Trusted Information for Healthy Pregnancies
inducing labor
Birth planning leads to surprising increase in premature births
Feb 8th
The rising trend of expectant mothers being involved in every aspect of planning their births has had an unintended consequence - a rise in pre-term deliveries.
"It never would have occurred to me or anyone I knew to think you had any kind of control over when the baby would come out," said Laura Crawford, who gave birth more than a decade ago.
Crawford, producer of the Kentucky Educational Television documentary "Born too Soon," said the increasing incidence of what is called late pre-term births is among the topics explored in the film.
Prematurity rates in the nation have increased quietly over the past two decades, according to public health officials. The premature-birth rate in Kentucky is 15.2 percent, and it's rising faster than the national rate, which is 12.7 percent. Kentucky has one of the highest rates of pre-term births, trailing only Louisiana, Alabama, Mississippi and South Carolina.
Some of Kentucky's rise is related to some not-so surprising subjects, including the rate of maternal smoking (more than twice the national average), poverty and environment.
Other reasons are more surprising. They include the rise in scheduling births.
It's just within the last three or four years that the scope of the problem of late pre-term births - babies born between 34 and 36 weeks' gestation - has become apparent, said Dr. Ruth Shepherd, division director for maternal and child health in Kentucky's Department of Public Health. Roughly 10 percent of all babies born in Kentucky fall into the late pre-term category.
Ideally, she said, babies shouldn't be delivered before 39 weeks.
Often, there are legitimate reasons for early delivery, especially if the health of mother or child is at risk.
Increasingly, choices are made for reasons other than health. Delivery might be scheduled to coincide with grandparents' dates of arrival from out of town, or before Dad must ship out for Iraq.
There are several complicating factors, Crawford said. The documentary states that people tend to underestimate the impact of premature births, especially late pre-term births. They tend to overestimate how accurately a due date can be determined.
Shepherd said there can be real consequences. They can include immediate physical challenges, including underdeveloped lungs and long-term problems involving learning and behavioral disabilities, for example.
And even if a mother gets an ultrasound within the first 16 weeks - the best way to accurately determine the due date - the date can be off by two weeks either way.
Those two weeks can be crucial, she said.
"It's an issue of planning and control," she said. Planning is good. The Centers for Disease Control and Prevention recommends that mothers have a birth plan. But, Shepherd said, "you can take it too far if you don't pay attention to the science."
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Natural Delivery OK in Cases of Intrauterine Growth Restriction
Feb 5th
Waiting for natural birth is as effective as inducing labor in pregnant women with intrauterine growth restriction (IUGR), a new study shows.
IUGR, which affects about 10 percent of pregnant women, means that the fetus is much smaller than normal. At birth, these babies are more likely to have low blood sugar, an abnormally high red blood cell count and trouble maintaining their body temperature. These babies are also at increased risk for jaundice, infections and cerebral palsy.
Later in life, people who were restricted-growth babies may be more prone to behavioral disorders, obesity, heart disease, type 2 diabetes and high blood pressure.
Currently, doctors have two main approaches for women with suspected IUGR who are nearing delivery. Some doctors induce labor because they're concerned about complications, while others await natural delivery.
This study compared the effectiveness of the two strategies among 650 women in The Netherlands. The researchers found that median birth weight was significantly lower among babies born after induced labor (2,420 grams) than among those in the spontaneous delivery group (2,560 grams). Both groups of babies had similar rates of adverse post-delivery outcomes.
The findings show that waiting for birth is equally as effective as inducing labor, the researchers concluded.
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Inducing labor may lead to more C-sections
Jan 7th
Dr. J. Christopher Glantz at the University of Rochester School of Medicine found that inducing labor introduces a risk of 1 to 2 cesareans per 25 inductions that might have been avoided by waiting for spontaneous labor to begin.
While this risk to individual women is not particularly large, Glantz told Reuters Health that 1 to 2 cesareans per 25 inductions can quickly add up to tens of thousands of unnecessary cesareans over the course of millions of inductions.
While the procedures have become more common, C-sections are major surgeries, and carry risk of infection, bleeding, blood clots, and injury to other organs, Glantz emphasizes in a report in the journal Obstetrics and Gynecology.
The researcher analyzed birth certificate data for some 38,000 women from 13 hospitals in the Finger Lakes region of New York State from January 2004 to March 2008. He excluded women with scheduled or previous cesarean deliveries, or who had come to the hospital with ruptured membranes.
While previous studies have already shown that induced labor increases the risk for cesarean, Glantz examined how that risk might shift given a redefined comparison group.
He examined C-section rates after induction using three comparison groups: a week-by-week comparison of women induced to labor compared with those delivering spontaneously; women induced at a chosen week compared with women who delivered spontaneously after that week; and women induced at a chosen week compared with women who delivered spontaneously on or after that week.
In a nutshell, the study found that all labor induced groups faced increased risk for C-section, except for those women delivering after 39 weeks.
Glantz advises that pregnant women and their doctors may be better off waiting for spontaneous labor. "Try to reserve interventions for situations where risk outweighs benefit," said Glantz, such as in cases of diabetes, high blood pressure, problems with the placenta, a baby that is not growing well, or a woman being 10 days past her due date.
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Pregnant Women Unaware of How Long Pregnancy Should Last
Nov 20th
Recent reports show that the rate of preterm deliveries continues to climb in the United States. Now, a new study suggests one reason why: Many women are confused about what constitutes a full-term birth in the first place.
About one-quarter of new mothers surveyed in the study considered a baby born at 34 to 36 weeks of gestation to be full term, while slightly more than half of women considered 37 to 38 weeks full term.
Though technically speaking, preterm births are babies born prior to 37 weeks, 39 to 40 weeks is optimal, according to the researchers.
Many women interviewed were also unaware that babies born even a little bit premature are at a higher risk of serious health problems compared to babies born at term, the new survey shows.
Misconceptions about what constitutes full gestation and how soon it's safe to schedule an elective induction or cesarean delivery are contributing to increasing numbers of premature births in the United States, said lead study author Dr. Robert L. Goldenberg, professor of obstetrics and director of research at Drexel University College of Medicine in Philadelphia.
The study, which included 650 first-time mothers ages 21 to 45 from around the nation who had health insurance, is in the December issue of Obstetrics & Gynecology.
When asked, "What is the earliest point in pregnancy that it is safe to deliver the baby, should there not be other medical complications requiring early delivery?", more than half chose 34 to 36 weeks, 41 percent chose 37 to 38 weeks and less than 8 percent chose 39 to 40 weeks.
However, experts warn that any delivery short of 39 weeks puts a baby at higher risk of respiratory distress, sepsis (blood infection) and needing to be placed in the neonatal intensive care unit, according to background information in the study. Only one-quarter of new moms realized 39 to 40 weeks was safest.
Technically, the World Health Organization and other major medical organizations define preterm births as babies born before 37 weeks. But that definition was developed some 50 years ago and is outdated, said Dr. Alan Fleischman, medical director for the March of Dimes.
More recently, studies have shown that babies born even a bit too early -- at 37 or 38 weeks -- have a greater chance of chronic respiratory disease and learning disorders than children born at 39 weeks or later.
Babies born between 34 and 37 weeks are six times more likely to die during their first week or life and three times more likely to die during their first year than babies born at 39 or 40 weeks, Fleishman added.
In many situations, there is probably some medical reason for choosing to deliver early -- perhaps the mother has slightly elevated blood pressure, for example, Goldenberg said.
"I call them semi-electives," Goldenberg said. "I believe over the last 15 or 20 years, the practice is evolving to deliver those babies earlier and earlier when there is no evidence of benefits."
TV shows and news reports about very premature babies that survive may also be fueling misconceptions, Goldenberg said. Some women are left with the impression that if babies born before 30 weeks can survive, infants that are just a little bit premature should have no problems.
The last few weeks of gestation are critical to fetal development. All of the organs continue to mature in preparation for moving from the womb to the outside world, Fleischman explained. Between 35 and 40 weeks, the fetal brain grows by about 50 percent.
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