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Dr. Jones: When should a baby be born? It's sort of a Goldilocks problem isn't it? When is too early? When is too late? And when is just right? This is Dr Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care. Today we are talking about when should babies be born, on The Scope.

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Dr. Jones: So how do you know when an apple is ripe? Just right. By color? By size? By season? Do you pull it off the tree? But if you're wrong you can't put it back. Do you wait till it falls until the tree thinks it's ripe? Well then it might get bruised. So is it the number of days? How do you calculate them? When is too early? When is too late? What about babies? When do we know that the baby is ripe?

Today we're talking with Dr. Erin Clark a perintologist, that's someone who specializes in high risk pregnancy, about when is the baby just right. Welcome to The Scope Dr. Clark.

Dr. Clark: Thanks for having me.

Dr. Jones: So how do we know when a baby is ripe? Is it 40 weeks? Is it nine months exactly? Is it certain amount of days? And how do we get that number?

Dr. Clark: The formal definition of when a woman is due is 40 weeks from the first day of her last menstrual period. We know generally that that's the date because that's around the time when most people spontaneously go into labor. We have great respect for when Mother Nature does it right. Certainly Mother Nature doesn't always get it right and outcomes for moms and babies are not always good. Ten percent of babies in the United States are born too early, but most of the time delivery occurs about that 40 week mark.

Dr. Jones: So when is it too late?

Dr. Clark: It's a complicated question but if we look at outcomes for moms and outcomes for babies, a variety of outcomes. Stillbirth, c-section rate, the ability of a baby to breath and do well after delivery. If we look at all of those outcomes, the lowest risk time, the sweet spot, so to speak, that perfectly right apple seems to happen at 39 weeks give or take a week or so. So between 39 and 40 weeks appears to be the lowest risk time.

There's very good data that suggest if we go before 39 weeks electively, sometimes there's a very good medical reason to do that, but before 39 weeks babies have more difficulties after birth. They can have difficulty regulating their temperature, they can difficulty with eating, they can have difficulty with breathing. We know that in a well dated pregnancy at 39 weeks or beyond, babies do really well.

There is a point though at which pregnancies can go too far and it's a gradual increase in risk that happens after the due date which is at 40 weeks. So again that sweet spot appears to be 39 to 40. In general we try to get women delivered about a week past their due date at the latest because those risks start to climb.

Dr. Jones: So what are those risks?

Dr. Clark: For babies there is a risk of stillbirth that climbs over time. That's the biggest and scariest risk because a baby who has a stillbirth does not survive to have any of the other outcomes. But there's also a high rate of c-section because the placenta while it's miraculously marvelous organ, it has a life span. And after the due date it starts to baby and labor is a stressful process for babies and if that organ is not functioning optimally, we see signs in labor by watching the baby's heart rate that the baby is just not getting the oxygen and nutrients that are necessary and so the c-section rate is higher.

There is also some other risks that are higher for moms. The rate of hemorrhaging associated with delivery, the rate of having a baby that doesn't fit because of size. Those things go up over time too. So when we look at those myriad of complications, all of them are at their lowest risk at that 39 to 40 week mark.

Dr. Jones: But it's not always so easy. So if you decide 39 to 40 is a good number, how do we get the baby out then?

Dr. Clark: Maybe this is the apple and the worm analogy.

Dr. Jones: Okay.

Dr. Clark: There's very good data, 39 to 40 weeks baby is ready to come out beyond 39. But the other question that you're getting at is when is mom ready? Sometimes the two are not in sync. But what has been shown is that if you don't induce labor in a timely fashion after the due date has passed, actually the c-section rate goes up and not down. The cervix is like a fist, before labor starts, it's hard, it's somewhat unyielding and as preparations for labor happens it gets softer.

Dr. Jones: Well that's a good thing because we want to get the baby in for those 40 weeks or 39.

Dr. Clark: Correct. It's appropriately unyielding. But as preparations for labor made it gets soft, it get thinner, it starts to open. These are signs that we like to see as women get ready for labor and even in a patient who has a cervix who's not quite ready, if they're going past their due date especially a week or more, we know that their lowest risk are to induce labor rather than wait.

There's the other question though of when is the earliest that's safe to induce labor without a medical indication? And 39 weeks appears to be the earliest based on what we talked about as far as risk for baby go up if we go any sooner than that. In a woman whose had babies before who has a cervix that is soft and ready for labor and who is known solidly to be at least 39 weeks gestation, induction of labor electively is felt to be a very reasonably medically safe practice.

What is less well known and what we need research is what about the woman who has not had babies before? There's many advocates, experts across the nation who say because of this data that suggest that 39 weeks is that lowest risk spot, maybe that should be a policy. Maybe we should induce everybody between 39 and 40 weeks because we know we would see less stillbirths, we would see less pregnancy complications like preeclampsia. Maybe that's the right approach.

Clearly there's a lot of push back saying Mother Nature, Mother Nature. We should let most of these labors go on until there's an indication to intervene. But it's still a big question, and it won't be answered until we take a group of women who have not had a baby before and randomly assign them to either watchful waiting. Seeing if they go into labor on their own and intervening if there's a medical reason. Or another group of women where when they hit 39 weeks and we say it's time to have a baby and regardless of what your cervix says as far as readiness, we're going to give you the medications that will stimulate labor.

Dr. Jones: So this is study that's ongoing?

Dr. Clark: This is a current study. This is a national multi-site study. In Utah we have several participating sites one of which is The University of Utah, one of which is Intermountain Medical Center in Murray, LDS Hospital in Salt Lake City, Utah Valley Regional Hospital in Provo, and McKay-Dee Hospital in Ogden. We are trying to enroll 6,000 women across the nation for participation in the study.

Dr. Jones: Are ladies anxious to sign up? I am assuming randomization is 50/50.

Dr. Clark: It's 50/50.

Dr. Jones: When they randomized and they get not the arm they wanted, are they doing okay?

Dr. Clark: Yeah, we have two camps of women. One is very much wanting spontaneous labor to happen. They want that story of my water broke in bed one cold winter night. They can tell over and over again to this child forever. They want that natural course. And they're not interested in participating and that is totally fine.

There's another group of women who says for logistical reasons this would be a really nice thing to have a time delivery about a week before my due date and there's some enthusiasm there for participation. Remember this is a group of women who are not eligible otherwise to have an elective induction a week early who, yes, are very interested in participating. The ones who are very much often want to be in that induction of labor arm and there are sometimes tears when they randomize the other way but again it gives them a chance at that earlier intervention whereby they wouldn't otherwise. So for some women it is a very nice option.

Dr. Jones: To round up, it sounds like you want your baby just right and somewhere between 39 and 40 weeks is, we think for babies, just right. Up to 41 is kind of practice now but maybe sooner is better. People, if they're having their first baby and want to contribute and they deliver at those places can sign up and hopefully you'll have a perfect little apple for Thanksgiving.

Dr. Clark: Right. That's the goal.

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Dr. Jones: Radiation, it's a scary word that causes visions of nuclear bombs, exploding nuclear power plants. Radiation is a term for a kind of energy that goes from one place to another, like infrared radiation that keeps us warm, ultraviolet radiation that makes vitamin D in our skin, and the visual spectrum that lets us see the world around us.
But let's go back to radiation of sorts that we have more questions about; microwave radiation, big power line radiation, and electromagnetic radiation from that little device that we hold next to our bodies all day long, our cell phones. What about this kind of radiation and pregnancy? This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care. Today on The Scope we'll be talking with Patti Wood in New York City who is the Executive Director of Grassroots Environmental Education, and a visiting scholar at Adelphi University School of Nursing and Public Health. And she's going to help us try to think about exposures in pregnancy to cell phone radiation. So welcome to The Scope, Ms. Wood.

Ms. Wood: Thank you very much. I'm delighted to be with you.

Dr. Jones: So Patti, tell me a little bit about what might be the concerns about the kind of electromagnetic radiation that comes from cell phones in pregnancy. What do we know, or what are we worried about?

Ms. Wood: Most people never really thought about what this is; what is making those cell phones actually work. But radio frequency waves have been used for more than 100 years, and this was when we actually were able to have the small receivers in our homes, called radios, and the distant transmitting towers. The technology offered today by the wireless industry puts these same powerful transmitters as well as receivers much closer to us than we think they should be. It's actually the two-way communication using this type of RFR, or radio frequency radiation, that is the reason for concern.

Dr. Jones: And people who are carrying a cell phone with them and when they have it on so they can receive calls, they may not know that they are constantly exposed to this radiation every minute, because your little cell phone while waiting to get a call is always signaling where you are. So it's on all the time.

Ms. Wood: That's right. Then you are actually receiving and transmitting all the time.

Dr. Jones: So tell us a little bit about what the concerns are, and in particular, in pregnancy.

Ms. Wood: Since we do use these ubiquitously and the cell phone towers are now becoming closer and closer to us as well, we are dealing with something that we have actually never seen before. It's a perfect example of how technology gets out ahead of science, and we're way out with the technology, and the science is really trying hard to catch up here.

Dr. Jones: Do we have some animal models?

Ms. Wood: Our baby-safe project, which is a project just to educate pregnant women about the safe use of wireless technology during their pregnancy, actually was inspired by the work of Dr. Hugh Taylor, who is the Chair of the Department of Obstetrics and Gynecology and Reproductive Sciences at Yale University.
He and his team of researchers actually did mouse studies where they found that the prefrontal cortex of the offspring of the pregnant mice who were exposed to very typical cell phone radiation levels actually were wired differently. That could be reason for concern, because we have so much of these neurobehavioral problems in our children today. I think the latest statistic is one in five, and anything from ADD, ADHD, to dyslexia, just behavioral problems, even autism. In fact there's a researcher at Yale, Dr. Martha Herbert, whose sole focus of her research is the link between cell phone radiation, or wireless radiation in general, and autism.

Dr. Jones: Did they put the phones right next to the mouse, or did they put it across the room from the mouse?

Ms. Wood: No, actually the cell phones were placed on top of the cage. And they actually had a control group where there was a cell phone that was turned off, placed on another cage. And they actually were able to look at not only the behavior of the offspring, but they were also able to look at the structure, the brain structure, of these offspring.

Dr. Jones: And do we have any data from humans yet?

Ms. Wood: Absolutely no data from humans, in fact the team at Yale is very interested in doing primate studies next. This would bring this closer to the human model. They were able to show that, like I said before, they had different electrical activity in their prefrontal cortex, which is the area of the brain that controls these behaviors that we just spoke about.

Dr. Jones: So what are your recommendations in terms of a precautionary story; well, we're not sure what's going to happen in humans, but it seems like it would be wise to take precautions.

Ms. Wood: When you're talking about precautions, this is what guides much of our work, is the precautionary principle, which states that if there is an indication of harm that precautionary measures could be taken even without scientific certainty. And this is certainly an area where I would employ that. Generally speaking proximity is the most important factor in determining the amount of wireless radiation to which you and your baby are exposed. Radiation levels will actually fall off pretty dramatically as you distance yourself from the source. We're just recommending avoiding carrying your cell phone directly on your body, not in a pocket, not in a bra, not in a bag that you carry on you all the time.
If you have to carry it, we recommend that you actually just turn the phone around so that the back of the phone, which is where the antenna is, is actually facing out. Obviously don't place your cell phone or your wireless laptop or tablet on your abdomen. I know that it's a convenient spot when you have that big bump there. If you're lying down you just kind of prop up your computer there. But it's probably not a great idea.

And then we advise talking on speaker setting, or with an air tube headset. We really recommend that you avoid using cordless phones as well, because a cordless phone gives you about the same amount of radiation as a cell phone does. We strongly advise that people have at least a couple of places in their home where they are talking on a hardwired or a landline phone, which of course presents zero risk.

Dr. Jones: The speaker phone allows you to put the phone several feet away.

Ms. Wood: That's right, and that's excellent. I mean, you really even begin to see the radiation levels fall off at a few inches. So the further away you get it the safer you are. Technology is moving so fast that we're beginning to replace our old analog utility meters now; so yet another exposure to try to avoid. I mean, if you're bed is right up against the wall, you know, which has these smart meters on the other side of it, we would strongly advise that you just move your bed or even move it into another room so that you're not right there.
Unplugging your home Wi-Fi router every single night should just be routine, like you lock your doors, you turn off your lights, and the router goes off, too.

Dr. Jones: I have one last little question, because although we're talking about women and pregnancy, I'm a fertility doctor, and I always think about my men. So what about those guys who carry their cell phones in their pockets, right next to their testicles?

Ms. Wood: We actually have quite a few studies linking cell phone exposure to harmful effects on sperm, and they've actually been done here in this country, as well as Australia and some European countries, and South Africa in particular. But they've used very diverse methodologies, and they've compared sperm counts and sperm health in men who wore cell phones on their hips, and those who carry them in other places on their bodies or didn't use them at all. And they actually saw a real difference in those men who were wearing their cell phones on their hips, or in their pockets. It's just something that you would probably try to avoid if you could.

Dr. Jones: Yeah, be careful with your man parts.

Ms. Wood: Be careful with your man parts.

Dr. Jones: Well, we've been talking with Patti Wood, who is the Executive Director of Grassroots Environmental Education, and she has her own radio show and a website. Patti, can you give that to our listeners?

Ms. Wood: BabySafeProject.org.

Dr. Jones: BabySafeProject.org.

Ms. Wood: There's a lot of information there and a lot of scientific studies on there, and a lot of helpful information about what you can do to just reduce those exposures.

Dr. Jones: And a website for your Grassroots Environmental organization?

Ms. Wood: Right, and our non-profit website is GrassrootsInfo, as in information; Grassrootsinfo.org. So that's GrassrootsInfo.org.

Dr. Jones: Well thank you so much and I'm going to even carry my cell phone farther away than I currently do in my purse. But thank you so much for joining us everyone who's listening, and thank you for joining us on The Scope.

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