It was after a notable study in 2019 that the question of changing the routines for childbirth became relevant. Research showed that fewer children died if the women's childbirth was initiated as early as 41 full weeks compared to 42, which was the routine at the time.
Since then, most maternity clinics in the country have changed their routines for initiation and control of pregnant women.
There were concerns beforehand that it wasn't the right way to go, but now we see a clear decline in both mortality and severe illness in newborns, says Karin Källén, professor of clinical epidemiology in obstetrics and gynecology at Lund University.
Fewer stillbirths
She is one of the researchers behind the study, which is published in the journal Plos Medicine. In it, a comparison has been made between the periods 2017 to 2019 and 2020 to September 2023, which shows a 47 percent decrease in the proportion of stillborn children or children who die within four weeks of childbirth.
Of all births after 41 weeks of pregnancy, 124 children died during the first period, which corresponds to 1.7 per 1,000, and 74 children, corresponding to 0.9 per 1,000 during the second period.
We don't know exactly what's behind the decrease, whether it's because they've started earlier or if better monitoring has led to being able to select who should be started to avoid increasing the risks for the children, says Karin Källén.
Satisfied women
A concern beforehand was that women would experience greater dissatisfaction when more were initiated.
But in surveys, the proportion of those dissatisfied with their childbirth experience has decreased, says Karin Källén.
The proportion of cesarean sections has, on the other hand, increased during the period, but the researchers don't know why.
During an initiation, the woman usually receives either a medication in the form of a drip or a tablet. Another method is to insert a catheter into the cervix to stimulate it mechanically. A consequence of an increased number of initiations is an increased burden on healthcare, as it requires more resources.
But it's about 18 children being saved every year, that's good news.
The current study, published in the journal PLOS Medicine, is based on registry data from over 150,000 births in Sweden where the women had gone a week or more over time.
The purpose was to investigate how the mortality and morbidity of children at later births have changed since 2020, when most maternity clinics in the country changed their routines for initiation and control of pregnant women.
The study is based on data from the National Pregnancy Register, the Swedish Neonatal Quality Register, and SCB. The women included had gone at least one week over time and had low-risk pregnancies, meaning they were healthy, expecting a child in head presentation (head first), and had not previously undergone a cesarean section.
Source: University of Gothenburg, Plos Medicine
