Timing of Birth

Across Australia, we are seeing the roll out of the ‘Safer Baby Bundle’. This is an initiative to reduce stillbirth. This is an obviously noble goal, with five key areas of focus in the form of hashtagable social messaging. The five key areas are:

#Quit4Baby #GrowingMatters #MovementsMatter #SleeponSide #LetsTalkTiming

As I explored the resources associated with the initiative, I became concerned about the language, intention and potential outcomes. When we roll out a blanket protocol, to reduce one outcome, what other risks come into play?

Of particular concern to me is the ‘Growing Matters’ and ‘Let’s Talk Timing’ focus areas.

#growing matters emphasises ATTENDING ALL APPOINTMENTS, which can be logistically challenging and, in fragmented care, ineffective. The focus is on ASSESS, MEASURE and MONITOR. This surveillance focus can lead to The Nocebo Effect: which is to say, create a problem by increasing stress. What they are looking for is ‘Fetal Growth Restriction’. This is where measuring the fundal height (from 24 weeks) comes in; however, if you are deemed to have risk factors, this may involve ultrasounds. One of the risk factors is a BMI above 30 (which is 30% of adult females in Australia). Many women report being discriminated against for BMI alone, regardless of other factors to be considered. What this focus area lacks is Connection, Continuity and Compassion.

#Letstalktiming introduces the concept of ‘planned birth’ at 28 weeks in the form of a brochure. This suggests, as with ‘planned pregnancy’, that it is more responsible than an ‘unplanned’ one. This normalises induction and pre-labour caesarean, which may be contributing to the rapidly increasing intervention rates.

The risk factors, listed are gestational diabetes, being ‘older’, above ‘healthy weight’, having your first baby, having conceived via IVF, some ethnicities or cultural groups, smoking, drinking or drug use throughout pregnancy. This pretty much includes everyone. The vagueness of ‘older’ and ‘above healthy weight’ are shockingly open for interpretation.

The brochure allows four lines for your notes and questions, suggesting that there isn’t that much to consider or that your input is limited. It also encourages ‘shared decision making’…to reach the “best decision”. What might that be? It is at risk of being coercive. This ‘decision aid’ is in line with the consent-model of care, and the trouble with consent, is the assumed yes. This is problematic for women and their care providers.

The brochure speaks of how rare stillbirth is, but then uses language that suggests the medical pathway is the safer one. It does not go into the risks associated with induction, or caesarean.

The language in this brochure over emphasises the safety of medicalised management of the timing of birth, by using language like ‘planned birth’ instead of calling it what it is: induction or caesarean, which is willfully misleading.

see also: Context-based Maternity Care