Only 4 percent of women give birth on their estimated delivery date. That’s because of the natural variation in how long it takes a baby to grow and because of our limited ability to predict due dates.
Medicine, it turns out, is surprisingly bad at measuring the precise age of a fetus or how far along a woman is into her pregnancy.
Having concrete information about a baby’s “gestational age” wouldn’t just help moms plan their pregnancies. It would also help doctors better determine whether a fetus is developing as it should, and what extra care may be needed for safer births. Doctors also have no way of accurately predicting whether a baby might arrive too early — a leading cause of infant death globally.
I gave birth seven years ago in a Boston-area hospital where I generally consider the care to be excellent. I arrived near the end of my labor, my cervix almost fully dilated. After an hour of moving freely around my hospital room, my midwife and labor nurse said, “It’s time for you to get into bed now.” And then they said, “Let’s have you get onto your back.”
Even though I had read the medical research that found that lying supine carries risks to a fetus — which is why pregnant women are advised not to sleep on their backs — I behaved like any woman in the suggestible state of labor: I did what I was told, though it went against my instincts and my preference.
(click link at top to read the blog post on wbur.org)
“THE notion that nothing good happens after midnight does not seem to apply to times of birth. Around the world the peak hours for vaginal births that have not been induced by drugs fall between 1am and 7am; the numbers then dwindle throughout the rest of the day. This has led many scientists to believe that giving birth during the early morning offers some sort of evolutionary advantage, perhaps gained long ago when hunter-gatherer mothers and their infants would benefit from having their group reunited during the small hours to help with care and to defend them against any predators.
The problem with this theory is that almost all the information on the timing of human births comes from modern, urban settings, such as clinics and hospitals, which could produce artificial conditions that skew the variation in timings. Not so, it turns out. As Carlye Chaney of Yale University shows in the American Journal of Physical Anthropology, early-morning births are common to communities with both modern and traditional lifestyles.”
(click link at top to read this fascinating article on economist.com)
“The birthing plan: Whether it’s set at home with a doula or in a hospital surrounded by family members, many expecting women have their perfect version in mind. And the location and company one keeps during delivery are just the beginning—with highly curated extras like pressure-relieving birthing balls and soothing “push playlists” growing in popularity. But the reality is that when it comes to child birth, there’s only so much you can control.”
The answer to the disparity in death rates has everything to do with the lived experience of being a black woman in America.
Black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data — a racial disparity that is actually wider than in 1850, 15 years before the end of slavery, when most black women were considered chattel. In one year, that racial gap adds up to more than 4,000 lost black babies. Education and income offer little protection. In fact, a black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth-grade education.
(click link above to read this powerful piece on NYTimes.com)
For more than 60 years, it has been the standard of care to try to speed up childbirth with drugs, or to perform a cesarean section if labor was seen as progressing too slowly.
Now a new set of recommendations is changing the game.
In February, the World Health Organization released a set of 56 recommendations in a report called Intrapartum Care for a Positive Childbirth Experience. One key recommendation is to allow a slow labor to continue without trying to hurry the birth along with drugs or other medical interventions. The paper cites studies showing that a long, slow labor — when the mother and baby are doing well — is not necessarily dangerous.
A little history is required to understand the importance of that one recommendation, says Dr. Aaron Caughey, chair of the Department of Obstetrics and Gynecology at Oregon Health & Science University, who did not work on the report. In 1955, Dr. Emanuel Friedman studied 500 women and concluded that labor is normal when, during the intense phase of contractions, the cervix opens at a rate of at least one centimeter (about 0.4 inches) an hour. “Dr. Friedman showed that 95 percent of women progressed” at this rate, says Caughey. “And that became the standard of care.”
On its face, Joseph’s prenatal and postpartum clinic might not seem unusual. But when you look into her statistics, you find something quite rare: Almost all of her patients give birth to healthy, full-term babies. Again, maybe not surprising until you learn that the majority of them are low-income African-Americans, Haitians and Latinas.
African-American women in the United States are four times more likely than their white counterparts to die during pregnancy or childbirth. Their infants are also twice as likely to die in their first year as white infants, and two to three times more likely to be born premature or underweight — a sign of insufficient development that can lead to a lifetime of health difficulties. Native Americans also suffer from higher rates of these problems than whites, as do some groups of Latinas.