I came across this from a couple of friends who sent this to me a year or two ago. It really sheds an interesting light on the fears surrounding postdatism. It is an exerpt from a forum on the subject, by an Australian doctor.
"In the eight years when I practiced homebirths as a registered
doctor, out of 1,190 bookings I had 106 post mature babies (more than forty-
two weeks) of which three went to forty-eight weeks, a few more went to
forty-six weeks, and lots went to forty-four weeks—and all those babies
fared very well. I did lose one at forty-two weeks, which is not outside
the obstetricians' limit. Of those 106 post mature babies, only one fitted
the textbook description of post maturity, looking like a little wrinkled
old man with stained skin, but that baby was extremely alert, and insisted on
looking around the room instead of suckling.
What decided me to do no inductions for post-maturity was a very early
mother in my homebirth series who refused induction despite my anxiety,
went to forty-four and a half weeks and gave birth to a chubby pink,
strong,healthy baby, with absolutely no sign of post maturity. If I had lost
one of those 106 babies who went past forty-two weeks, obviously I would have
done some deep soul-searching, but I doubt whether I would have changed my
mind.
Babies mature at different rates, not at exactly forty weeks, just as
we adults do not become senile at seventy years.
Some might say I was lucky to deliver 106 post mature babies without
losing one, but remember that my clients were mostly very health-conscious,
especially regarding diet. None of them was driven to homebirth by
financial difficulties—quite the reverse. In Australia it is far cheaper to
birth your baby in hospital. I should also mention that I tend to disregard
meconium as a supposed sign of fetal distress, because of other possible causes,
for example, if the mother took laxatives.
I feel the advice from the midwives was always correct. I would not
rely on ultrasound to establish dates. The best check, if the mother presents
early enough, is that before ten weeks the fetal heart is more than 160,
often 180, but by twelve weeks it usually settles to 144 or less. But my
present mood is—don't be fussy about dates. When you estimate the due date (I
use 283 days, i.e. nine months and ten days, slightly more accurate than
the received forty weeks), also advise the prospective parents not to tell
friends and relatives the precise date, but be vague, like "before the new
year" or "before Thanksgiving," so that they will not be pestered by
nervous well-wishers if they go past the "due" date.
Marion's response in The Birthkit Issue 25 is very good ["A CNM
Discusses Post maturity Syndrome"], but I must take issue with one sentence. She
says "Post maturity syndrome has recognized signs, and that's why the
pediatrician who tried to resuscitate Barbaranne's baby knew it was forty-four
weeks." With the background of my experience with post mature babies, which is
far more comprehensive than most other practitioners under the rule of
induction at forty-two weeks or earlier, I have to assert categorically that the
so-called recognized signs of post maturity are fallacious because
babies mature at different rates. Those signs are practically never due to
real post maturity, they are more likely to be due to other factors like a
severe illness during pregnancy, or placental infarction well before term. I
knew that post maturity signs were unreliable long before I ever started
attending homebirths, because I can still remember the famous and respected
pediatrician Kate Campbell telling us students about post mature
babies having long hair and long fingernails and other signs, and premature
babies having the reverse. But once I got into general practice and was
delivering babies in hospital, I noticed that those signs were most unreliable,
and that some babies born before term had long fingernails and hair, and
some babies born after term did not. In any case I cannot share Marion's
confidence that the pediatrician who tried to resuscitate the baby
knew it was forty-four weeks, even though he said so. I know pediatricians and
obstetricians better than to trust a statement like that."
Dr. John Stevenson
Victoria, Australia
Thank you, very interesting read. Sharing on FB fanpage
ReplyDelete