Dietary advice during pregnancy

We discovered an interesting trend in dietary advice.

We advise women who are planning a pregnancy to see their GP and have a health check. But our results show that women who are planning a pregnancy do more research. Friends, family and the media also have more influence – they listen to their doctors less!

On top of that, once pregnant, women see their doctor for dietary advice about supplements more than any other time. However, they discuss their dietary needs with their midwife in less than 10% of cases.

The question is, why? Are women accessing midwifery care too late in their pregnancy to have any real influence? Are they not getting the information from their midwives and going elsewhere? Is midwifery knowledge about diet and nutrition lacking? Or is it the shortage of midwifery continuity-of-care models?

Perhaps there some emotional or psychological need in pregnant women using supplements? Do pregnant women feel like they should, even when there is no medical need for them? Do women think that pregnancy is a medical condition or is the GP as the first port of call in pregnancy in Australia influencing these decisions?

More than 25% of women in the My Body My Baby study (1) were taking individual supplements on top of their pregnancy multivitamin, with no identified nutritional deficiency. Do they need them?

Can’t hurt right?

A recent review of supplement practices and outcomes in South East Queensland found that over-supplementation was associated with a longer pregnancy. Great if you aren’t due yet, but not so good if you are impatiently waiting and term. In fact, in this study women who took multiple supplements in the third trimester had a higher chance of induction of labour for post-dates pregnancy (2).

So here it is in a nutshell…..the information-seeking behaviours shown by this group of women indicate that the recommendations around medical review and input into the preparing for pregnancy process are not being observed. Rather, they consult a wide range of sources while preparing for pregnancy. However, once pregnant they return to their doctors for guidance rather than to midwives. These behaviours are of concern as they do not support the recommendations arising from the Australian Maternity Services Review (3) and evidence-based best practice (4).

For more information on diet during pregnancy please click here.

COVID-19 and pregnancy

The novel human coronavirus (COVID-19) is a public health emergency of global proportions…but what does it mean for you, your pregnancy and your baby?…what are the NEED TO KNOWS of this situation and how do you stay as safe and well as possible during this very worrying time?

Here are some simple answers and links to reliable information for expecting families.

Protect yourself from COVID-19

Droplets from a cough can travel up to 5 meters; a sneeze up to 10. COVID primarily spreads through airborne droplet transmission. While COVID may not fly that far, there are other viruses that can…

Best way to avoid them?

  1. Stay inside and connect with people by phone, skype, facetime, messenger…whatever your preferred online method may be.
  2. Social distancing works. The further the mucous has to travel the less likely it is to land on you.
  3. Remember! During pregnancy your immune system is dampened to keep your baby on the inside. This means you are less able to fight off a contagious illness.
  4. Wash your hands. All of the time. Soap and water works better than hand sanitiser. It not only kills the virus but it washes off with the soap. Hand sanitiser will kill it and leave it on you.
  5. Try not to touch your face (easier said than done) – this is how a virus moves from a surface to your insides.
  6. COVID-19 has been detected on metal/glass/plastic surfaces for up to 9 days after contamination. Its got staying power! However, it can be killed with household bleach.
  7. A person who had had COVID-19 can potentially continue to shed the virus (‘viral shedding’) for up to 14 days after their immune system has adapted to it. Steer clear of known COVID-19 positive people for that little bit longer and you will be that little bit safer.
  8. If you have access to a flu shot, get one. It may not protect your from COVID-19 but will give at least some protection from the nasties we do know.

Face masks..have been a topic of hot debate.

The reality is:

  • N95 masks (protecting against airborne particles) is in short supply. Health workers need these to work safely and care for our sick and most vulnerable loved ones. Finding one to wear to the shops is unlikely.
  • Surgical masks provide some protection, however (as health workers are currently considering reusing their disposable masks) these are also in short supply. Resources need to be directed toward the health sector for the time being.
  • Fabric face masks have been recently criticised as not providing adequate protection against COVID-19, and to some extent this is correct. Further, not much research has been conducted on health personnel using fabric facemasks (see one of the few here). If a COVID + someone sneezes in your face there’s a good chance you will get it, no matter which masks you wear. However, the US CDC has recently released information on how properly constructed fabric face masks (such as those found here) can slow the spread of the disease (click here to see information). Also, if you have had the misfortune to need an innocent sneeze any time in this last month you get way fewer death stares if you are wearing a mask… Anything is better than nothing, so long as it is properly cleaned and dried before use.
  • None of these measures alone is likely to stop you catching COVID-19 if it comes your way. However, a combination of all of them will maximise your chances of steering clear of it (and a number of other viruses).

Want more information?

Click the links below for further resources.

 

Pregnancy supplements – a comparison

Which is best for you?

When we are planning a baby – or are already pregnant – one of the first things that health professionals recommend is taking pregnancy supplements. But which multivitamin is best for us as individuals?

No matter which one you choose (if any) multivitamins should complement your diet, rather than replace a broad selection of foods. A healthy, balanced and varied diet will usually give you everything your body and growing baby needs.

Here’s a comparison of three popular brands of pregnancy multivitamin and mineral supplements…..why not decide for yourself?

Please note that the RDA’s below include food sources. Most of these nutrients are available in sufficient quantities from your diet.

Pregnancy multivitamin comparison

Micronutrient

RDA

(Total from food and supplements)

Elevit

Blackmores pregnancy and breastfeeding gold

Swisse ultinatal pre-conception & pregnancy multivitamin

Betacarotene
(Provitamin A)

800 mcg

2.4 mg

 

Vitamin B1

1.4 mg

1.4 mg

 

700 mcg

700 mcg

Vitamin B2

1.4 mg

1.4 mg

 

700 mcg

700 mcg

Vitamin B3

18 mg

18 mg

 

9 mg

9 mg

Vitamin B5

5 mg

6 mg

2.5 mg

2.5 mg

Vitamin B6

1.9 mg

1.9 mg

950 mcg

950 mcg

Vitamin B9


(folic acid)

1000mcg

800mcg

250 mcg

250 mcg


methylfolate

Vitamin B12

2.6 mcg

2.6mcg

1.3 mcg

1.31 mcg


methyl B12

Vitamin C

55-60 mg

85 mg

 

30 mg

30 mg

Vitamin D

200 IU

200 IU

 

500 IU

500 IU

Vitamin E

7.7 IU

7.7 IU

 

5.22 IU

5.22 IU

Iron

27 mg

60mg

5 mg

5mg

Iodine

220 mcg

220mcg

75 mcg

110 mcg

Zinc

11 mg

11mg

5.5 mg

5.5 mg

Copper

1.3 mg

1mg

 

 

Chromium

30 mcg

 

15 mcg

 

Calcium

1000-1300 mg

125mg

50 mg

20 mg

Magnesium

350-400 mg

100mg

35 mg

25 mg

Manganese

5 mg

1.9 mg

 

 

Omega 3

115 mg

 

150 mg

250 mg

Selenium

65 mcg

50mcg

32.5 mcg      

32.5 mcg

Biotin

30 mcg

30 mcg

15 mcg

15 mcg

Dose

 

1/day

2/day

2/day

Price

 

100/$69.99*

180/$71.49*

180/ $64.99*

Cost per day

 

$0.70

$0.79

$ 0.72

Composition and prices correct at 22nd August 2020

Antenatal expressing

full belly baby

What is antenatal expressing?

Antenatal expressing is the practice of hand expressing the early breastmilk (colostrum) before the birth of your baby. The colostrum is usually collected and stored in syringes with a unique cap, labelled with date and time of collection and frozen. The stored colostrum is then defrosted during your labour. It is then ready to feed to the baby if there is a delay.

Why do it?

Having a store of colostrum can be valuable, especially in the case of women with gestational diabetes (GDM). Babies born to women with GDM require frequent feeds to ensure baby’s blood glucose doesn’t drop below normal levels. Feeding this expressed milk in the first few hours after birth may support the baby to stabilise its sugars. It may also be useful under other circumstances. For example, women who want to breastfeed exclusively may choose to express breastmilk. That way if the baby doesn’t latch well they still get colostrum.

What’s the evidence?

Historically, recommendations around antenatal expressing were logic based. However, these practices evidence-based. In 2011-12 two studies looked at the birth outcomes for women expressing milk before their babies were born (1,2). These found that babies were more likely to be admitted to the special care nursery if their mothers expressed breastmilk antenatally. They were also born a week earlier than those born of mothers who did not.

This result prompted many health services to stop recommending women express before the baby was born under all circumstances. A large study was then launched in Australia to research these connections further. Women with diabetes in pregnancy (either GDM or pre-existing) but were otherwise low risk were the study subjects. These inclusions included women whose diabetes was controlled by either diet, medication or insulin.

What are the findings?

It reported that antenatal expressing from 36 weeks did not affect on nursery admissionsThat is, while it didn’t appear to increase the risk of a baby’s admission to the nursery, it also didn’t reduce the nursery admission rate. In other words, while it didn’t do any harm, it didn’t act to protect babies of GDM mums from needing nursery care.

The study also found that there was statistically no difference between the preterm birth rate in expressing and non-expressing mums and that how many weeks and day baby was at birth was about the same. In other words, no effect, harmful or beneficial.

It did find that babies of mothers who expressed antenatally were more likely to be fed breastmilk only during their hospital stay and in the early weeks of life. This effect did not last beyond three months of age. These findings are of great value when we look at breastmilk and its role in long term infant health. In particular, it may act to establish the infants’ microbiome and protect the baby against future diabetes.

Is antenatal expressing for me?

The finding of this research only applies to the women included in these groups – with diabetes in pregnancy but otherwise low risk. The expressing commenced at 36 weeks. Under these circumstances, the research supports antenatal expressing as there is no evidence of harm, and it supports a family’s wish to breastfeed exclusively. There is no substantial evidence about this practice in women without diabetes. There is also no evidence for low-risk women or women with more complicated pregnancies.

Please speak to your doctor or midwife about the potential risks and benefits of antenatal expressing. Should you decide to express colostrum before your baby is born, please see a midwife or lactation consultant to learn correct expressing and storage techniques.

To weigh or not to weigh…

pregnancy weight

To weigh or not to weigh pregnant women…

The question of whether to weigh pregnant women throughout pregnancy has been a sticking point in practice for decades. Initially, the routine weighing of pregnant women at pregnancy visits began in 1941. This practice emerged amid concerns that wartime rationing might result in maternal malnutrition.

In the 1970s the focus shifted towards the risks associated with excess weight gain, including its potential as a sign of pre-eclampsia. Additional research linking maternal weight gain and infant outcomes changed the purpose of weighing women during pregnancy. It became a screening tool for small-for-gestational-age (SGA) and low birth weight infants, to help detect pre-eclampsia, and to clinically monitor maternal obesity.

In the early 1990s, the decision to weigh pregnant women during antenatal visits became unpopular. Some believed that the process caused pregnant women anxiety with little evidence of an improvement in outcomes. This belief resulted in an attitude and cultural change in antenatal care and a decline in this practice.

As the debate continues and practice evolves around available evidence, this may no longer be the case. Now we know the association between excessive weight gain during pregnancy, birth outcomes and long term maternal health. So, weight monitoring in clinical practise has become more routine.

Please discuss this with your pregnancy care provider in order to ensure you have all the information. You need to make an informed decision about whether your weight will be routinely monitored throughout your pregnancy.

Group B strep

GBS

Recently Queensland Health changed its policy on the dose of antibiotics given to women in labour. These changes affect women who have identified risk factors including Group B Strep and preterm labour. Women who are found to have a high temperature in labour and labouring women whose waters have been broken for 18 hours or more will also be affected by this change. However little information is provided to pregnant women regarding the evidence around intravenous antibiotics (IVAB’s – antibiotics directly into your vein) in labour, particularly when it comes to GBS. A consumer information leaflet produced by Queensland Health can be found here. While this is a good source of balanced information it doesn’t give you information about the changes Queensland has made to the recommended dosage given to women who consent to this treatment.

Here’s what you need to know to make an informed decision about whether you consent to IVAB’s in labour if you have been found to be GBS positive.

What is Group B Strep (GBS)?

Group B streptococcus is a variety of bacteria which are primarily found in the gut, vagina and urethra. It is found in people of all ages and sexes worldwide and is usually asymptomatic (you don’t even know you have it). It is not a sexually transmitted infection, however, people can become colonised with GBS through sexual contact. GBS bacteria are part of the normal microbiome in up to a third of people and colonise the vagina of about 25% of women. The life cycle of the GBS bacteria is said to be 4-6 weeks. This means that women who are colonised with GBS can still test negative from time to time.

GBS and your baby

Half of babies born to women with GBS also become colonised with the bacteria. The most common means of infection is through contact with GBS from the mother’s vagina, however, it can be passed on through contact with the mother’s skin and through the breastmilk. For 98-99% of babies, this presents no problem. The bacteria becomes part of their normal microbiome. However, 1-2% of babies will develop a GBS INFECTION rather than a GBS COLONY. While infection rates in newborn babies are very low, GBS is responsible for the majority of these cases. A GBS infection can have serious consequences for your baby and is considered to have a high mortality rate (10%). Babies with severe infection can also be left with long term consequences.

What are the odds?

If we pull the numbers together and apply them to a specific number of women these are the odds.

In a hospital birthing 5000 women per year:

  • 25% with be GBS positive = 1250 women per year
  • 50% of those babies will be colonised with GBS = 625 babies per year
  • 1-2% of those babies will develop GBS infection = 6.25-12.5 babies year
  • 10% of those babies will die = 0.625 – 1.25 babies per year (1 baby in a 7.5-15 month period.)

In real terms, this means if we knew the GBS status of every woman birthing in that facility and didn’t treat any of them we would lose one baby a year to GBS infection. While these seem like long odds (1:5000), potentially losing one baby a year to an infection which may be prevented by antibiotics in labour is unthinkable.

Do IVAB’s work?

Many studies have found that the incidence of GBS infection in the first seven days of life of newborn babies is greatly reduced if the mother has had IVAB’s in labour. While much of the research done around GBS and IVAB’s is not considered gold standard or high level, medical research cannot ethically perform the required trials to provide this evidence. Having found that IVAB’s reduce the incidence of GBS disease in newborns we cannot withhold treatment for babies with increased risk.

This is why women who are known to have risk factors for GBS in labour are advised to have antibiotics. However, babies can still develop GBS in the first 7 days (AKA Early-onset GBS disease – EOGBSD) when a GBS positive mother has IVAB’s in labour. Babies can also develop EOGBSD when their mother has tested GBS negative.

GBS infection risk factors

  • A baby born before 37 weeks of pregnancy has increased risk of a GBS infection than a baby born at term.
  • You have had a previous baby who was infected with GBS
  • You develop a high temperature (> 38 degrees C) in labour or within 24 hours of your baby being born
  • Your waters break more than 18 hours before your baby is born
  • A GBS screen during this pregnancy has come back positive.

Group B strep screening

There are two ways that GBS is screened. How and when these tests are performed may change depending on your maternity care provider.

  1. A urine test may be done in early pregnancy with your blood tests.  This may involve a test for bacteria, including GBS. It may also be done at any time during the pregnancy if you develop a urinary tract infection.
  2. A vaginal (or vaginal/rectal) swab which is either specific for GBS, or any bacterial infection.

A GBS positive result in any of these tests will prompt the recommendation for IVAB’s in labour.

Some health services perform universal screening by vaginal swab between 35-37 weeks of pregnancy. Others screen if and when they are given a reason to do so. Research around universal vs risk-based screening shows a negligible difference in outcomes with a lower cost for testing to the health service overall. Queensland Health has adopted the risk-based approach. However, should you wish to be screened for GBS you can request this from your health care provider.

Informed consent

Whatever method of screening is used, balanced information should be provided to you prior to you consenting to have the test performed. This is for a number of reasons:

  1. The testing can be uncomfortable and invasive (especially a vaginal or vaginal/rectal swab – these can be performed yourself at your appointment to minimise discomfort).
  2. If a positive result is returned you need to be aware of the recommended management of the associated risk. IVAB’s are also invasive and the treatment itself is not free of risk.

When considering consenting for (or requesting) this test to be performed, you need to know what you are going to do with the results. There is no point being tested if you would decline treatment for yourself and/or your baby. Additionally, if you are found to be group B strep positive and you decline treatment you will find that a number of health professionals will discuss your decision not to treat and you may feel pressured into complying. In Queensland, the babies of women who are not tested for GBS are treated no differently to babies of mothers who are tested and GBS negative.

Effective treatment of group B strep

If you consent to IVAB’s in labour we need to treat you to a level that the antibiotic gets to do its job. The antibiotics needed to prevent GBS disease depend on the drug being in the babies system for a certain length of time. Research has found that the level of antibiotic in your babies blood is at its highest 1 hour after being given. This is because it needs to make its way from your blood, across the placenta and into the baby. Once it’s there it needs to stay high enough to prevent the bacteria from taking hold.  

To ensure we are keeping the antibiotic level in baby’s blood high enough, you will be given a high dose to start with followed by top-up doses every 2-4 hours (depending on your health service). These antibiotics are most effective with a minimum of 90 minutes to work.  However, any antibiotics are sometimes better than none. Penicillin is the preferred antibiotic for GBS prevention. For women with a penicillin allergy alternatives are available. Low levels of antibiotic resistance have been found in some strains of GBS bacteria. All of these factors have contributed to Queensland Health increasing the recommended dosage. The IVAB protocol for the initial dose has changed from 1.2g to 3g. Top-up doses have increased from 600mg to 1.8 g.

Benefits and risks of IVAB’s

Benefits

  • Reduces the risk of GBS infection in the newborn baby from birth to 7 days of age
  • Reduces risk of GBS related infection in the unwell mother

Risks

  • Anaphylaxis (allergic reaction to antibiotic) in mother
  • Less severe reactions including rash
  • Nausea
  • Thrush (mother and baby)
  • Negative affect on the good bacteria in the system of mother and baby (the Microbiome)

Your microbiome

Ok. So you have been found to have risk factors for a GBS infection and consented to antibiotics in labour. How do you support yours and your babies microbiome? There is good news! Some research suggests that lactobacillus bacteria (such as you find in probiotics) can resist penicillin when under stressed conditions (such as during labour). If you have risk factors prompting IVAB’s in labour it may be a good idea to start taking probiotics prior to labour so the good bacteria have a chance to make themselves at home.

Probiotics after your baby is born will help to balance out your gut flora again. Minimise your refined sugar intake after the baby is born, as the microbes responsible for thrush thrive on it. Starve them and the good bacteria in the probiotics will be able to control them again. Breastfeed your baby whenever possible. Colostrum and breast milk are full of good bacteria that are there to colonise your baby’s gut. Your milk is probiotics for baby.

Waterbirth safety

water birth

Babies born into water experienced fewer negative outcomes than babies born on land.

Waterbirth safety is highest when:

  • both you and your baby have no medical complications
  • your midwife or doctor has water immersion training;
  • the model of care you have chosen supports your choice to use water in labour and birth;
  • your facility is prepared for waterbirth emergencies.

If the use of a birthing pool during your labour and birth is important to you, please find out what your options are in your area.

Researchers with the Midwives Alliance of North America Statistics Project found that;

“Waterbirth confers no additional risk to neonates; however, waterbirth may be associated with increased risk of genital tract trauma for women”

This study investigated waterbirth safety and the outcomes of 18397 births, finding that waterbirth babies experienced:

  • less than half the rate of hospital transfers,
  • 25% lower admissions to hospital in the first six weeks, and
  • 40% fewer NICU admissions than land born babies.

For women, waterbirth (compared to non-waterbirth) resulted in less postpartum transfers and hospitalisations in the first six weeks after their birth; however, increased odds of genital tract trauma. Waterbirth was not related to maternal infection (1).However, these findings apply only to well women with no pregnancy complications. If you (or your baby) have pre-existing conditions that may complicate your labour and birth, please speak to your health care provider about the risks and benefits of this option for you.

Waterbirth  safety

Some hard and fast rules need to be understood if you intend on birthing your baby into the water.

  1. You must keep your bottom under the water.
    Once baby’s head starts to come, you must keep your bottom entirely under the water until your baby is born, or we ask you to do otherwise.
  2. If we ask you to move or get out, it is because there is a reason for it.
    There are a few things which may make listening to your midwife an actual matter of life or death. If we ask you to move or to get out of the bath, it’s because there is a safety concern.
  3. We need to listen to the baby’s heartbeat.
    While midwives are mindful of interrupting the birthing space as little as possible, we are also required to monitor your baby (so long as you have consented to this). The need to do this increases during the second stage. With your permission, we will request access to your tummy so we can listen to the baby.
  4. Babies born into water are hands-free.
     Your baby’s head will ideally be born without assistance or interference, and the shoulders and body follow gently in the next contraction. When your baby is born, you will need to lift your baby out of the water and onto your chest. If you are not in a position to be able to reach your baby, your midwife can help you with this.
  5. Keep baby’s head above water.
    Baby’s head must be kept above the waterline once they have been brought up and out of the water.  They must not be submerged again after this because the baby’s breathing has already been triggered.

COVID-19 and your birth plan

During the COVID-19 crisis, there has been lots of information about how to protect yourself and stay well (see our previous post). Social distancing and pressure on health systems will have had an effect on your journey already. Hospital-based antenatal classes are not an option and tours of the birth suite have been cancelled. Restrictions are in place controlling the number of support people you can have with you at your birth and visitors after your baby is born. So let’s talk about COVID-19 and your birth plan?

Options for antenatal education

As the world takes advantage of digital technology, now is a great time to explore some online options. Websites such as this provide excellent and evidence-based information for expecting parents about the physical journey (these are not restricted to mums-to-be…dads also find them really useful). Health and hospital services also publish COVID-19 related news and changes to their available services. Online antenatal classes are available and worth having a look at (while the team here develop some too).

COVID-19, your birth plan and support people

If you have been thinking about who you would like to support you during your birth, you might need to think again. Many health services are limiting the number of people allowed in the room with you when your baby is born. This may include tag teams and support shifts. If you are booked to birth over the coming few months, please contact your provider to find out the measures in place to protect your and your family during your stay.
While you may need to keep your physical support to one person, you might consider using programs such as Skype, Facetime or Messenger to include those who can’t be in the room.

There are some real advantages to this method of inclusion:

  • You can point the camera away from any action you don’t want them to see…
  • Reduced crowding in the room, increasing safety
  • This who don’t get along can avoid each other
  • Everyone you want to be there can be, without (the sometimes) uncomfortable family politics

Want more information?

Here’s some extra resources for you, with one especially for dads!

 

Eating your placenta (placentophagy)

placenta pills

Eating the placenta is common in mammals, however, no modern human culture incorporates this practice in its birthing traditions. Yet, consuming your placenta is becoming more popular, with some services assisting a woman’s wish to ingest placental tissue. You can eat your placenta raw, cooked, dehydrated, encapsulated or made into tinctures or smoothies.

The theory behind ingesting your placenta is that hormones in the placenta help the mother avoid postnatal depression. Anecdotal evidence suggests it also helps the uterus to contract directly after birth. As such, it is thought that eating your placenta raw (either as is or in a smoothie) can help to control post-birth blood loss.

Here are some of the reported benefits of taking placenta capsules:

  • Help to balance hormones
  • Assist with iron levels
  • Help the uterus to shrink down
  • Reduce post-natal bleeding
  • Increase milk production
  • Reduce the risk of post-natal depression
  • Boost your energy levels

A 2018 review looked at the research behind some of the reported benefits. The study found no high-quality evidence to support this practice, as the nutrients and hormones did not withstand the process in levels that have a physical effect. Further, the Australian Government’s Therapeutic Goods Administration warns of the potential health and legal risks, and recommends women don’t consume their placentas.

To see how one woman dealt with eating her placenta, please click here.

To find a calculation service near you (Australia) please click here.

Your placenta

afterbirth

Your placenta

Between day 5 and 8 after your egg is fertilised the developing ball of cells attaches itself to the wall of your uterus. When this happens the some of the cells will start to burrow into the lining of your uterus. These will become your placenta, while others become the sac (membranes) that your baby grows inside.

The placenta is the source of nutrition, oxygen and energy for your baby. It also removes waste products from your baby’s blood and transports it back to the mother’s circulation to dispose of via the umbilical cord. A mothers and baby’s blood do not generally mix. However, they do pass by close enough for substances and gasses to transfer between them. This happens through the walls of tiny blood vessels.

The placental clock

Your membranes, your placenta and your baby all stem from the same clump of cells. The formation of these started with conception. Therefore, your placenta will have the same DNA as your baby. It is, in a way, one of your baby’s organs. It is just required by your baby to function on the outside of its body. However, it is not designed to live beyond your baby’s birth, and placental function can start to decline before your baby is born. As you reach full-term (or beyond) the placenta can begin to show signs of ageing.

As any organism ages its ability to reproduce its cells and to produce energy and remove waste slows down. In the placenta, any drop in function can have an effect on the baby. Research has found that the placenta has its own “clock” – a self-limiting life span that appears to be responsible for the dramatic increase in the risk of stillbirth after 42 weeks of pregnancy. However, as each placenta is as individual as the baby, it is impossible to tell how fast that clock is ticking.

Induction of labour

This is one of the main reasons an induction of labour is recommended as you approach 42 weeks pregnant. While some placentas are still healthy and functioning well when you reach this gestation, others are not. They may not have been functioning well for several weeks. Sometimes an ultrasound scan can tell if a placenta isn’t functioning well. Other times it is a baby who isn’t growing as we would expect that alerts us to a problem. Sometimes it may be a baby who isn’t moving like they normally would. But sometimes we really don’t know.

As with all interventions please do your homework. Induction has risks as well as benefits. If you require further information before you consent to induction please ask questions. If you decide you don’t want to be induced we can monitor the health of your baby a variety of ways. A normal CTG is usually a good indication that your baby is healthy and well.

While your baby appears to be well regular monitoring, risk assessment and counselling will keep everybody’s concerns at bay. However, if your baby is showing signs of not coping your carer will talk to you about the increased risk and discuss your options again. If you change your mind an opt for induction that’s ok too. Health care providers are well aware of the risks of post-mature pregnancy and will be more than willing to accommodate your change of heart.