Worth the wait | by Debra Melani

Posted on Tue, Jun 4, 2013

Babies born before 39 weeks can face problems

Dr. Kristen Garcia has heard it all: Grandma’s coming to town. Dad’s going on a business trip. I really need the tax write-off. Although pleas for early deliveries are a common part of office visits, mostly from women simply tired of being pregnant, no amount of begging will sway the obstetrician.

“Although I can sympathize with them, I don’t do elective deliveries before 39 weeks unless there’s a maternal or fetal complication,” says Garcia, an OB/GYN with North Suburban Medical Center. The reason: The repercussions for baby can be severe, from urgent respiratory problems because of immature lungs, to long-term learning troubles because of underdeveloped brains.

Dubbed “designer births” or “social deliveries,” these elective births were once more common, when doctors thought, and literature claimed, vital fetal development was complete by week 37. Sometimes doctors would even schedule births for their own convenience, or to fulfill a promise of personally delivering a patient’s baby.

Dr. Jeff Hanson, a Neonatal Intensive Care (NICU) specialist at Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s Medical Center, remembers the days of “designer” births too well. “The baby would be immature and end up in the intensive care nursery and requiring support with a mechanical ventilator. Not only is it expensive, but there are risks,” says Hanson, adding that those who deal with babies fighting for their lives every day have no tolerance for the issue. “Don’t fool with Mother Nature. There’s nothing better than the human uterus for a fetal-growth environment.”

And now doctors know waiting until 39 weeks can make the difference between a happy, normal homecoming and a stressful hospital stay, prompting polices rejecting early elective births, including at HealthONE, and a large-scale educational campaign by the March of Dimes.

“We hate to see babies that are separated from their parents,” says Dr. Joe Toney, NICU director at Sky Ridge Medical Center, who emphasizes that not all babies born at 37 to 38 weeks will need support. Natural labor at 37 weeks or labor induced because of medical issues are appropriate reasons for early deliveries, he says. “There are many medical reasons to induce labor. And babies who go into labor naturally are responding to hormonal cues and have fewer respiratory problems.”

One reason, which doctors only recently learned: When the birthing process starts, the fluid in the lungs begins being reabsorbed into the baby’s body, with about 30 percent reabsorbed before the onset of labor, another 30 percent reabsorbed during labor, and the remainder absorbed after labor. “So when the normal process is interfered with, more respiratory problems can occur,” Toney says.

“When you look at 4 million babies being delivered in the United States per year, births between 37 and 38 weeks account for tens of thousands of babies needing oxygen for a period of time and almost 3,000 babies a year requiring a ventilator,” Toney says. “And there’s a slight increased risk in even mortality. Some of these babies can have respiratory failure and unfortunately die. The risk is small, but if it happens once, that’s once too many times.”

Other risks of early induction: Sometimes due dates are wrong, and a mom who thinks she’s 37 weeks has not reached that mark yet, further increasing the chance of complications. An induction also might not work, leading to a C-section because labor was falsely started, a procedure that, in itself, carries higher risks, Toney says.

Long-term issues, from a NICU separation leading to unsuccessful breastfeeding attempts, to a child’s not excelling in school, are also both real concerns, Toney says. A study published in Pediatrics found lower reading and math scores for children who were born between 37 and 39 compared with those who were past 39 weeks (Pediatrics, Vol. 130, No. 2, Aug. 1, 2012).

A fetus’s brain at 35 weeks weighs only two-thirds of what it weights at 39 to 40 weeks, the March of Dimes points out. Parents often ask Toney when brains stop developing. “And I say: When you die. Even a full-term baby’s brain hasn’t finished developing, or we’d all come out walking and talking.”

Once she explains the issue to parents, Garcia says, there’s seldom an argument. “Most moms want what’s best for their baby.” The Colorado Hospital Association has set a goal of reducing the state rate for “elective” deliveries prior to 39 weeks to no more than 4 percent by the end of the year. The rate was about 7.4 percent in January. Hanson says, the lower the better, adding that he would never recommend an elective 37-week birth to his own family member. “At that point, it really isn’t about you. It’s about your baby.”

Taking care of Mom during pregnancy can mean the difference between a full-term and pre-term birth. Here are some factors, shared by Dr. Kristen Garcia of North Suburban Medical Center, that can lead to early births:

• Low maternal birth weight

• Smoking and substance abuse

• Short interval between pregnancies

• Uncontrolled diabetes

• Uncontrolled high blood pressure

• Poor prenatal care

 

 

Tags: 39 weeks, a Neonatal Intensive Care (NICU) specialist at Rocky Mountain Hospital for Children at Presbyterian/St. Luke’s Medical Center, Denver, Dr. Jeff Hanson, Dr. Joe Toney, Dr. Kristen Garcia, full term, healthy pregnancy, NICU director at Sky Ridge Medical Center, pregnancy, Women's Health Group