Monday, November 26, 2012

Does Baby Really "Know" When to be Born?


Photo courtesy of MaceyBuchanan

I have heard and read it a million times on my natural childbirth (NCB) websites and forums that "baby will know when to be born," "baby won't come until he (or she) is good and ready," "your baby wants to choose her (or his) birthday," etc....

This was something I once really believed.... that the baby will be born when ready and not a minute too soon.... but in past 6 months (or more like year, actually), I have been doubting more and more. Here are some lingering questions I have that fill me with doubt....

What about those babies that are born via induction at 41+ weeks, mom who passed all BPPs and NSTs, but placenta shows signs that it was shutting down.... had mom refused induction, what would have been the outcome?

What about babies that are born premature and then spend weeks in a NICU? Or worse, what if baby is born too early to live outside the womb? These are purely anecdotal but I know of two very healthy, low-risk moms who went into preterm labor prior to 30 weeks.... one whose labor was able to be stopped with medical assistance at the hospital but the other whose labor couldn't be stopped and baby lived but had a long NICU stay. (no problems or assistance with conception in either case, in case you're curious)

Yes, due dates can be wrong, so a baby born at 42 weeks might actually only be 40 weeks.... but what if it swings the other way? What if mom waits until 42 weeks and baby is actually 44 weeks?

And finally...

What about the babies that are born at 41+ weeks that are stillborn because the placenta stopped functioning completely.... all signs and tests were good until it was "too late."

According to ACOG, a baby is considered full term from 37-42 weeks.... but can being too close to either end of that range be dangerous? Does it mean all babies born in that range are full-term and ready to be born? Or does it mean most babies? Also, how do we know which "due date" to use? Which is ACOG using according their definition? As many of us moms have experienced our due date based on last menstrual period might differ from our due date given during the first trimester ultrasound.

I would love to hear your thoughts on this! Please chime in, leave a comment.... any particularly thought provoking comments I will quote and add to this post.

Thanks!

**To be clear, I realize - and always have - that a baby does not make an actual decision to be born. But rather, what I'm questioning is that for a normal, low-risk pregnancy, all the pieces would fall together at the right time and baby would be born at the right time.... baby would be ready, body would be ready, and labor would start.

Update 01/12/2013:
I expanded on this thought looking at evidence for induction vs waiting for spontaneous labor. Click here to read the post.


12 comments:

  1. My answer to this is simple: no. We don't know exactly why labor begins when it does, but we do know that induction can improve outcomes for the baby: http://summaries.cochrane.org/CD004945/induction-of-labour-in-women-with-normal-pregnancies-at-or-beyond-term

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  2. Of course babies don't "know" when to be born. They don't know anything.

    As Becky said above, I believe it is still unclear exactly what triggers labor. My children are twins. It is KNOWN that twins (or HOMs) carry a high risk of pre-term labor/delivery. To me, that indicates that 1)the uterus can't distinguish between singletons and multiples and 2)uterine capacity probably is a factor. Also, we know that placental function deteriorates over time. I don't know why (will try to look up), but that's a clue that cues from the placenta may also be involved. It seems clear that if "babies knew when to be born", then preemies and stillbirth from post-dates would not occur.

    I had pre-term labor at 30wk, and again at 32wk, stopped both times, until my babies came at 36wk. If babies "knew" when to be born, what was going on there? Were my babies indecisive? No matter what, they were still premature. They were fine, and are fine, but prematurity is not desirable. I believe we were lucky---several women in my online multiples support group were not so lucky and had preemies anywhere from 22wk to 34wk and the earliest ones died, and even some of the 34wkers ended up with CP or other disabilities. I can't imagine that anyone would choose to go through life with severe special needs, so were those babies just stupid?

    There is a scientific reason for how/when labor starts--even if we don't know what it is yet. I have no doubt that science will figure it out eventually, and that knowledge may lead to technologies that can prevent preemies, or post-dates stillbirths.

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    Replies
    1. Indeed. These are things that made me wonder how much we can really "trust" the birth process.

      I added a little note to my blog above, just for some clarification.

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    2. I don't "trust" the birth process. There are many things about me that are sub-par: I have asthma,PCOS and I wear glasses to name a few. If I trusted my lungs to work optimally all the time, I'd be dead, if I trusted my hormones to control themselves, I'd be completely infertile, acne-ridden and bald.

      We have medical advances which were discovered/invented to help/cure/prevent when something goes wrong with the human body or one of its processes. There are no guarantees about anything, but I tend to trust the experts in a given field, rather than nature or any of my biological processes.

      I would agree that most of the time, in developed countries, birth works out fine. I think women in developing countries who have no access to medical care would beg to differ.

      I am, however, very curious to learn what signals the onset of labor, and hopefully an answer will be forthcoming sooner than later. :)

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    3. Haven't heard anything this ignorant in a while.

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    4. Really anonymous? Would you like to elaborate and give us the benefit of your wisdom?

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    5. Maybe she had a problem with the "I would agree that most of the time, in developed countries, birth works out fine. I think women in developing countries who have no access to medical care would beg to differ." sentence. It is a bit awkward and I apologize. I meant that in developed countries it usually works out fine because women have access to prenatal care, clean water, sanitation, vaccines, and modern obstetrics for the birth. True, even in places where women don't have those things, the majority of women and babies survive the birth, but the mortality rates for both are significantly higher, much higher than would considered acceptable in the Western world, where we can knock them down with all things I mentioned in the last sentence.

      http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf
      That is from 2006, so not the most up to date, but the developing world had almost 7x greater perinatal mortality rate compared to North America....we must be doing something right, and trusting birth isn't it.

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  3. http://jcem.endojournals.org/content/96/4/E624.full.pdf+html

    That's an interesting article that suggests that surfactant protein from the mother is a factor involved with signalling labor. I found another paper that I could only read the abstract. That one talked more specifically about the inflammatory cytokines involved. So this is issue is most certainly being explored. :) I would find more, but my children are clamoring for my attention.

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  4. We just had our first baby last month and it didn't actually occurred to me. All it matters is we're both healthy and a complete family. Now, as inquisitive as we are, there are just things that are just best left alone.

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  5. My mother lost a baby in the second trimester. My second baby came just fine at 37 weeks. With my third I was in and out of the hospital and on bedrest from 16 weeks onwards; at 34 weeks and change I got the go-ahead to get up out of bed. I went out for dinner for my birthday, came home and went into labour. My sister went into labour at 24.5 weeks and was on a whack of drugs including mag sulfate, in hospital, for 10 weeks. Whatever the genetics of all that are, I am pretty sure my body in fact does not know when to start labour and I am so, so glad for modern medicine so that my youngest and his cousin are both fine.

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  6. I have a friend who had a stillborn bc she waited to 42 weeks. Fact of the matter is, after 42 weeks there is greater likelihood of fetus swallowing maconium in utero, which is the last thing you want your baby to have.

    For her next baby, she was induced at 41 weeks.

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  7. I had my first at 42 weeks exactly, bang on the nose as I knew my conception date. My midwives would only induce at 42 via breaking the amniotic sac, which instantly proved to be full of pea-green, chunky meconium. I was transferred to the hospital, had an uncomplicated labor, and delivered a healthy 10-lb boy who, thank God, had not aspirated the mec.

    For #2, I had that cocky assurance that #1 was a fluke because "subsequent babies usually come earlier" or some nonsense I believed because I wanted to, followed all the "rules" for a healthy natural birth and again wound up in the hospital at 41.5 weeks because he failed his ultrasound. This time I was glued to the bed, on oxygen, with worrisome heart tones and a sluggish induced labor. Healthy 9-lb boy with a crusty placenta.

    For # 3 I had accepted that my body just does not know when to go into labor and got myself an OB, buying into the natural birth line that an OB would induce me the minute I looked cross-eyed at him after 37 weeks. Ironically, he refused to induce until I was past 41, despite all my assuring him that I was not going to EVER show signs of imminent labor so the only thing gained by waiting was weight, by the baby. I did finally start contracting on my induction date so that was the easiest induction ever, resulting in a 10.5 lb healthy girl (still had to be on O2 for worrisome fetal heart tones during labor, again, due to a barely-functioning placenta).

    So in my case, even having an unmedicated birth in hospital was pretty much impossible, since in all my births, complications of post-dates left me flat on my back attached to monitors, infusions, oxygen, you name it. Epidurals with all three as I had no other options for relief. I was lucky that I have the physical ability to birth large babies as I am sure many women would have had to have C-sections due simply to their monstrous size.

    People get cancer. They get genetic deformities and syndromes. They get auto-immune disease (hi!). Nature plays roulette with us. The body defeats itself in all sorts of idiotic ways. This whole business of "trusting your body" can result in emotional crisis for mom and at worst, the death of a baby who could have been saved if we trusted the evidence a little bit more.

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