I am wondering about this study. The recommendation is for universal testing of all pregnant women over 40 starting at 38 weeks. With homebirth clients, this could be difficult. Is over-40 birth headed for automatic high-risk status? Should it be?

Sorry - I forgot to link to the report http://www.eurekalert.org/pub_releases/2007-02/yu-iro020807.php Thanks!

For those of you who didn't follow the link, the article is about an analysis of a national perinatal database that concludes that pregnancy over age 40 is an independent risk, that is, a risk unconnected with other risk factors such as high blood pressure, for late fetal demise and stillbirth. The article states that routine testing beginning at 38 weeks would reduce this risk.

Unfortunately, the article is based on a presentation at a medical conference. There isn't a published study that I can look up, read, and evaluate. What I can say in the absence of more data is that it is a leap of logic to think that fetal surveillance testing could avert this risk. For example, women over age 40 may be more likely to have babies with fatal congenital anomalies, or the problem may be one that comes on suddenly and would not be picked up by periodic testing.

Also arguing against the practice is that we have no evidence that routine fetal surveillance testing improves outcomes in low- or high-risk women. Moreover, testing of this type has a high false-positive rate, meaning the test says there is a problem when nothing is wrong. When the odds of something being wrong are tiny, as they almost certainly will be here, the odds of a false positive are much higher than a true positive. A positive test will result in inducing labor or scheduling cesarean surgery. This is not benign. Both procedures carry risks for babies and mothers. Among other adverse effects, even at 38 weeks, which is officially full-term, babies born from other than spontaneous onset labors are more likely to have respiratory and feeding difficulties. 

-- Henci