U.S. gestational age has shortened dramatically 1990-2020

One of the best ways to gain perspective on typical pregnancy and birth practices in the US is to see what other countries are doing. We live in an age of information. A big difference in the US is that pregnancy length is shrinking. People here are literally not pregnant for as long as they are in other countries.

graph of pregnancy length by week in 3 countries

A study came out recently that got me back on my shit about the U.S. perinatal system. When I look at this graph that compares pregnancy length a lot of questions come to mind:

• Why did pregnancy length decrease from 1990 to now?

• Why is the US so different from two other countries in the year 2020?

• Why do other countries deliver a measurable number of babies at 42 weeks but the U.S. does not?

• What is happening in week 39 in the US but no where else? Look at that blue bar!
  

I have some hypotheses. One part of that answer is that providers don't get sued for taking extreme measures to save an unborn baby's life. In other words, most providers will error on the side of "just in case" when recommending an induction. Sometimes people need inductions, but often they do not. Providers have a low risk tolerance because in the event that something does go wrong, they are on the hook for not recommending an intervention.

Another answer is the ARRIVE trial. Woo, baby. One of the most divisive and over-cited studies in the birth world. Even though the study found that inducing labor at 39 weeks did not improve the primary outcome of death or serious complications for babies it is still cited as a reason to induce. The study did find that induction at 39 weeks lowered the rate of cesarean from 22% to 19% if the provider follows the induction protocol set in the study. You know what else lowers your risk of cesarean? A doula. I could go on and on, but I urge you to check out Evidence Based Birth and do your own research.

Of course we can't talk about differing outcomes in the US and not talk about institutionalized racism and the systemic intentional eradication of Black midwives. Gestational length is on average 5 days shorter for Black pregnant people as compared to white birthers. I would suggest that this is in part due to the stress of racism in the US, also sometimes called weathering.

So what does this look like irl? You go in for an ultrasound and one small thing looks off. You're told that you are "overdue" at 40 weeks and 3 days. Or the fetal heart rate slowed one time during your NST. Or you're considered "high risk" because you're over 35 or have a higher BMI. Your provider tells you that it could be nothing but they highly recommend that you head to the hospital immediately for an induction. Better safe than sorry, right?

You rush to the waiting room without your stuff, frantically trying to secure pet care or notifying work. Your adrenaline is through the roof. They tell you that L&D is backed up so you have to wait. You start to think that if this is really an emergency, shouldn't they be getting you in? Finally, after a restless wait you're admitted. Then, you have a multi-day induction that is hard on you, your partner, and your baby. Again, elective inductions are not inherently bad. I just see a lot of providers "offering" in a way that makes them seem medically necesarry and that is NOT INFORMED CONSENT.

Maybe zooming out like this or reading research is overwhelming. That's why you hire a doula - preferably one who knows how to reach and decode research. Maybe even one who has published their own research.

🔗 for the article I cited