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The last few weeks of a woman’s pregnancy can be uncomfortable, exhausting, and filled with anxious feelings. It’s tempting for many women (and their doctors) to see an induction or cesarean surgery “just a little” before the due date as a welcome relief. However, a growing amount of research is showing that giving a baby those last few weeks of gestation can be critical to having a healthy baby.
“Born a Bit Too Early – Recent Trends in Late Pre-Term Births,”[1] a new report from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics documents the growing prevalence of “late pre-term” births, pointing to a 20 percent increase in late pre-term births from 1990 to 2006. A key finding from the report suggests the increase in induction rates is influencing the dramatic rise in pre-term births.
“Late pre-term” typically describes babies born between 34 and 37 weeks[2], though studies have also shown babies can have difficulties when they are delivered in the 37th and 38th weeks:
• A 2007 study showed that babies born between 34 and 37 weeks were six times more likely to die during the first week of birth than babies born full-term [3]
• Another 2007 study showed late pre-term babies were at increased risk of learning and behavioral problems [4]
• A 2009 study showed babies born at 37 weeks were four times more likely to have serious breathing problems or be admitted to the newborn intensive care unit (NICU) and that babies born at 38 weeks had twice the risk of these health problems as babies born at 39 weeks [5]
“Research shows that a baby’s brain is only two thirds developed by the 35th week of pregnancy [6],” said Debra Bingham, DrPH, RN, LCCE, and president-elect of the board of directors for Lamaze International. “When babies are deprived of those critical last few weeks of pregnancy, it can have lifelong consequences for the child and the family.”
To support women in their efforts to have safe and healthy births, Lamaze advocates for mothers and their health care providers to allow labor to start on its own, in the absence of a clear medical problem. In a healthy mother, spontaneous labor is the most accurate sign that the baby is mature and ready for life outside the womb, and letting labor start on its own is one of Lamaze’s six steps to a healthy and safe birth.
“While we don’t suspect many physicians are delivering babies at 35 or 36 weeks for convenience, non-medical reasons can drive a lot of deliveries at 37, 38, or 39 weeks. These early deliveries can come with a price,” said Sharon Dalrymple, RN, BN, MEd, LCCE, and president of Lamaze International. “The problem is compounded when women and their care providers pre-empt spontaneous labor and rely on due-dates that are often inaccurate.”
Pregnancy usually lasts anywhere between 38 and 42 weeks. This month-long window range is often replaced in a physician’s chart and in a mother’s expectations by a single date on the calendar, marking the estimated 40th week.
The process of generating a due date relies on sometimes faulty memories of mothers about their cycle, and assumes all women’s cycles are the same length. Research shows that women’s cycles can vary widely, and these variances can profoundly impact when a baby will be mature enough to be born.
“Even with the more accurate dating methods of early sonograms, which can still be wrong by plus or minus one to five days, the concept of a specific due date for women has got to go,” said Dalrymple. “A due-window is a more accurate and useful term for women and for any physician supporting a woman’s normal body processes, and working to achieve safe and healthy birth.”
Problems can arise when a baby is forced to be born “a little bit early” in a mother with an inaccurate due date. “For women being delivered at 38 or 39 weeks, it may actually be 36 or 37 weeks if they have an inaccurate due date. If you add to that a baby who would have rather gestated to 41 or 42 weeks, you are suddenly talking about taking a very early baby who was simply not ready to be born,” said Bingham.
Women can play a key part in driving down avoidable prematurity. “Just say no,” said Dalrymple. “It may sound oversimplified, but saying no to any induction or cesarean that doesn’t have an urgent and compelling medical reason behind it is a good way to protect your baby from being born too early.”
Even with mature babies who are ready to be born, induction and cesarean can still cause problems. Research shows that induction can results in various complications, including increased need for resuscitation for newborns, increased risk of admission to neonatal intensive care unit (NICU), and increased need for treatment of jaundice. Cesarean can result in respiratory trouble for babies, increased risk of allergies or asthma, and failure to breastfeed; for mothers, cesarean increases the risk of death, blood clots, infection, uncontrolled bleeding, and chronic pain. [7]
About Lamaze International
Lamaze International (lamaze.org) promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting practices. Knowing that pregnancy and childbirth can be demanding on a woman’s body and mind, Lamaze serves as a resource for information about what to expect and what choices are available during the childbearing years. Lamaze education and practices are based on the best, most current medical evidence available. Working closely with their families, health care providers and Lamaze educators, millions of pregnant women have achieved their desired childbirth outcomes using Lamaze practices.
1. cdc.gov/nchs/data/databriefs/db24.pdf.
2. Engle, W.A., et al, and the Committee on Fetus and Newborn. “Late-Preterm” Infants: A Population at Risk. Pediatrics, Volume 120, Number 6, December 2007, Pages 1390-1401.
3. Tomashek, K., et al. Differences in Mortality Between Late-Preterm and Term Singleton Infants in the United States. Journal of Pediatrics, Volume 15, November 2007, pages 450-456.
4. Engle, W.A., et al, and the Committee on Fetus and Newborn. “Late-Preterm” Infants: A Population at Risk. Pediatrics, Volume 120, Number 6, December 2007, Pages 1390-1401.
5. Tita, A., et al., The Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network, Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes N Engl J Med 2009 360: 111-120
6. Engle, W.A., et al, and the Committee on Fetus and Newborn. “Late-Preterm” Infants: A Population at Risk. Pediatrics, Volume 120, Number 6, December 2007, Pages 1390-1401.
7. Goer H, et al. The Coalition For Improving Maternity Services: Evidence Basis For The Ten Steps Of Mother-Friendly Care, Journal of Perinatal Education, Winter 2007, Volume 16, Number 1.
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