it sounds fine, but it isn’t a reason to allow elective induction at 36 weeks. Daleth said the risks of prematurity were “basically gone” at 36 weeks, and that isn’t true. It makes sense in high risk situations like mo-di twins, but in the absence of pressing need, it’s not a good idea.

          • Amy M
            July 28, 2016 at 11:49 am #

            yeah, you just never know. My twins were born at 36 weeks, and had no problems. My cousin had all 3 of her sons prematurely, and the one that did the worst (in terms of NICU time and assistance needed) was the one born the latest, at 36 weeks. His brothers (35wk and 34wk) did better. It’s a crap shoot.

    • graysmama
      July 28, 2016 at 12:23 pm #

      I am actually secretly relieved that my hospital won’t do a VBAC for anyone and that I have a repeat c section scheduled at 39 weeks 1 day scheduled 12 days from today. I have seen way too many women with post term stillbirths on sites like babycenter. A VBAC and natural labor isn’t worth a baby dead from meconium aspiration at 42 weeks as I have seen happen to multiple women. Yet women still continue to screech on those sites about inductions and c sections are bad while “waiting until the baby is ready”, VBAC and natural birth is best. My first baby was an emergency c section due to preeclampsia and a failed induction at 36 weeks 0 days and did require a week in the NICU so I understand the push to not have babies come early if avoidable but it shouldn’t come at the cost of avoiding medical risk to the mother or the baby. My first child does still struggle with developmental delays and ADHD at the age of 6 but we suspect these may be more genetic rather than related to being born early and I would rather have my healthy child with his challenges than one dead thanks to preeclampsia.

      • Heidi
        July 28, 2016 at 12:51 pm #

        I used to belong to a gestational diabetes forum and I had to leave. I could no longer be supportive when women thought the 39 week induction recommendation was the worst thing ever. Sometimes their “research” wasn’t even saying what they thought it was saying. Someone posted a study that showed waiting LONGER to induce increased the likelihood of C-Section, not the other way around, but thought the study concluded inductions increase likelihood of c-sections so inductions are bad.

        The idea that doctors don’t take early inductions very seriously is frustrating. I really don’t think too many OBs think anytime after the 35 weeks and 6 days is prime for induction or a planned c-section. Sometimes, it’s a matter of a potential rough start versus no start, as in baby is dead.

        • OttawaAlison
          July 28, 2016 at 12:56 pm #

          I will be an exception if I have another baby, but yes, it is so frustrating that women see GD as no big deal. I don’t know if GD was partially responsible for my daughter’s death (I was borderline and my blood sugar was fine most of the time). It doesn’t help that blogs like “Evidence Based Birth” repeat that it isn’t a big deal, even some doctors dismiss it as a condition that just produces “big babies”.

          • 3boyz
            July 28, 2016 at 1:08 pm #

            I think the reason people see GD as “no big deal” is that it’s easy to catch and straightforward to treat. Of course, there’s a REASON we test for it, treat it, and monitor the situation, so it obviously can become a big deal, but i get why it sometimes doesn’t seem that way. I had GD in my third pregnancy, and believe I had an undiagnosed case with my second (wonder if anyone can tell me how often that happens; I was told I passed the 1 hour test and it was never spoken of again, but the baby was 9 lbs and hypoglycemic at birth).

          • OttawaAlison
            July 28, 2016 at 1:13 pm #

            I was barely hungry so it was easy to follow the GD diet.
            I wonder about my first daughter as well. I failed the screen but passed the GTT. She was just a hair under 9lbs and thankfully was fine, but she was bigger than anticipated. Granted I’m not petite even at a healthy weight. Funnily enough my oldest daughter is tiny and smaller than all of her friends now, but she was bigger than all of them at birth (she’s 10).

          • Heidi
            July 28, 2016 at 1:28 pm #

            I passed the one hour and my doctor’s office used a fairly strict cut-off. Their cut-off was 130 and I came back at 129. I know some offices still use 140 and some 135. The lower cutoff does prevent more women from falling through the cracks and remaining undiagnosed, I do know that. I’m personally one of those who would have still fallen through the cracks if I had opted out of taking the three hour. I don’t know if anything that bad would have happened if I went undiagnosed, but then again, while I didn’t have to be super vigilant – I had bread, potatoes, a small dessert occasionally but I knew to keep it to a smallish serving along with protein – I didn’t give into eating ice cream for dinner or having french fries and a milkshake for lunch. Sometimes, that’s all that sounded edible while I was pregnant so who knows what my diet would have been without the knowledge?

  8. OttawaAlison
    July 27, 2016 at 1:00 pm #

    But what’s a stillbirth or two*
    *I’m being sarcastic. As a stillbirth mom it disturbs me that there is a lack of research in general for late preterm/early term stillbirths. There still seems to be an inevitability about it, which doesn’t really make sense since you can save preemies and have them live generally normal lives from before 28 weeks, but my 37 weeker who died doesn’t seem to be a blip on many people’s radar.

    • Roadstergal
      July 27, 2016 at 1:08 pm #

      🙁 God, I’m so sorry.

    • Daleth
      July 27, 2016 at 1:20 pm #

      Oh, god, I’m so sorry.

    • BeatriceC
      July 27, 2016 at 1:21 pm #

      huge hugs. I lost three babies much earlier and had three more pre-term. I can’t imagine the pain of losing a baby so late.

    • Jules B
      July 27, 2016 at 5:37 pm #

      So sorry for your loss :-(. A close friend of mine experienced a stillbirth on her baby’s actual due date. This was ten years ago (she went on to have three living children after that), and I remember being utterly shocked even back then that none of the doctors had ANY real answers as to why. One doc just said to her “Sometimes babies just die.” To me, that seems like the medical community is just throwing up their hands and saying “I dunno!” Surely medical science could figure it out if they really wanted to…?? I don’t know, it just seems so needlessly tragic.

      • Clorinda
        July 27, 2016 at 8:47 pm #

        Even today, with my friends who have had stillbirths, maybe about 50% can be tied to a known cause. Often it takes an autopsy because the cause isn’t obvious. Cord knots, placenta failure, infection, genetic issues, etc. are known reasons. Sometimes, they guess that it might have been cord compression from how the baby was lying.

        Lots of things can go wrong that have no explanation. In our case, the 20 week ultrasound showed cysts in both kidneys. There are something like 4 versions of cystic kidneys, one of which affects babies forming in the womb, and either that one or another one that affects infants has a genetic component to it. Our son had the adult-onset version, non-genetic version.

        • Jules B
          July 27, 2016 at 9:46 pm #

          Did they think the cysts were the cause..? I totally understand that a lot can go wrong, so it would be impossible to know in all or maybe even most cases what caused the stillbirth to occur. I just saw my friend go through so much anguish, I remember feeling quite angry at the doctors on her behalf. I also witnessed her fear in subsequent pregnancies so I remember feeling like “How can there be nothing out there to help prevent this?” I think research into prevention should be a priority, but it seems like it is not…maybe I am wrong about that?

          • Clorinda
            July 27, 2016 at 11:14 pm #

            It was pretty obvious. Cysted kidneys, no amniotic fluid. Everything else was normal at the autopsy barring the lungs because of the lack of fluid for development. He actually managed to live for a time after delivery so his wasn’t a stillbirth, just an example of things that can go randomly wrong in pregnancy. At least part of his issues had a known cause but there was no answers to how the cysts started.

          • OttawaAlison
            July 28, 2016 at 12:59 pm #

            I am so sorry for your loss.

      • OttawaAlison
        July 28, 2016 at 12:57 pm #

        We don’t know the cause. I apparently produced a big placenta, but there were two calcified plaques on it. With my symptoms though (she was very active the night before and the cord was around her neck), I am beginning to believe it was a cord accident. I had very mild GD too. I wish I had an answer, non-pregnant I’m very healthy asides from my weight.

  9. Roadstergal
    July 27, 2016 at 12:14 pm #

    How on earth is early term even a bad thing in isolation? Isn’t term… term? Is there any negative about early term?

    • Irène Delse
      July 27, 2016 at 1:30 pm #

      My thoughts exactly. Unless they redefine “term”, we’re not talking premature births, here.

      • guest
        July 27, 2016 at 1:59 pm #

        From the abstract: Annual country-specific late preterm (34-36 weeks) and early term (37-38 weeks) birth rates.

    • Sarah
      July 27, 2016 at 2:18 pm #

      I think there’s more likelihood of breathing problems at 37 weeks than, say 39-40. You weigh that up against other factors, such as the lower stillbirth rate at 37 weeks, but my understanding is that there are some respects in which 40 weeks would be better than 37.

      • Megan
        July 27, 2016 at 4:24 pm #

        Yes. From the recent post here:

        “This is a graph of stillbirths vs. gestational age. As you can see, the stillbirth rate begins to rise precipitously at 36 weeks. But babies born at 36 weeks have a small but significant risk of immature lungs leading to breathing problems requiring intensive care. The graph below summarized the data of 3 studies on the risk of lung immaturity.

        The lines on the two graphs cross at approximately 39 weeks when the risk of lung immaturity is 0% and the stillbirth rate continues to rise.

        In other words, the optimal time for birth is at 39 weeks gestation.”

        • Megan
          July 27, 2016 at 4:25 pm #

          Obviously, the individual risk profile for each pregnancy has to be weighed in the decision though. The optimal time for birth *for me, my babies and my crappy placentas* definitely were not 39 weeks.

          • Kelly
            July 27, 2016 at 8:10 pm #

            I have had my kids at 37, 38, and 39 weeks with no issues but obviously that does not work for all. I wonder if there are factors in my pregnancy that makes my kids “cook early” but causes others to have issues with their babies?

          • Mac Sherbert
            August 9, 2016 at 4:01 pm #

            I’ve wondered if it might vary by woman too or something. I have friend that had all 4 of her babies at 35 weeks. They all did fine and went home after a couple days.

          • Kelly
            August 11, 2016 at 12:06 pm #

            I really think it does. I bet at some point they will figure out what makes that happen and I am interested to find out. It might help doctors make decisions on who to induce or not.

  10. Cyndi
    July 27, 2016 at 10:59 am #

    Another example of the tail wagging the dog.

  11. guest
    July 27, 2016 at 10:22 am #

    I can’t believe they didn’t even look to see if the decreased caused any harm to women or babies.

    • MaineJen
      July 28, 2016 at 9:29 am #

      I think modern obstetrics has made birth so “safe” that people just assume. OF COURSE the baby and mom both live, right? It doesn’t even enter most people’s minds.

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