[00:00:00] Dr Renee White: Knowledge is power, and we are all about empowering the mamas of the world. In each episode, we will unravel and interpret the latest research and evidence-based practices for pregnancy, postpartum, and motherhood. As mums and researchers ourselves, we have experienced firsthand the overwhelming complexity of information myths and those classic old wives tales.

[00:00:27] I'm Dr. Renee White, and this is the Science of Motherhood. Hello and welcome to episode 185 of The Science of Motherhood. I am your host, Dr. Renee White. Thank you so much for joining me today. This episode is proudly brought to you by Fill Your Cup, Australia's first doula village that provides science backed birth and postpartum care that actually works.

[00:00:52] Now here at Fill Your Cup we combine over 16 years of health expertise with nurturing care so you mama can recover faster, bond deeper, and embrace motherhood with confidence not chaos. We are so proud to be supporting mothers and their families across Australia. We are now in eight major cities across this beautiful land, including Melbourne, Sydney, Brisbane, Perth, which is a new one Geelong, Newcastle, Hobart, we are all about town. So if you were thinking, oof, I'm pregnant, I'm feeling a little bit concerned about that. Birthing process or what life looks like after birth. How are you gonna juggle it all? Are you a little bit worried about having a baby for the first time?

[00:01:49] Or maybe you've got toddlers in toe and you're like, holy moly guacamole. How am I going to manage and juggle the load? Well, that is where a doula can really help support you and your family during this process. And so you know, things like making beautiful, delicious, nourishing meals weekly, doing your laundry, holding your baby while you go have a nice hot shower, or you go for a nap, if that sounds like bliss to you.

[00:02:25] Maybe having a doula is something you might be interested in having. We've had some recent reviews from our beautiful families. I'm just gonna read out a couple. Maddie said that we were soul and sanity saving. Thank you, Maddie. Paris said, I don't think I could have made it out the other side without Fill Your Cup, which is just absolutely beautiful.

[00:02:45] And Emily said, Fill Your Cup is a godsend for new mamas. Well, thank you. Thank you, thank you. You can have a look at the reviews that we've got on our website and also our Google reviews. They are glowing. Okay. You know, like it is so nice to have those beautiful words said about Fill Your Cup and our gorgeous doulas.

[00:03:09] If you are interested in having some extra support, you know, extra set of hands in the house after you have your baby, feel free to jump over on our website, I feel your cup.com. It's in the show notes as well, and you can go to our offerings and then you can check out our birth doula and postpartum doula packages.

[00:03:31] All right, everyone. Let's dive into today's episode, which is a Check In Tuesday episode. This is where I am flying solo, and I talk about all things motherhood, all things research, because hello, I used to be a medical researcher and I cannot help myself. Every Monday I get served up some amazing research that has something to do with pregnancy, birth, you know, women's health, you name it.

[00:04:02] I've got it. I look through it and I do a deep dive on some of the articles that really sparked my interest. And there was one a few weeks ago that we are gonna talk about today, and it is about planned deliveries. So we're talking induction of labor and also elective cesareans. So let's have a look. Now, if you follow us on Instagram, you probably saw our post about a massive Australian study on birth timing.

[00:04:32] And boy, oh boy, did she explode. Oh my goodness. Nearly half a million pregnancies. Studied some pretty compelling findings and a comment section on the post that. Well, let's just say it sparked some intense conversations. So today what I wanted to do was walk you through exactly what this research found, why it's creating such polarized reactions, and most importantly, what it actually means for you and your birth choices.

[00:05:06] And I have had a number of women privately DM me and say, Hey, can I read that paper? Can you send through the paper please? Because I've got choices to make and I'd really like to be informed, and that is what this podcast is all for. So let's look at the research. Let's break it down. Okay, so let's start with the study itself.

[00:05:30] Now, this research was published in the Lancets eClinical Medicine Journal, and it looked at 472,520 to be exact low risk. Singleton pregnancies in Queensland, Australia between the years 2000 and 2021. Now that is a huge sample size, so we are looking at, you know, nearly half a million births now the researchers wanted to answer a specific question, and that question, I guess, has been brewing in obstetrics for a while.

[00:06:10] Is it better to plan delivery at 39 weeks or wait for labor to start naturally after 40 weeks? Now when I say planned delivery, they looked at two approaches. The first being labor induction. The second being scheduled cesarean section. Now about 97,000 women had planned deliveries, 40,000 had inductions, and 60,000 had scheduled C-sections.

[00:06:43] Now here's what they found, and these numbers are pretty striking. The first, perinatal mortality, so that's baby's deaths during pregnancy, birth, or shortly thereafter, dropped by 52%. That translates to preventing one death for every 2,220, uh, 78 planned deliveries. The second severe neurological complications in babies.

[00:07:12] So we're looking at things like seizures, brain hemorrhages, birth asphyxia. That was reduced by 54%. The third thing that they found was severe non neurological complications. So things like sepsis, birth trauma, prolonged NICU stays that dropped by 35% and here's something interesting. Scheduled cesareans showed even bigger benefits than inductions for most of these outcomes.

[00:07:44] So for perinatal uh, mortality, specifically scheduled C-sections reduced risk by 61%. While inductions didn't show a statistically significant reduction. But inductions had their own advantages according to this study, 46% reduction in emergency C-sections, 47%, uh, fewer severe perineal tears and 27% fewer cases of, uh, shoulder dystocia, if that's how you pronounce it.

[00:08:21] On the surface, these look. Like pretty compelling arguments for planning delivery at 39 weeks. Right. Okay. Now let's look at the social media explosion of this particular research. So we shared this research and honestly, the response has been intense, and I totally get it. Birth timing is deeply personal, and research like this can feel quite overwhelming or validating or frustrating, depending on your experience.

[00:09:00] Now, I have seen beautiful stories from people who had positive experiences with planned deliveries At 39 weeks, I am one of those people, you know, people sharing how their inductions went smoothly, how they felt empowered by having a plan, how their scheduled C-sections felt really right for their family.

[00:09:22] But I've also seen frustration and rightfully so about how this research, like so many others, seems really laser focused on baby outcomes while maternal wellbeing really takes a backseat. You know, where were the measures around birth satisfaction, postpartum depression rates, breastfeeding success, you know, recovery experiences, long-term maternal health, you know, the, this, this pattern of prioritizing neonatal outcomes over maternal experiences is something we see repetitively in obstetric research. And I have to say, it's a real problem.

[00:10:04] You know, birth people aren't just vessels for delivering healthy babies. They are whole humans whose experiences, preferences, and wellbeing genuinely matter. And then there's the polarization. Some people are reading this as, you know, everyone should have a planned deliveries at 39 weeks and others are pushing back hard feeling like this is another example of overmedicalization of birth. I get it. Both reactions make sense, but they're missing something crucial and that is, the limitations of this research, you need to read this study as a whole.

[00:10:48] So this is what I'm gonna do. I'm gonna break it down. I'm gonna work through and critically analyze and you know, tell you what this study can't tell us. So this is where we need to put our critical thinking caps on. Boop, because while this study is really impressive in size, it has some significant limitations that affect how we should interpret these findings.

[00:11:13] Now the first thing is, okay, everyone ready? The first thing is very important. This is an observational research study, not about causation. That's a huge distinction. Now, the study shows associations, so patterns, but it can't definitively prove that planned delivery at 39 weeks causes better outcomes. There could be other factors at play that we are not seeing.

[00:11:47] Now, think about it this way. Imagine we found that people who carry umbrellas have lower rates of getting wet. We could say there's an association, but we'd need to consider whether it's the umbrella itself or the fact that people who carry umbrellas might also check weather forecasts, wear raincoats avoid going out in storms. You get what I'm saying here, people.

[00:12:15] The second is that this data comes from a single healthcare system. Queensland Australia healthcare practices, cultural approaches to birth population characteristics and resources vary dramatically around the world. And so what works in one system might not translate to your local hospital at all.

[00:12:42] The third is that this is a retrospective study, so the researchers looked back at data that was already collected. So this isn't a randomized control trial, which you know, is typically gold standard kind of level, where researchers would randomly assigned some women to plan delivery and others to expectantant kind of management.

[00:13:05] Instead, they're analyzing decisions that were already made often for reasons that. We can't fully account for. Okay the fourth thing that we need to be aware of is that there is potential selection bias. We don't know all the reasons why some women had planned deliveries. Were there subtle clinical factors that influenced these decisions?

[00:13:26] Maybe women who, you know, planned deliveries had slightly different risk profiles, so the researchers couldn't measure. And in all fairness, the authors themselves acknowledged they couldn't account for all possible confounding variables okay. The fifth, and this is a big one for me, there are no maternal experience measures now no data on birth satisfaction, trauma rates, you know, bonding, breastfeeding success, or how these different approaches affected the birthing person's overall wellbeing and recovery.

[00:14:02] And finally, you know, generalizing kind of questions. This study included low risk pregnancies only really excluding people with things like diabetes, hypertension, advanced maternal age and other conditions.

[00:14:19] And so real world birth populations are much more diverse than this study sample. However, as I said, the authors themselves were appropriately cautious about their findings. Now, they explicitly stated that these results should not be taken as unqualified support for a policy of routinely offering planned birth, particularly by scheduled C-sections at 39 weeks in all low risk women.

[00:14:47] They themselves have called for randomized control trials before implementing major practice changes, and that in and of itself is really responsible science. So that's good to see that. Alright, so with all that said, what does this mean for you as an individual, as someone who's maybe pregnant or thinking about having a baby?

[00:15:11] Where does this leave us? How should you think about this research when making decisions about your own birth? Now, the first is this is one piece of information among many. It is one piece of the puzzle. And it adds to our knowledge base, but it shouldn't be the only factor in your birth decisions, your individual circumstances, your health history, your preferences, your previous birth experiences, and ultimately your gut feeling all matter enormously.

[00:15:49] So if you had a planned delivery at 39 weeks and it was positive woo go girl. Like I'm all for it. Your experience is valid and it's important, and if you are considering your options for an upcoming birth, which many people who privately dmd me are doing this research gives you, I guess more. More data points for conversations with your healthcare provider, but it's not a directive.

[00:16:17] So if you choose to wait for spontaneous labor and you know, have a beautiful experience that's equally valid. One study doesn't invalidate your choice. Or your experience. The second thing that I wanted to highlight is that you can use this as an opportunity for deeper conversations with your care provider.

[00:16:41] So, you know, ask them about their approach to birth timing. What factors do they consider? How do they balance potential benefits with individual circumstances? And I guess, what does the research landscape look like beyond this one study? Right. The third thing I wanted to highlight is, remember this, that you know, correlation does not equal causation.

[00:17:09] Just because planned delivery was associated with better outcomes in this specific population doesn't mean it will have the same effect for everyone, everywhere. And finally. You know, this is a great opportunity to advocate for research that includes maternal experience. We need studies that value the whole person, not just clinical outcomes.

[00:17:35] We want things like birth satisfaction, mental health, long-term wellbeing. These all matter. And I know that there are groups doing this. Hello, big shout out to Hannah Darling whoop, whoop. But you know, this is, this is the positive. Let's turn it into a positive of like, okay, look, this really polarized people and angered some people that it was missing all of these maternal experiences.

[00:17:56] This provides us more fuel, more conversations, and more focus to going, Hey, let's do more studies around women's health. And you know what, what happens to the mothers, not just our babies. So I just wanted to, you know, take a little bit of a lens back. Let's look at the bigger picture here. Now what this viral response really shows me.

[00:18:23] Is how hungry we all are for nuanced, thoughtful discussions about birth research. We want studies that consider the whole person. We want research that includes diverse populations and respects the complexity of human birth experiences. And as birth workers, advocates, and you know, birthing people, we really need to keep pushing for things like, research that values maternal experience alongside, you know, neonatal outcomes. We need studies that include diverse populations and healthcare systems. We really need investigations into the psychological and social impacts of different birth approaches. Um, ideally we would love to see randomized control trials, you know, obviously where ethically possible, and we really, really need to understand and recognize that correlation doesn't equal causation.

[00:19:26] Okay. This study contributes to understanding, but that's not the final word, right. Science is, it's iterative. You know, we build knowledge pieces by piece, by study, by study, you know, always refining our understanding. I remember during my PhD, you know, my, uh, supervisor said to me, you are gonna answer one question.

[00:19:51] You know, with that particular experiment, and that answer is then going to give you 10 more questions to then answer and so on and so forth. It is like opening Pandora's box, but we just need to take it one step at a time. So just to wrap up, here's what I want you to take away from today's episode.

[00:20:15] Ultimately knowledge is power, but only when it is presented with context, nuance and respect for individual choice. And our job here at The Science of Motherhood and Fill Your Cup isn't to tell you what to choose. It's to help you critically analyze information so you can make informed decisions that align with your values and your circumstances.

[00:20:40] You know, whether you are planning, waiting, or somewhere in between, you absolutely deserve support. You deserve accurate information and providers who listen to your concerns and preferences, your birth experience matters, all of it. Not just the clinical outcomes. So I want you to keep asking the hard questions.

[00:21:03] I want you to keep demanding for better research, and I want you to keep sharing your stories and keep trusting yourselves. If today's episode really resonated with you, I'd love to hear your thoughts, share this with someone who might benefit from this discussion and remember, you've got this. We've totally got you. Alright until next time, keep filling your cup with knowledge, compassion, and confidence. Mamas, I'll see you next week.

[00:21:33] If you loved this episode, please hit the subscribe button and leave a review. If you know someone out there who would also love to listen to this episode, please hit the share button so they can benefit from it as well.

[00:21:48] You've just listened to another episode of The Science of Motherhood proudly presented by Fill Your Cup, Australia's first doula village. Head to our website I fill your cup.com to learn more about our birth and postpartum doula offerings where every mother we pledge to be the steady hand that guides you back to yourself.

[00:22:09] Ensuring you feel nurtured, informed, and empowered so you can fully embrace the joy of motherhood with confidence. Until next time, bye.