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Do the Final Weeks of Pregnancy Really Matter?

1/1/2012

November was prematurity awareness month, bringing in to focus the importance of completing as much of the 40 weeks of pregnancy as possible.  Intermittently in the news or among friends and family, we hear of moms scheduling deliveries, having cesarean deliveries before 39 weeks (to save their figure), and the whole notion that labor happens when it is scheduled and the body isn’t allowed to go into labor naturally.  In our nation, there has been a trend to deliver babies when it is convenient for parents (who doesn’t want to know exactly when their baby will be born so they can plan accordingly?), convenient for physicians and healthcare staff (being able to plan deliveries during the day, when staff is available, or around scheduled time off), or when the discomforts of pregnancy become unbearable.  If this has been the practice, then are the final weeks of pregnancy really needed?  Yes!!  As the nation has followed this trend of delivering baby according to convenience and not mother’s body or baby’s needs, we have seen dramatic increases in unplanned cesarean sections, babies born earlier than expected due to inaccurate due dates, sick newborns soon after birth, increased NICU admissions, longer hospital stays, and increased hospital readmissions soon after birth,
 
Why do the last weeks of pregnancy matter?  Babies born electively (by choice, with labor being started artificially) before 39 weeks have a much higher risk of complications than those born naturally, after 39 weeks, or due to medical complications.  During the last several weeks of pregnancy, final preparations for life outside of the uterus occur, including brain development, organ development, weight gain, and lung development.  All of these contribute to the infant breathing well at birth,  being able to fighting infection (infants born at 37 weeks or less have a 7 fold risk of getting ill), maintaining their temperature and blood sugar (because of the extra weight gain), being able to eat without difficulty, and decreasing the risk of jaundice.  New studies have shown more long term risks of premature birth including learning difficulties, increased risk of breathing problems (asthma, RSV, colds), visual and hearing impairments and an increased risk of SIDS.  Not every premature newborn has these risks, but it is important to realize there are risks to taking over for mother nature.  Those final weeks of pregnancy really are important to the baby for their immediate and long term health.

So, if it is better for the baby to finish out their full 40 weeks of development, why is it even a possibility to “choose” when to deliver?    Again, we are back to convenience and maybe a lack of knowledge.  A nationwide study showed that the majority of mothers thought their baby would be just fine if born at 32 weeks (Green, 2003).  Prematurity is defined as birth less than 37 weeks, five weeks older than the average mother believes the baby will be okay at.   Nationwide, research has shown that it may be convenient for parents, physicians, and hospitals, but not so convenient for the newborns who have to fight the first couple days of life because they really could have used a bit more time to prepare for the outside world.  There are times a baby needs to be delivered early, due to medical complications with either mother or baby.  But, when this is the situation, the baby actually does better than they normally would because the stress makes them develop more quickly.  

Now that we know babies should be born on their own terms (when labor begins or at least after 39 weeks), organizations such as March of Dimes,  ACOG (American Congress of Obstetricians and Gynecologists), and AWHONN (Association of Women’s Health, Obstetric, and Neonatal Nurses) are creating guidelines saying elective inductions (labor is started by medications or other interventions) should not be done before 39 weeks.  Cheyenne County Hospital is working to implement these guidelines into our obstetric practice, to help protect our newborns from the complications that come from being born too soon.  Giving infants their best fighting chance to get off to a good start is of much greater importance than setting convenient schedules or to eliminate mom’s discomfort in the last weeks of pregnancy.  Most times, everyone has waited the last 8 months for this baby to born, a couple weeks to give them a head start isn’t that much to sacrifice for a lifetime of benefit!

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