Unnecessary early delivery
Back in 2012 I published an article entitled “The C- Section Epidemic.” One of the ways I suggested to reduce the number of C-sections was to avoid the unnecessary inductions of first-time mothers prior to 41 completed weeks of gestation. I suggested that induction be avoided till 39 weeks in women with at least one prior vaginal birth and a ripe cervix. Within the text of the article I mentioned that “The LeapFrog Group National Quality Forum and the Institute for Healthcare Improvement, have made it a priority to reduce the early (prior to 39 weeks) elective delivery rate.” I am now very happy to report that because of this national initiative, there has been a great improvement in reducing unnecessary, and often harmful early elective inductions. Many women were asking their physicians to deliver them prior to 39 weeks for inappropriate indications such as a mother or other relative coming into town, work release, or just plain being tired of being pregnant. I understand how difficult it may be at times to go all the way to your due date, but many of these early babies ended up in the Neonatal Intensive Care Unit without a good reason.
However, because of this initiative, between 2010 and 2014 the early elective delivery rate nationally fell by a whopping 14 percent. The actual numbers were 17 percent in 2010 and that decreased to just 3 percent in 2014. This so called LeapFrog or 39 week hard stop rule has transformed into fewer NICU admissions and shorter hospital stays for these so called “near-term elective deliveries.” I remember very clearly one woman who was just tired of having to be pregnant and wanted an early 37 week delivery. I refused but another physician agreed to induce her after an early amniocentesis for Fetal Lung Maturity. Despite having a “mature amnio” this woman delivered and her baby subsequently ended up being unnecessarily in the hospital nursery for nearly 2 weeks! She later apologized to me for not trusting my wisdom and caution. Unfortunately, there are still certain physicians and hospitals that are not in compliance with this “39 week hard stop” rule. If your physician wants to deliver your baby prior to 39 weeks, be sure to question him or her as to why. There are indeed many legitimate indications for early delivery, but in reality they are quite limited. Certain medical conditions such as poorly controlled diabetes mellitus, poorly controlled hypertension, preeclampsia, or Intrauterine Growth Restriction are just a few examples. Even these conditions need to be carefully weighed against the potential harms of prematurity. Not only is prematurity the main reason for fetal death, but often leads to other complications such as Intraventricular brain hemorrhage and NEC, or Necrotizing Enterocolitis. The best place for your baby till your due date is typically your womb!
If you do happen to have one of the above mentioned or other medical or fetal conditions, your doctor may suggest increased surveillance of your unborn baby by utilizing antenatal testing. The most common of these tests to evaluate the wellbeing of your baby is the so called NST or Non-Stress Test. This test is simply monitoring the baby’s heartbeat for 20-30 minutes. If the baby does not have appropriate accelerations in the heart rate, then an additional test called a Bio-Physical Profile or BPP may be ordered. This test is simply adding direct ultrasound observation to the already performed NST. Despite these tests, the best and least expensive monitor of all is your own perceptions of fetal movements. I frequently tell my patients that “an active baby is a healthy baby.” That dictum could go for the mother too, that is, “an active mother is a healthy mother.”
Often we hear only of the negative, but it is good to note that the LeapFrog initiative has actually done much good for both mothers and especially for their unborn children. Patience truly is a virtue. Along with the “patience theme,” are the new recommendations that the second stage of labor may now be safely extended by an hour without necessitating surgical intervention.
In summary, if your healthcare provider wants to induce you prior to 39 weeks of gestational age, be sure to question if is absolutely necessary in order to prevent potential harm to an infant delivered too early. You may even consider getting a second opinion if you are not comfortable with his/her explanation. For more information on this or other obstetrical or gynecological questions contact Dr. Saunders at 801-692-1429.
-Mark T. Saunders M.D. FACOG