You wouldn't take a cake out of the oven before it's ready, but how about that bun in the oven? For some pregnant women, the answer is "Sure!" In fact, 10 to 15 percent of all births in the U.S. are "early elective" deliveries (meaning prior to 39 weeks' gestation, via cesarean section or induction, without a clear medical reason), two new studies find -- and some hospitals report that number is as high as 44 percent.
But, the American College of Obstetricians and Gynecologists (ACOG) staunchly advises against elective deliveries before 39 weeks. Term has long meant between 37 and 41 weeks, but this is a time frame for allowing normal, spontaneous labor to start without intervention, explains Caroline Signore, M.D., an ob-gyn with the Eunice Kennedy Shriver National Institute for Child Health and Human Development, in Bethesda, Maryland. Elective, early deliveries can lead to problems for mom and baby that are uncommon in spontaneous deliveries. Because of this, many health experts refer to all babies born at 37 or 38 weeks as early term. Of course, if you have a condition such as preeclampsia or diabetes, whose risks outweigh the risks of an early delivery, it may be best to welcome the baby early -- and you should feel no guilt about that. But waiting until the final, er, stretch is often worth it. Read on to learn the downsides of rushing things.
More than 25 percent of infants born electively between 37 and 39 weeks required admission to the neonatal intensive care unit (NICU) for an average of 4.5 days, compared with fewer than 5 percent of infants who were delivered at 39 weeks or later, according to a recent study published in the American Journal of Obstetrics & Gynecology.
Early babies may end up in the NICU for a host of reasons, most of them relating to immaturity. "They may have a tough time maintaining a normal body temperature because they don?t handle cold or stress well," says Alan R. Fleischman, M.D., medical director of the March of Dimes Foundation. For others, low blood sugar is often a problem until they get the hang of feeding -- and feeding can prove tricky because early-term babies tend to be smaller and weaker, causing struggles at the breast. Doctors typically let babies go home when these issues resolve within a few days, but many newborns end up back in the hospital with jaundice or lingering feeding problems, which can result in dehydration. If nursing continues to be difficult, your baby could miss out on the benefits of breastfeeding, such as increased immunity to common illnesses.
Here's another thing to think about: At 35 weeks of gestation, the brain weighs only about two thirds of what it will at 40 weeks. "Preliminary data show that full-term babies do better in school than those born early," says Bryan T. Oshiro, M.D., associate professor at Loma Linda University School of Medicine, in California. That makes sense, especially in light of the mounting evidence that the earlier a baby comes, the greater the risks for having learning and behavioral problems. Babies born between 34 and 36 weeks are more than three times as likely as those born at term to be diagnosed with cerebral palsy, a recent study finds. The number of babies affected is still reassuringly small, but after 37 weeks, the risks do drop significantly.
You might not know it from the earsplitting wails of a newborn, but a healthy set of lungs is one of the last organs to mature. That's why respiratory problems are especially common in babies who arrive too early. In fact, newborns delivered at 37 weeks are three times as likely to experience respiratory distress syndrome (a severe newborn lung disease), transient tachypnea (rapid breathing), pneumonia, a need for a ventilator, and respiratory failure as babies born between 39 and 40 weeks, according to recent research published in the Journal of the American Medical Association.
Labor inductions can set in motion a chain of events that ultimately make a C-section more likely. First-time mothers who have had their labor induced double their risk of requiring an emergency C-section, which typically results in a longer recovery period for mom, according to a recent study in Obstetrics & Gynecology. After all, even though the procedure has become as common as sneezing these days, it's still major surgery.
To simulate natural labor, induction usually involves medications such as prostaglandin (taken orally or inserted vaginally) to soften the cervix, or an IV with a synthetic form of the hormone oxytocin (Pitocin or Syntocinon) to get contractions going. Your care provider might also consider breaking your water (also called an artificial rupture of membranes). Many experts note that induced contractions tend to be stronger than those experienced during spontaneous labor, and a recent study reported that synthetic oxytocin (Pitocin) is the medicine most commonly associated with preventable complications during childbirth -- with cesarean sections heading up that list.
In fact, the March of Dimes notes that elective inductions are a major contributing factor to skyrocketing C-section rates, giving credence to the idea that the body doesn't always perform optimally on command. Indeed, among women who had elective inductions, 37 percent had to have an emergency C-section because their cervix simply wasn't ready for labor, according to a report in Obstetrics & Gynecology.
The C-section rate in the U.S. has surged over the past four decades, from 5 percent in 1970 to above 31 percent today. Sure, the tabloids may trumpet that "too posh to push" celebrities are opting for an easier childbirth, but any woman who has actually spent time recovering from a C-section will probably tell you there's nothing posh or painless about it. It is surgery and thus still carries with it increased risks for complications, infections, and a considerable recovery period (typically two to four days in the hospital, plus another four to six weeks of healing time at home).
Having one cesarean also ups the odds of an encore with your next baby, which can be more dangerous than many women realize. Repeat C-sections carry increased risks for hemorrhage, infection, hysterectomy, bowel and bladder injury, and abnormal placenta conditions. And although ACOG recently revised its guidelines to state that 60 to 80 percent of women are candidates for vaginal birth after cesarean (VBAC), lots of clinicians and hospitals are still wary of allowing them. In fact, many ob-gyns are offering fewer opportunities for VBACs these days, according to ACOG.
When you're recovering from surgery or your baby is in the NICU, you may not be able to cuddle him right away. We know that early skin-to-skin contact can have positive effects on breastfeeding duration, bonding between mother and child, infant crying, and the baby's cardio-respiratory stability. Complications during pregnancy and birth (including emergency C-sections, suspicion of fetal distress, and hospital admission of the baby) were also associated with postpartum depression, which hampers bonding. Of course, there's only so much you can control. What matters most is a healthy baby and mom; talk with your doctor so you can try to stick it out as long as you can.
Of course, there are plenty of valid reasons to be induced early or schedule a C-section:
-- Fetal-development issues
-- High blood pressure or preeclampsia
-- Gestational or preexisting diabetes
-- Problems with the placenta Ruptured membranes prior to labor
Talk to your doctor about your condition and make sure he thinks it's essential to go early, Dr. Fleischman advises. "If there's a true medical indication, definitely move forward."
Originally published in the April 2011 issue of American Baby magazine.