Paul M. D'Amore
39 Week Induction
Midwives and gynecologists have been educating mothers with low-risk pregnancies for decades that keeping baby in the womb for 40 weeks or more is the most beneficial for health and development. But now, new research examining inductions of 39-week old babies is questioning whether the 40-week recommendation is actually the safest for mom and baby.
Inducing Labor at 39 Weeks Could be Safer
Last week, research released by Northwestern University in the New England Journal of Medicine (NEJM) suggested that inducing labor at 39 weeks during pregnancy may be safer than allowing mothers to go to 40 weeks or more waiting for labor to begin naturally. The study examined a total of 6106 pregnancies across 41 sites in the country, separating them into two groups:
- Labor Induction: 3062 women were assigned to this group and given elective induction one week prior to their due dates (39 weeks pregnant).
- Expectant Management: 3044 women were assigned to this group and allowed to let labor begin naturally, even if exceeding 40 weeks.
The results of the study showed that women in the elective induction group had more favorable outcomes in the following categories:
- Fewer cesarean births
- Lower rates of maternal and fetal complications
- Fewer newborns needing respiratory support
- Reduced incidents of preeclampsia after birth
High blood pressure in the elective induction group, a condition causing serious harm to mothers during delivery, was also significantly lower: rates in the induction group were 9% compared to 14% in the expectant management group.
What is perhaps the most shocking finding in this study is the majority of the benefits experienced by the induction group were linked to one factor: a higher number of vaginal births. Inducing at 39 weeks itself did not contribute to less adverse effects on mother and baby, but avoiding the need for a cesarean showed significant health benefits compared to the expectant management group which had a higher c-section rate with more complications.
The Risks of Cesareans
Cesarean births save the lives of many mothers and babies every year, but this method is still a major surgical procedure carrying the risk of several possible complications. For mothers with high-risk pregnancies, the risks of c-sections can outweigh the risks of a vaginal birth. For low-risk pregnancies, however, this birthing procedure could be far riskier.
Mayo Clinic identifies multiple health risks connected to c-section births for both mother and baby in low-risk pregnancies:
- Breathing issues (tachypnea- a breathing issue characterized by fast breathing)
- Injury from the incision (accidental nicks to baby’s skin)
- Death (extreme cases)
- Infections (lining of the uterus, also known as endometritis, or wound from the incision)
- Hemorrhaging (postpartum heavy bleeding during and after the procedure)
- Negative reactions to anesthesia
- Blood clots (inside deep vein, legs, pelvic organs, lungs, can be life-threatening)
- Surgical injury (damage to bladder, bowel, or other surrounding organs)
- Future pregnancy complications (higher risks of placenta previa, uterus tearing)
- Death (extreme cases)
An article published by LiveScience also highlighted that c-section mothers are at a higher risk of developing post-infections from hospitals due to longer recoveries and early breastfeeding issues leading to stress, anxiety, failure to thrive, and the possibility of increased postpartum depression.
Most Common Reasons for C-sections
At least one in three women in the United States deliver by means of cesarean births every year, labeling c-sections as the most common operating room procedure in the country. Mayo Clinic identifies several reasons why women or doctors would opt for a c-section birth as opposed to a vaginal delivery, including:
- Slow progressing labor (cervix is not opening).
- Baby showing signs of distress.
- Abnormal position of baby (breech or transverse).
- Multiples in pregnancy.
- Placenta issues.
- Prolapsed umbilical cord.
- Health concerns that could be passed during vaginal delivery.
- Mechanical obstruction.
- Previous c-section.
Sadly, these are not the only reasons why physicians are encouraging women to choose a c-section delivery over a vaginal birth, especially when it comes to doctors in the United States. Every day, American health professionals are suggesting medically unnecessary cesarean deliveries for low-risk pregnancies and putting these women at a higher risk for complications during and after birth- but why?
C-Sections Rates Rising in America
In an article by Childbirth Connection titled Why is the U.S. Cesarean Section Rate so High, researchers state that health professionals and journalists are often found blaming the mothers for the increase in cesarean deliveries across the country when in very few circumstances are they being given a choice. Some of the most popular myths for why American women are getting more c-sections include:
- More women are asking for c-sections without the medical need.
- The number of women who require c-sections for safer deliveries is increasing.
- Liability on health professionals is driving up the rate of c-section deliveries.
Despite the myths, the Childbirth Connection found these as the leading factors contributing to the increasing rate of c-sections in the United States:
- Low priority to encourage women to give birth vaginally: A number of c-sections are being performed because of non-medically necessary reasons: baby is too big, woman is too small, baby is not positioned correctly. Instead of providing women with the care and knowledge that would encourage vaginal births, c-sections are being performed as an alternative.
- Negative side effects of common labor interventions: Many of the medical interventions and medications that our mothers are being offered to make vaginal labor more comfortable are actually making vaginal births harder and raising the risks of c-sections. Epidurals, for instance, are encouraged to help mothers push through the pain but can result in fetal distress or even delayed dilations, requiring further interventions that eventually could result in a c-section.
- Refusing to offer the choice: Some women are being offered c-sections and do not realize they have a choice not to have the procedure. Due to lack of information or lack of confirmed choice by their health professionals when it comes to their birth options, women are missing out on the opportunity for vaginal births and increasing their risks for complications.
- Normalizing major surgeries: Just because c-sections are performed every day, does not mean they don’t come with risks. Health professionals are talking too casually about c-sections, making the risks on the consent forms sound far less likely to occur and making the procedure appear to have low health risks.
- Financial stress: Health professionals may be suggesting more c-sections as a result of feeling financial pressures by institutions due to the tightened payments for services and increasing practice expenses.
- Work-life balance for professionals: It sounds terrible to say, but vaginal births are not as convenient for health professionals as c-sections. Where cesareans can be scheduled during the day with a predictable time from start to finish, vaginal births can occur at any time and last for hours depending on each patient. Scheduling c-sections allows physicians more of a work-life balance with the option for predictability than having to stay on-call for vaginal deliveries.
- Women trust in their maternity care: Most women trust their maternity professionals. They are not only putting their own lives in their hands but the lives of their unborn children. A national survey called Listening to Mothers found that most women have little awareness when it comes to the side effects or outcomes of interventions proposed by their maternity health professionals- they trust them so they do not feel the need to ask questions.
Fighting Back For Mothers
Expecting mothers deserve far better than convenient procedures and incomplete education when it comes to labor and delivery. Mothers should be given all options for their pregnancies upfront with adequate time and support to make an informed decision about their birth plan. Encouraging mothers to avoid a difficult vaginal birth that is actually safer for them is not a path maternity care professionals should be promoting, especially when it puts the lives of mothers and babies at an unnecessary risk.
D’Amore Law is committed to fighting back for mothers when it comes to attaining the best quality health care available. If you or a loved one has sustained an injury or illnesses due to medical negligence by a provider, our knowledgeable medical malpractice team is here to help. Schedule a free consultation with our winning attorneys to see what options are available for justice in your case.