Worth The Wait: Curbing The Practice Of Deliveries Before 39 Weeks

Waiting. In our daily lives, we greet it with frustration, and even irritation. But when it comes to childbirth, the time we spend waiting can affect whether a child is born healthy, or not, and sets a baby on a path toward lifelong health.

The U.S. Department of Health and Human Services (HHS) recently launched an important initiative, Strong Start, to prevent premature births, a public health problem that costs society an estimated $26 billion a year. That initiative aims to improve prenatal care for pregnant women, but its focus is also on curbing the unsafe practice of scheduling elective, medically unnecessary deliveries before the 39 week mark.

That's an important step, but more must be done to reduce the threat posed by elective deliveries of healthy babies before 39 weeks, which often are scheduled for reasons that have more to do with convenience than with health.

More than half a million infants are born prematurely in the United States each year, a number that has increased 36 percent since the early 1980s. We also know that 25 percent of those births are due to early elective deliveries -- either by inducing labor early, or by scheduling a cesarean section.

That's a dangerous trend that continues, despite a growing body of scientific studies that indicate that babies born before the 39 week mark run a high risk of underdeveloped organs, infections and other health problems that can lead to disabling conditions that can last a lifetime.

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Too Many C-Sections: Docs Rethink Induced Labor

The rise in cesarean-section deliveries in recent years has been characterized by some as a key indication of the overmedicalization of childbirth. While the procedure undoubtedly saves lives and leads to better health outcomes for mothers and infants who face problems during pregnancy and labor, many experts say the procedure is being performed too often, and in many cases for nonmedical reasons, putting healthy women and babies at undue risk of complications of major surgery.

The rate of C-sections has reached more than 31% in the U.S., a historical high, according to 2007 data from the American College of Obstetricians and Gynecologists (ACOG). The reasons for the increase are many and have been widely discussed: the rising rate of multiple births, more obesity in pregnant women, the older age of women giving birth. In fact, C-sections have become so common that many women may have an inflated sense of safety about them. "For the most part, moms and babies go through the process healthy and come out healthy, so maybe there's this sense that we're invincible," says Dr. Caroline Signore of the Eunice Kennedy Shriver National Institute for Child Health and Human Development. (See pictures of pregnant-belly art.)

But C-section carries all the attendant risks of major surgery; and data show that compared with vaginal birth, cesarean delivery increases the odds that a mother will end up back in the hospital after birth with complications such as bleeding or blood clots.

Now obstetrics experts are actively seeking ways to drive down the number of C-sections. On July 21, the ACOG issued new guidelines recommending that hospitals allow most mothers who desire vaginal birth after cesarean, or VBAC, to attempt a trial of labor, including some mothers who are carrying twins or have had two prior C-sections. Despite studies showing VBAC to be safe for most women — ACOG data suggests that 60% to 80% of women who attempt VBAC will succeed — many hospitals have urged women to undergo a repeat cesarean over the past decade, largely to avoid medical risks and malpractice suits. (Read how postpartum depression can strike fathers.)

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