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Inducing older first-time mums earlier reduces stillbirths

Inducing birth one or two weeks earlier in older first-time mothers could reduce the number of stillborn babies by two thirds, a study has found.

Current guidelines recommend induction be offered when the baby is one or two weeks late.

But the latest research – involving 80,000 women over 35 – found that when births were induced at the due date, normally the 40th week, it led to a large reduction in stillbirths.

The research by the London School of Hygiene and Tropical Medicine and University of Cambridge found inducing birth one to two weeks earlier would cut the rate of still birth from 26 per 10,000 pregnancies to 8 per 10,000, providing in the mothers were thought to be at low risk of complications.

The drawback to the finding is that inducing all women over 35 could create an ‘enormous’ impact on the cost of giving birth to the NHS, experts warn.

It means applying induction across the board to older mothers would prevent one stillbirth for every 562 inductions of labour.

The new research suggests current guidelines recommending induction be offered when the baby is one or two weeks late should be changed to on their due date (stock photo)

Reducing complications

In 2015, 40,000 women aged 35 or older gave birth for the first time according to the Office for National Statistics.

The risk of risk of pregnancy complications, including stillbirth, while low, are higher for women having their first baby at age 35 or over.

Hannah Knight, the lead author, said: ‘The number of first-time mothers over the age of 35 is rising.

‘Although their risk of experiencing a stillbirth or neonatal death is relatively small, it’s still very important that these women receive the best advice on how to minimise the risks to themselves and their baby.

‘This study represents the strongest evidence yet that moving the offer of induction forward to 40 weeks might reduce the risk of stillbirth in this specific age group, which we know face a greater risk of stillbirth and neonatal death.’

Previous research has found that that induction of labour at 39 weeks of gestation has no short-term adverse effect on the mother or infant among pregnant women aged 35 years or older.

How the research was carried out 

In the latest study, the authors used data from English Hospital Episode Statistics covering 77,327 first time mothers aged 35 to 50 to determine whether the routine induction of labour earlier than recommended was associated with a change in risk to mother or child.

Induction of labour involves giving the mother a hormone – prostin – that triggers birth contractions. At present one in five of all births are induced.

The study compared rates of still birth and deaths shortly after birth between induction of labour at 39, 40 and 41 weeks of pregnancy.

Dr Knight said: ‘Whilst our study suggests bringing forward the routine offer of induction of labour to 40 weeks of gestation in first-time mums aged 35 or over may reduce the risk of perinatal death, there are other important factors to consider.

‘There are potential downsides to such a policy, such as acceptability of induction of labour to women and the increased demand on resources.

‘Further studies are needed to examine the impact of such a change in policy on NHS costs and women’s satisfaction.’

Senior author Professor Gordon Smith, Head of the Department of Obstetrics and Gynaecology, University of Cambridge, said: ‘The study indicates that women aged 35 or over in their first pregnancy should consider induction of labour at their due date.

‘Our best estimate is that one stillbirth would be prevented for every 562 inductions of labour.

‘Some women might prefer to avoid induction and to accept this small risk.

‘Other women may opt for induction given concerns about the possibility of stillbirth, but a key aspect of the paper is that this analysis provides the best evidence for the magnitude of the risk and allows women to make an informed choice.’

Promising research 

Commenting on the study, Professor Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists (RCOG), said: ‘This large study supports emerging research which suggests that moving forward the offer of induction to 40 weeks may play a role in reducing the proportion of stillbirths and neonatal deaths, but it should be emphasised that this study is the first to focus on a specific patient group – first time mothers aged 35 and over.

NEARLY A THIRD OF BIRTHS ARE NOW CAESAREANS

Older mothers, obesity and a fear of childbirth are driving record numbers of caesareans, according to experts.

Last year almost 28 per cent of women who gave birth had a caesarean, a three-fold rise since the 1980s.

This included 12 per cent who had a planned caesarean – one in eight – the remainder had one as an emergency.

The figures from NHS Digital are the highest since records began in 1980.

They also show that only half of women who gave birth last year went into labour naturally, 55 per cent.

The remainder were either induced as doctors were worried they were late or had a planned caesarean. 

Doctors said the trend was due to the rise in older and obese mothers who tend to have more complex labours. 

Many of these women are advised to have planned caesareans to avoid life-threatening complications during the delivery.

But the figures also reflect the fact that rising numbers of women are choosing to have caesareans because they are so scared of having a natural childbirth.

‘The RCOG welcomes any new research which may help to reduce stillbirth and neonatal death rates, however, as the authors acknowledge, the implications of such a change in policy would be enormous for both the health service and women themselves so further research to determine the impact of such a change in practice is needed.’

He added: ‘These findings should help women over the age of 35 make an informed choice with regards to induction of labour and are likely to influence the production of future guidelines.’

Janet Scott from Sands (Stillbirth and neonatal death charity), said: ‘This very welcome study provides much-needed new information to inform decisions about inducing a group with a significantly higher risk of pregnancy complications including perinatal death. 

‘We hear from too many older mothers whose babies have died after 40 weeks but who had no idea they were at a higher risk, and in retrospect deeply regret their baby was not induced in time. 

‘These new findings must urgently be translated into accessible information for women and the healthcare professionals advising them, to support mothers in making genuinely fully informed choices about their maternity care.’ 

Read more at DailyMail.co.uk


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