Tuesday, February 2, 2010

Can We Reduce Premature Birth with Better Communication?

by Eileen Ehudin Beard, CNM, FNP, ACNM Senior Practice Advisor

We are so time conscious in our society. Life in the fast lane frequently requires scheduling out major events. Childbirth is one of the important life events that cannot and should not be scheduled. I wonder if midwives and other health care providers are taking the time to explain why. More specifically, how many women understand how the estimated due date (EDD) is calculated and what constitutes a full-term pregnancy?

Last month, we looked at a study in Obstetrics and Gynecology that analyzed women’s perceptions of full-term birth. And in December, we made note of the rising incidence of premature birth in the United States. I’d like to expand on one aspect of the study authors’ conclusion:
“…with the trend of an increased patient role in medical decision-making, ensuring that women understand the implications of the timing of delivery may be an important component of interventions to reduce the number of elective or semi-elective late preterm and early term deliveries.”
Do women and their families really understand the possible consequences of a preterm delivery? Perhaps we need to spend more time explaining how the EDD is calculated and why it is important to avoid delivery before 39 weeks.

Midwives need to take time to explain that the 40 weeks used to calculate EDD is 9 months because there are 4½ weeks in most months. We need to explain that for the EDD to be most accurate, a woman must be certain of her last normal menstrual period and have a regular 28-day cycle. Even then, EDD is an estimate. Women are not machines and don’t always have the same cycle. The EDD can often be unreliable, which may unwittingly lead to early induction of what looks like a full-term pregnancy on paper—more reason to avoid unnecessary induction.

Since many women and obstetricians are “scheduling delivery’” before 40 weeks, the picture can get pretty fuzzy for women. Early delivery may appear safe since it happens so often. There are many important issues to discuss on the initial prenatal visit, but I wonder if we breeze over the issue of what constitutes preterm delivery and how the EDD is calculated. We need to give this topic the careful explanation that it deserves. It could turn out to be a key intervention that helps decrease the incidence of late preterm and early term delivery.


kelli said...

So true...there is a healthcare delivery system that changes the way information is shared with pregnant women and their families. Families have over 20 hours during a pregnancy to process and facilitate discussions about their pregnancy and bodies. There is never waiting in a waiting room - they do their own weight , BP and write it in their chart - which they have complete access to at all times. THIS has been proven to reduce preterm birth by 33%!!!!!!!!

Ethel said...

Actually 1 month = 4.33 weeks, one could round up but that would be inaccurate.

Sisters Midwifery said...

I think this can also be framed as an ethical concern in the context of informed choice, which (here comes the shameless plug) is addressed in our new book, Professional Ethics in Midwifery Practice (Jones and Bartlett, 2010). Consistent with the Midwives Model of Care, informed choice promotes the empowerment of families to make good choices for themselves when fully informed of risks, benefits, etc.