In This Issue—The Optimal Time to Give Birth

Abstract

In this column, the editor of The Journal of Perinatal Education discusses factors associated with determining the optimal time to give birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth and postpartum.

There continues to be much controversy about the optimal time to give birth. There was a time pregnant women would receive an expected due date and then wait in anticipation for labor to begin. The due date was simply a guide. Many of us relied on Naegele’s rule, which involved a simple calculation of adding 7 days to the first day of the last menstrual period (LMP) and then subtracting 3 months. We knew that most babies didn’t appear on their due date—only 1 in 20 do—and there was no way to tell whether they would arrive on time. Most babies will either be born early or late, somewhere between 2 weeks before or after the due date. In other words, labor would begin when it was supposed to begin.

In the eighteenth and nineteenth centuries, labor induction was used mainly in cases of pelvic deformity, before the fetus grew too large to be delivered. Up until the twentieth century, induction methods tended to be unreliable. Once pituitary extract, and then synthetic oxytocin and prostaglandins, became available, induction became more reliable. In the early 1970s, ultrasound became readily available as a diagnostic procedure to establish reliable due dates. Today, many women receive a dating ultrasound scan between 8 and 14 weeks of pregnancy to help estimate a baby’s due date. In early pregnancy, most babies of the same gestational age are about the same size. According to the American College of Obstetricians and Gynecologists, the American Institute of Ultrasound in Medicine, and the Society for Maternal–Fetal Medicine, ultrasound measurement of the embryo or fetus in the first trimester (up to and including 13 6/7 weeks of gestation) is the most accurate method to establish or confirm gestational age.

We invite readers to respond to the contents of this journal issue or share comments on other topics related to a natural, safe, and healthy birth. Responses will be published as a letter to the editor. Please send comments to Wendy Budin, Editor-in-Chief (wendy.budin@rutgers.edu).

Accurate determination of gestational age can positively affect pregnancy outcomes. There is evidence that pregnancies that extend beyond 42 weeks are associated with adverse fetal outcomes. Therefore, judicious use of labor induction for post-date pregnancy can improve outcomes. At the same time, there is growing evidence that the last few weeks of pregnancy are extremely important for fetal development, therefore inducing labor in low-risk women prior to labor beginning on its own has its own risks. The question then becomes what is the optimal time to give birth?

There was a time pregnant women would receive an expected due date and then wait in anticipation for labor to begin.

Today, many women receive a dating ultrasound scan between 8 and 14 weeks of pregnancy to help estimate a baby’s due date.

In this issue’s feature article, Debby Amis discusses the worldwide recommendations for the optimal time for routine labor induction for the low-risk pregnant person, the recent research about the optimal time for routine labor induction, and recommendations to help the pregnant family make an informed decision about routine induction. This article is an adaptation for the print of Debby Amis’s presentation at the 2022 Lamaze International Virtual Conference. This article includes an important new study not included in the Lamaze Virtual One-Day Conference that found an increase in perinatal deaths for low-risk pregnancies that were induced at 39 weeks as compared to low-risk pregnancies that were not induced at 39 weeks but were delivered no later than 42 weeks.

IN THIS ISSUE

In addition to our feature article “Healthy Birth Practice #1—Let Labor Begin on Its Own,” where Debbie Amis provides current best evidence on the risks and benefits of routine induction at 39 weeks, also in this issue of the Journal of Perinatal Education (JPE), co-authors Jennifer Vanderlaan, Tricia Gatlin, and Jay Shen discuss outcomes of childbirth education for women with pregnancy complications. The purpose of their study was to examine associations between pregnancy outcomes and childbirth education, identifying any outcomes moderated by pregnancy complications. This secondary analysis of the Pregnancy Risk Assessment Monitoring System compared selected outcomes with childbirth education for three subgroups: women with no pregnancy complications, women with gestational diabetes, and women with gestational hypertension. Findings suggest that women with pregnancy complications do not receive the same benefit from attending childbirth education as women with no pregnancy complications. Women with gestational diabetes who attended childbirth education were more likely to have a cesarean birth. The authors recommend that the childbirth education curriculum may need to be altered to provide maximum benefits for women with pregnancy complications.

The content of all JPE issues published since October 1998 is available on the journal’s website (https://connect.springerpub.com/content/sgrjpe). Lamaze International members can access the site and download free copies of JPE articles by logging on at the “Members Only” link on the Lamaze Website (www.lamaze.org).

According to the American College of Obstetricians and Gynecologists, the American Institute of Ultrasound in Medicine, and the Society for Maternal–Fetal Medicine, ultrasound measurement of the embryo or fetus in the first trimester (up to and including 13 6/7 weeks of gestation) is the most accurate method to establish or confirm gestational age.

Also in this issue, Fallon Cluxton-Keller and Martha L. Bruce present findings from a pilot study testing an educational intervention to increase postpartum medical visit attendance in home-visited mothers. Because socioeconomically disadvantaged women may experience barriers to attending postpartum medical visits, they explored the feasibility, acceptability, and preliminary effectiveness of an educational intervention to increase postpartum medical visit (PMV) attendance in mothers enrolled in early childhood home visiting. Home visitor implementation of the intervention with mothers was determined to be feasible and acceptable. These findings provide preliminary effectiveness for a brief educational intervention in increasing PMV attendance in home-visited mothers.

The role of intrapartum social support (SS) in preventing postpartum depression (PPD) was explored in a cross-sectional, multicenter study conducted by Rieko Kishi Fukuzawa and Chang Park. Using survey data that covered 8 of the 25 PPD risk factors identified by a recent umbrella review, the analysis determined that prenatal depression, pregnancy and childbirth complications, intrapartum SS from healthcare providers and partners, and postpartum SS from husbands, and others were significant predictors of PPD, while intrapartum and postpartum SS were intercorrelated. In conclusion, intrapartum companionship is as important as postpartum SS in preventing PPD.

Finally, in this issue, Julie Blumenfeld and Melanie Miller present findings from an innovative project to determine if educating housekeeping staff on the benefits of breastfeeding and limiting the use of infant formula would encourage a culture of supportive breastfeeding. They discuss how Latina women not only breastfeed at high rates immediately postpartum but also frequently introduce formula. Evidence shows that the early introduction of formula negatively affects breastfeeding, and maternal and child health. The Baby Friendly Hospital Initiative (BFHI) has been shown to improve breastfeeding outcomes and BFHI-designated hospitals must facilitate lactation education for clinical and nonclinical personnel. Housekeepers, often the sole hospital employees sharing the linguistic and cultural heritage of Latina patients, have frequent patient interactions. This pilot project at a community hospital in New Jersey investigated Spanish-speaking housekeeping staff’s attitudes and knowledge regarding breastfeeding before and after implementing a lactation education program. After the training, the housekeeping staff overall had more positive attitudes toward breastfeeding. These authors suggest that this intervention may, in the short-term, contribute to a hospital culture more supportive of breastfeeding.

Biography

WENDY C. BUDIN is the editor-in-chief of The Journal of Perinatal Education. She is also Professor and Associate Dean for Entry to Baccalaureate Practice at Rutgers School of Nursing. She is a fellow in the American College of Childbirth Educators and member of the Lamaze International Certification Council Governing Body.