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What are the “absolute” risks of stillbirth?
Many healthcare providers create fear in women when they say, “the risk of stillbirth doubles by the end of 42 weeks.”
This is the “relative” risk of stillbirth.
It is important that you obtain the “absolute” risk before making any decisions.
The “absolute” risk means how often does that thing actually happen and where is the supporting evidence?”
So, what is the absolute risk of stillbirth?
If we look at recent studies conducted, all researchers found a relative increase in the risk of stillbirth as pregnancy advanced, but this risk was 0.052% – 0.072% in all weeks of gestation except with 42+ weeks as shown by Morken and Rosenstein, but even their study still showed the risk as being 0.117%.
| Morken (2014) | 1,855,682 women between 1967 – 2006 | 37 weeks = 0.14 per 1000 38 weeks = 0.18 per 1000 39 weeks = 0.26 per 1000 40 weeks = 0.52 per 1000 41 weeks = 0.68 per 1000 42+ weeks = 1.17 per 1000 |
| Weiss (2014) | 472,843 women between 2004 – 2009 |
37 weeks = 2.77 per 1000 38 weeks = 1.09 per 1000 39 weeks = 0.90 per 1000 40 weeks = 0.72 per 1000 41 weeks = 0.44 per 1000 42+ weeks = 0.70 per 1000 |
| Rosenstein (2012) | 3,820,826 women between 1997 – 2006 |
37 weeks = 0.21 per 1000 38 weeks = 0.27 per 1000 39 weeks = 0.35 per 1000 40 weeks = 0.42 per 1000 41 weeks = 0.61 per 1000 42+ weeks = 1.08 per 1000 |
There is no evidence to support that women planning a VBAC must go into labour by 39 weeks to prevent stillbirth.
Healthcare providers often state that “the risk of stillbirth doubles after 40 weeks.” While this is statistically accurate in terms of relative risk, it’s essential to contextualise it with absolute risk figures. For instance, the risk increases from 0.52 per 1,000 at 40 weeks to 0.68 per 1,000 at 41 weeks – a relative increase, but still a low absolute risk.
The most notable increase occurs after 42 weeks, where the risk rises to 3.18 per 1,000 pregnancies.
With induction you need to do your research and assess your own risks, not what someone else has done or is advising.
You need to find out what factors would increase the likelihood of you having a stillbirth.
You then need to look at all your options and decide if you are in a position where you can just wait and keep monitoring the health of you and baby and then induce if there is a medical need.
Think about whether your decision is based on treating an “actual” problem or treating a “potential” problem that may not even occur.
https://evidencebasedbirth.com/evidence-on-inducing-labor-for-going-past-your-due-date/
Understanding both relative and absolute risks is crucial for making informed decisions about pregnancy management. While the risk of stillbirth does increase with gestational age, especially after 42 weeks, the absolute risk remains low. It’s important to discuss these statistics with your healthcare provider to determine the best course of action based on your individual circumstances.
Resources:
Rate-of-Stillbirth-at-42-Weeks-of-Pregnancy.pdf
https://evidencebasedbirth.com/studies-that-calculate-risk-of-stillbirth-by-gestational-age/
Risk of stillbirth increases by continuing pregnancy to 41 weeks’ gestation
If you have any questions or would just like more information please don't hesitate to get in touch by clicking the button below and filling out the contact form.
Contact Vicki