Does early elective birth impact fetal development? Kristen Oganowski — doula, blogger, aspiring childbirth educator, PhD candidate and mother of two — weighs the risks associated with early induction.
As women near the end of their pregnancies, many encounter an onslaught of questions and comments from friends, family members, and even their care providers about when their babies will be born:
“So, when are you going to induce?!”
“Do you have your c-section scheduled yet?”
“Since 37 weeks is ‘full term,’ why don’t you just schedule and induction already?”
“Babies really only gain weight during the last few weeks of pregnancy, so we can schedule your induction or cesarean section as soon as you’re technically full term!”
But as casually as people discuss scheduled birth in everyday conversation, current research shows that the topic might deserve a bit more seriousness after all. In fact, the topic of early elective birth has been buzzing throughout the world of maternity care advocacy lately.
Early elective births are scheduled cesarean sections or inductions of labor that occur prior to 39 weeks and without medical indication. And while many care providers and moms choose to schedule birth before the 39th week of pregnancy, one message has become increasingly clear in recent years:
Because of the risks associated with early elective induction, women and their care providers should avoid scheduling elective inductions or cesarean sections before 39 weeks.
Research shows that when babies’ births are scheduled before 39 weeks, they are at an increased risk for respiratory problems, NICU admission, and even neonatal and infant death. These risks are serious, and they have even prompted various hospitals in the United States either or to require onerous paperwork in the event of an early scheduled birth or to prohibit early elective births altogether in order to minimize these risks.
Acknowledging both the seriousness of these risks and the fact that the induction and cesarean rates have been growing with alarming frequency over the past two decades, The Leapfrog Group (a hospital quality watchdog group) recently released the results of a survey documenting the rates of early elective births at hospitals across the United States. Setting a target rate of 12%, the Leapfrog Group found that the hospitals’ rates varied from nearly 0% to well over 50%. Notably, the wide variations in these rates even occurred in hospitals within the same city or region.
On the one hand, these results (which hospitals offered voluntarily) demonstrate just how crucial it is for women to know not only their own care provider’s induction and cesarean rates but also the rates and patterns of early elective birth at the location where they will give birth. On the other hand, they also demonstrate just how important it is for women to know why they should think twice about scheduling their babies’ births before 39 weeks. Avoiding early elective birth isn’t about trying to make busy families’ lives more inconvenient—it is about protecting their new babies from the harms of scheduling their births too early!
This doesn’t mean that inductions and cesarean sections should never happen before 39 weeks. When scheduling birth is medically indicated—when a mother and/or her baby’s health would be compromised by continuing pregnancy—then the benefits of an early birth certainly outweigh the risks. To this effect, Childbirth Connection has published a resource on labor induction that outlines the instances in which the evidence does support induction of labor as a way to improve outcomes for mothers and/or babies. This resource also defines the circumstances in which research is either inconclusive regarding the effects of labor induction or clear about the ineffectiveness or even harm of induction.
But without a medical indication for an early scheduled birth, there is the chance that a baby will miss out on the important fetal development that occurs up to and perhaps even beyond the 39th week of pregnancy. This information is especially significant considering that many women are told erroneously by others (including some care providers) that babies “only gain weight” during the last weeks of pregnancy.
As a final note, it is also important to remember that unless an induction or planned cesarean is medically indicated, there are benefits to waiting for labor to begin on its own—even after the 39 week mark. Induction and cesarean section at any time carry risks and thus should not be taken lightly by mothers or by care providers. For unless otherwise indicated, waiting for labor to begin spontaneously is healthy for mothers, and it’s healthy for babies too!
Kristen Oganowski, CD(DONA) changed career paths from academic philosophy to maternity care advocacy after being utterly awed and inspired by the births of her two children: one born via cesarean, one born via VBAC. Now she is a doula, blogger, aspiring childbirth educator, PhD candidate and mother of two in Columbus, Ohio. You can find her speaking up for healthy pregnancy and birth on Twitter (@BirthingKristen), on Facebook, and on her blog, Birthing Beautiful Ideas