Fewer moms having C-sections before 39 weeks

Fewer moms having C-sections before 39 weeks
MGN Online

POSTED: Sunday, April 14, 2013 - 12:00am

UPDATED: Sunday, April 14, 2013 - 12:04am

Moms can be convinced to change their minds about having their babies before they are at full term, according to a study released this week in the journal Obstetrics & Gynecology.

For years, medical groups have been encouraging moms to wait until their baby has remained in utero for 39 weeks. At the same time, the number of women choosing to induce labor or have an elective cesarean section for nonmedical reasons has been rising.

Just last month, the American College of Obstetricians and Gynecologists reiterated its recommendations, encouraging moms to avoid early elective deliveries.

The study

Twenty-five hospitals in California, New York, Florida, Illinois and Texas implemented what's called the Big 5 State Prematurity Initiative, a program that used a tool kit designed to help hospitals eliminate elective deliveries of babies before 39 weeks of gestation unless medically necessary. Thirty-eight percent of births in the United States occur in these five states.

In just one year, there was a remarkable decrease. "These 25 hospitals overall saw an 83 percent drop in early-term deliveries," said Dr. Edward McCabe, a pediatrician and medical director for the March of Dimes Foundation, which developed the tool kit and partly funded the study. In January, nearly 28 percent of babies were born at 37 or 38 weeks, but by December, that number had dropped to 5 percent. There was a corresponding increase in births at 39 to 41 weeks, McCabe said.

A cultural change has to occur for more hospitals to help mothers wait just a little longer, he said. With this tool kit, labor and delivery nurses were empowered to tell moms-to-be if there was a medical reason to deliver the baby before 39 weeks.

Why women deliver early

Often it can be a matter of convenience. A doctor may be going out of town, and the mother may want to ensure that doctor delivers her baby. Or grandma and grandpa may be coming a little earlier than the due date. Some couples may even try to have their baby before the end of a year, so they can claim a tax credit.

They may think that it's OK, because they've been told or have heard that 37 weeks of gestation is full term.

What is full term?

"It wasn't until recently that we recognized that there are more complications and mortality at 37 weeks," McCabe said.

"Important growth and development occur throughout pregnancy -- all the way through the final few weeks," according to the Centers for Disease Control and Prevention. "If the mother is healthy, current research indicates that delivery should not be scheduled before 39 weeks' gestation."

According to a 2007 CDC study, infant mortality risk for babies born at 37 or 38 weeks is 1.5 times higher than babies born at 39 to 41 weeks.

"That's a 50 percent higher risk of infant mortality," McCabe said. Mortality at 39 to 41 weeks is very low, he said.

In 2009, researchers showed that delivering a baby a week or two before 39 weeks, or even three or four days before that milestone is reached, can have a significant impact on the child's health. For one, babies need every extra day for their lungs to mature.

McCabe said he hopes more hospitals will consider banning elective inductions and C-sections unless medically necessary. One way for this to change is to make it clearer what full term really is.

"The nomenclature is changing," he said. "Thirty-seven and 38 weeks are now considered 'early term.' It's not yet official, but there is a movement toward calling 39 to 41 weeks full term. It's in the literature; people are using it."

It's hard to say exactly how many women choose to induce labor before 39 weeks. In 2008, 23 percent of babies were born because the mother's labor was induced, according to the American College of Obstetricians and Gynecologists. It's unclear, however, how often labor was induced before full term, as the data is gleaned from medical records that don't specify at what gestational age a baby is born.

Data from a 2006 report from the National Institutes of Health found an estimated 2.5 percent of all babies in the United States were delivered by C-section at the mother's request. 

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