Recent years have seen a dramatically increasing number of women giving birth early. Experts are now saying that these early births pose new health risks to both mothers and newborns.
So significant is this increase that the average time of fetus gestation has been reduced by seven days in the United States since 1992, according to researchers and data from the Centers for Disease Control and Prevention. This trend is being called an evolutionarily dramatic event.
Researchers say that the increasing number of women and doctors now scheduling childbirth for convenience parallels the shortening pregnancies. A 2007 study of nearly 18,000 births showed that almost 10 percent were early births due to scheduled inductions or C-sections for non-medical reasons.
Shorter pregnancies can affect a babys lung development, vision, weight, and some fine-tuning of the brain, according to doctors.
For every day and every week before 39 weeks, it’s an increasing risk to the baby, said Dr. Bryan Oshiro, vice chairman of obstetrics and gynecology at Loma Linda University. The vast majority of early term babies do fine, but it’s like playing Russian roulette.
The California Maternal Quality Care Collaborative, a task force of medical researchers, has recently focused inattention on how many babies are delivered for non-medical reasons before they would arrive naturally. Until now it has been an issue confined to articles in medical journals and among maternal health professionals.
A normal pregnancy length is 40 weeks, and induced delivery at a full 39 weeks is thought probably safe. Women often naturally give birth earlier than this, and in some cases, medical problems require an early delivery. Problems arise when babies are delivered before they are ready.
According to national vital statistics, between 1990 and 2006, the number of babies born at 36 weeks increased around 30 percent, and babies born at 37 and 38 weeks rose more than 40 percent, At the same time a corresponding drop in the number of babies born in later weeks is seen in the data. There are now more babies born at 39 weeks than at full term. The data examined is considered ‘fresh’ by academic standards and covers such a long period of time (16 years) that experts say the trend is unmistakable. Lack of knowledge among both doctors and patients seems responsible for this trend.
Babies born early through induction or C-section without a medical reason are nearly twice as likely to spend time in the neonatal intensive care unit, researchers say. They also are more likely to contract infections and need the assistance of breathing machines, according to a 2009 study in the New England Journal of Medicine and a number of other reports.
Many organizations are responding with programs designed to eliminate early elective deliveries. Most significantly, chapters of the American Congress of Obstetricians and Gynecologists have begun to notify doctors about the serious consequences of performing early elective births.
In California, the state Department of Public Health, March of Dimes and California Maternal Quality Care Collaborative have released what its authors call the Toolkit, which recommends that, unless medically necessary, c-sections and artificial induction of labor before full gestation should be eliminated.
The state chapter of the American Congress of Obstetricians and Gynecologists is also supporting this recommendation. To support this they are holding teaching sessions and reaching out to obstetrics leaders at every hospital in the state. At the same time, doctors groups are initiating the toolkits guidelines in New York, Florida, Illinois and Texas.
Part of the problem has to do with education, said Kowalewski, one of the authors of the Toolkit. Because we learn that human gestation lasts nine months, many people think that 36 weeks is full term. It’s a misconception even within the March of Dimes, which has worked for years to teach people about infants born too early.
While there is evidence that some women seek early delivery before week 39, there is also significant evidence that doctors are driving some of the rise in earlier births. In 1979, the American Congress of Obstetricians and Gynecologists began advising doctors not to do elective inductions before 39 weeks gestation, but early elective deliveries have continued to rise, except in the places where there is a system to hold doctors accountable.
It’s easy for doctors to get the impression that delivery a few days early doesn’t matter, because complications occur so infrequently, You need to look at the entire population to see the cumulative risk said Bingham, one of the Toolkits authors.
It isn’t uncommon for women to be told that they need a cesarean delivery because their baby is “too big”. Research however, is now finding that some of the medical justifications for early delivery actually don’t help. The authors of the Toolkit point out that numerous studies show that babies induced early to limit their growth are actually more likely to get stuck in the birth canal and need a C-section.
Is this the beginning of a shift in attitudes to child birth in medical practice, that will possibly see a reversal in the dramatic increases in c-sections and other medical interventions in childbirth. We hope so and would love to know our thoughts and experiences.
photo cortesy of Tammra McCauley