The Risks of Elective Early Delivery

According to the CDC, the average age of gestation at birth has dropped by 7 days in the last two decades.¹ While increasing numbers of multiple births (due to fertility treatments) and other factors play a part, the practice of induction or surgical delivery with no medical indication has a significant role in this drop.

Although 37 weeks is considered "term," and it may seem convenient to deliver early and get relief from the symptoms and discomforts of late pregnancy, there are risks. The ACOG has been trying to educate both doctors and patients about these risks. A newsletter article published in February of 2010 describes the problem: " We were alerted by our neonatologists that they were seeing term babies on ventilators. When we investigated this further, we found that these babies were being delivered primarily between 36 and 38 weeks, and, for the most part, there were no medical or obstetric indications for the deliveries. Overall, we found that 28% of elective deliveries were being performed before 39 weeks. We knew we had to do something." ² The article goes on to explain that the risk of respiratory distress increases greatly with each week before 39 weeks, and that waiting for spontaneous labor, or at least waiting a full 39 weeks has no negative medical repercussions in normal, low-risk situations.

This would seem to be a fairly logical conclusion. Human beings develop at slightly different rates in each stage of development, and pregnancy is no exception. Just as there is a "range of normal" rather than a set date for things like teething, crawling, walking, losing baby teeth, puberty, and menopause, there is a "range of normal" (37 through 41 weeks) when babies reach the physical maturity they need to cope well with life outside the womb. Some babies will do just fine delivered at 37 weeks (and this is more likely to be the case when there is a healthy baby and healthy mother involved, and when the start of labor is spontaneous). Other babies, however, need just a little more time in the womb to allow their lungs to develop fully. While it may seem like an eternity to a heavily pregnant woman, 3-4 weeks is a relatively short time to suffer through, especially given the potential risk vs. benefit trade off that happens with induced delivery before 39 weeks.

There are absolutely times when early delivery is necessary. Certain conditions make the womb inhospitable for a baby to continue growing and thriving, and necessitate immediate delivery to give the baby the best chance at survival possible. In that case a high risk is traded for a slightly lower risk. However, when there is no medical reason for an early delivery, a low risk is traded for a much higher and completely unnecessary risk. Decreased respiratory function, or outright respiratory distress in a newborn is nothing to fool around with. It is a major health risk.³

Known for raising awareness about prematurity and birth defects, the March of Dimes organization is also campaigning to end the practice of elective births before 39 weeks. Their list of reasons to make every effort to let pregnancy continue to at least 39 weeks includes: the importance of giving vital organs (lungs, brain, liver, etc) every opportunity to fully develop, better chances to have good vision and hearing, increased chance of a healthy birth weight, and delivering a baby that is more alert and thus able to feed well.⁴

Given the risks, and the very strong statements from the ACOG and March of Dimes (among others) about the detriments of elective early birth, women considering elective induction or c-section before 39 weeks gestation should carefully consider whether the perceived benefits truly outweigh the risks. Wanting to be relieved of the discomforts of late pregnancy, a desire to "meet" your baby and get on with life as a mother, desiring the convenience of a planned delivery, all are normal feelings and not inherently bad. But having to wait a few more weeks cannot compare to the real medical risk of early delivery. Tolerating the unpleasantness of those last few weeks gives your baby the tremendous gift of full physical development and the best chance at a healthy start in life.

¹As early elective births increase, so do health risks for mother and child, Nathanael Johnson, California Watch
²ACOG Fellow leads charge to decrease elective inductions, John P. McHugh, MD, ACOG
³Neonatal respiratory distress syndrome, staff, MedLine Plus
⁴Why the last weeks of pregnancy count, staff, March of Dimes