The timing of your baby’s birth is important.
Every week your baby continues to grow and develop is critical to preventing medical treatment at birth or possible long term learning difficulties or brain development. There are also so many variations that can define your babies due date and gestational age. Using a one size fits all approach such as Naegele’s rule can only give you an estimate, however this estimated date can vary from anywhere between 3 weeks prior and 3 weeks after. Naegele’s rule was developed in 1812 by a German professor named Carl Naegele but he never clearly explained if you were supposed to add 7 days to the first day of your last period or to the last day of your last period. Naegele’s rule assumes that all of the 6 million women who get pregnant around the world each year ovulate on day 14 of their cycle, have a 28-day menstrual cycle, implant the embryo in the uterus at the same time and track their menstrual cycles to recall these dates to their care provider. Only 35% of women actually birth their babies in the week of their ‘due date.’
When your care provider discusses risks with you due to your babies gestational age, it is important to remember that there are so many variations to your due date and there are lots of other factors that might influence your decision for intervention. You can read more about this in Rachel Reed’s ‘Why Induction Matters’ book.
Professor John Newman
Professor John Newman is an Obstetrician and researcher working in the Obstetrics and Gynaecology department for the University of Western Australia. John has been researching preterm birth and the short- and long-term impacts on babies for 30 years and is passionate about health care professionals being up to date in their knowledge and understanding of this matter. Using the results from his multiple studies, John and his team developed an intervention program aimed to engage and inform mothers about the short- and long-term consequence of preterm birth, provide educational tools and resources for all health professionals involved in obstetric care and to facilitate ongoing discovery and research in the field of preterm birth prevention.
What is Preterm Birth?
Preterm birth is the single greatest cause of death and morbidity in children up to 5 years of age in developed countries. Preterm birth is defined as birth before 37 completed weeks of gestation and after 20 weeks of pregnancy. 8-9% of births in Australia are preterm affecting approximately 30,000 births every year. For Aboriginal and Torres Strait Islander women, the percentage increases to 15% of births, strengthening the call for bringing Indigenous women together and bringing birth back into a cultural setting so that a disproportionate number of First Nations women are not experiencing adverse outcomes in pregnancy and birth. The rate of preterm birth for Aboriginal and Torres Strait Islander mothers is almost double that of non-Indigenous mothers.
Premature babies may have more health problems and need to stay in hospital longer than babies born at term. The earlier in pregnancy a baby is born, the more likely he or she is to have health and behavioural problems. Some preterm babies have to spend time in a hospital’s neonatal intensive care unit (NICU) where they are taken care of 24 hours a day by a team of experts. Some of the health problems that can affect premature babies include:
- Apnea: This is a pause in breathing for 20 seconds or more. Premature babies sometimes have apnea. It may happen together with a slow heart rate.
- Respiratory distress syndrome: This is a breathing problem most common in babies born before 34 weeks of pregnancy. Babies with RDS don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing.
- Intraventricular hemorrhage: This is bleeding in the brain. It usually happens near the ventricles in the center of the brain.
- Patent ductus arteriosus: This is a heart problem that happens in the connection between two major blood vessels near the heart. If this doesn’t close properly after birth, a baby can have breathing problems or heart failure.
- Necrotizing enterocolitis: This is a problem with a baby’s intestines. It can cause feeding problems, a swollen belly and diarrhea. It sometimes happens 2 to 3 weeks after a premature birth.
- Jaundice: This is when a baby’s eyes and skin look yellow. A baby has jaundice when his liver isn’t fully developed or isn’t working well.
- Anemia: This is when a baby doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body.
- Bronchopulmonary dysplasia: This is a lung condition that can develop in premature babies as well as babies who have treatment with a breathing machine. Babies with BPD sometimes develop fluid in the lungs, scarring and lung damage.
- Infections: Premature babies often have trouble fighting off germs because their immune systems are not fully formed. Infections that may affect a premature baby include pneumonia, a lung infection; sepsis, a blood infection; and meningitis, an infection in the fluid around the brain and spinal cord.
Unnecessary Preterm Birth
So, reflecting on what we now know about the variations in due dates and the importance of your baby growing and developing inside your uterus for as long as it is safe for mother and baby, it is important to understand that sometimes early inductions and early caesareans are performed without a medical basis. A large portion of John Newman’s research focused on understanding why the percentage of caesarean sections performed at less than 39 weeks’ gestation without obstetric or medical indication was so high, ranging from 42-60%. Rates were generally higher for privately funded patients than for publicly funded patients for planned caesareans conducted prior to 39 weeks. Where there are certain obstetric or medical complications, such as pre-eclampsia or foetal growth restriction, earlier planned caesarean section may be necessary because the risks of waiting until 39 weeks’ gestation outweigh the benefits. If serious complications develop in the mother or baby, caesarean section may be performed regardless of gestation (that is, an emergency caesarean section). Waiting until 39 weeks’ gestation for a planned caesarean section, if there are no medical reasons for earlier birth, is recommended by World Health Organisation, RANZCOG and most state and territory guidelines. The emerging evidence states that these more serious situations result in less than 20% of caesarean sections performed before 39 weeks gestation, creating a serious need for John Newman’s Preterm Prevention program; The Whole Nine Months.
The Whole Nine Months
The Whole Nine Months is the public health campaign of the Australian Preterm Birth Prevention Alliance, led by Professor John Newman. The program features a state-wide obstetric outreach service that aims to prevent the premature birth of thousands of babies. Pregnant women under this program have their cervix measured mid-pregnancy, and for those identified with a shortened cervix, which can be an indicator for preterm birth, they are administered with a course of steroids to reduce that risk. The program is based in Western Australia and began in the King Edward Memorial Hospital in Perth. In 12 months, the program recorded an eight percent drop in preterm births and so will now be rolled out to other states as well as New Zealand. The early success of the program led to the establishment of the Australian Preterm Birth Prevention Alliance in June 2018, and this is a national partnership of clinical leaders, researchers, health departments and communities working together to safely lower the rate of early birth and save heartache for many Australian families.
Impact on Maternity Care
The impact of John Newman’s work and the development of the Whole Nine Months program and Australian Preterm Birth Prevention alliance on maternity care is astonishing. It is especially important for women on the journey to motherhood as preterm birth can place babies in NICU’s for prolonged periods of time, isolating them from their mother and influencing the onset of mothering, breastfeeding and the nurturing bond that is heightened by immediate skin to skin time and the burst of oxytocin. When mother and baby are separated, data shows that there is an increase in the onset of postpartum depression and postpartum psychosis. According to research, more than half of pregnant women in Australia believed that 37-38 weeks’ gestation was the earliest time for safe birth. In order to improve birth outcomes for women, care providers should be held responsible for providing information about the short- and long-term effects of birth before 39 weeks gestation. Prospective mothers who have also opted for a planned caesarean section and who have no obstetric or medical indications for an early-term birth should be given this information in their first appointment so they can plan for and visualise the timeline for their pregnancy and birth, without putting their baby at risk of preterm side effects. Informing mothers about the role of vaginal birth after caesarean section could also reduce the overall planned caesarean section rate, as approximately 58% of caesarean sections are repeat procedures.
The multifaceted approach of combining better education for pregnant women as well as their clinicians, provides a way forward for decreasing the number of preterm births without medical or obstetric basis. John Newman has contributed so much of his life to this project and the research and studies he has driven has made a huge impact on the data already. There is also a much wider impact on our community as hospitals will have a reduced need for neonatal services, health care providers will treat a decreased percentage of children with disabilities including cerebral palsy and chronic lung disease and schools will have less children with learning and behavioural problems. It is crucial in the birth space to be educated, follow evidence-based practice, and understand where you can refer woman on to for further advice, research and recommendations.
My name is Charlotte Lucas, and I am a qualified doula who has trained at the Doula Training Academy. If you would like more information about my doula services, please contact me:
0411 967 744
Further Reading and Resources
To further your understanding on Professor John Newman’s work or read more about preterm birth and the Whole Nine Months prevention program, I have listed some sources below for your perusal.
- Preventing Preterm Birth in Western Australia – https://www.youtube.com/watch?v=yPBHZrKrrus
- The Whole Nine Months Prevention Program – http://www.thewholeninemonths.com.au/
- Early planned caesarean section without medical or obstetric indication – special report – https://www.safetyandquality.gov.au/sites/default/files/migrated/1.1-Text-Early-planned-caesarean-section-without-medical-or-obstetric-indication-special-report.pdf
- Reducing preterm birth by a statewide multifaceted program: an intervention study – https://www.ajog.org/action/showPdf?pii=S0002-9378%2816%2932063-4
- New program offers hope for premature babies- https://babyology.com.au/pregnancy/birth/new-program-offers-hope-premature-babies/
- Every Week Counts- https://everyweekcounts.com.au/
- Australian Preterm Birth Prevention Alliance- https://www.pretermalliance.com.au/