Management and women's experiences of pregnancies lasting more than 41 gestational weeks

Abstract

It is well known that the risks for complications of both the foetus and the mother increase in post-term pregnancy. To date, there is no uniform worldwide guideline for when to induce a pregnant woman who has passed her estimated due date. Little research has been conducted about women’s own experiences of a pregnancy ≥41 gestational weeks. The overall aim for the thesis was: 1) to investigate if a policy of induction of labour at 41 gestational weeks is superior, in terms of neonatal and maternal outcomes, versus induction at 42+0 gestational weeks, among healthy women with a low risk pregnancy. 2) To get a deeper knowledge about women’s experiences of pregnancy ≥41 gestational weeks. Study I comprised the study protocol, and Study II the register based randomised controlled multicentre trial SWEPIS. In Study III the qualitative method phenomenology was used and the lifeworld hermeneutic approach in Study IV. The results showed no perinatal mortality in the early induction group compared to six perinatal deaths in the expectant management group, and no difference in primary outcome between the two groups. The results from the qualitative studies showed that the women experienced a state of limbo, a void, characterised by contradiction in relation to time, giving birth, and treatment from the caregivers. Further, the women experienced the time of waiting for the onset of labour as the start of a voyage into unknown waters. In conclusion, it is advantageous to induce at 41 gestational weeks, compared to induction at 42 gestational weeks, without increasing the risk for caesarean section or instrumental vaginal delivery. In addition, women need clear information and support to be strengthened in the transition from being pregnant to giving birth.