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I found the following story on the NPR iPhone App:
http://www.npr.org/2011/07/18/138473097/doctors-to-pregnant-wom
Doctors To Pregnant Women: Wait At Least 39 Weeks
by Gretchen Cuda Kroen
- (null)
In her living room, Caroline Nagy introduces the newest member of her family
— the 6-week-old infant in a striped onesie cradled in her arms. "This is
Alex Joseph. He was born May 24th — my birthday," she says.
Their shared birthday wasn't entirely a coincidence. Two weeks before her
due date, Nagy was swollen, and uncomfortable. So she asked her doctor for
relief.
"I was just miserable. It was like uncomfortable to walk; I couldn't sit on
the floor and play; I felt like I was neglecting my first kid because I just
couldn't move and I couldn't do anything," says Nagy. "So I asked, 'Is
there any way I can speed this up and have a baby earlier?' "
For Jackie McGinty, it wasn't discomfort but timing that caused her to
schedule her daughter's birth by C-section eight years ago. McGinty's first
child was delivered by C-section for medical reasons, and although this time
around she had hoped to deliver naturally, she had just moved out of state
and wanted her family nearby to help with the baby.
"My mom was coming out and she was only going to come out for a few weeks. I
needed her to be there after the birth. ... So having the option to
schedule it was good for us," says McGinty.
Harm In Planning Too Far Ahead?
Stories like these are common. Statistics show that from 1990 to 2006 the
percentage of women who induced labor more than doubled, and nearly a third
of women were having cesareans.
The increase wasn't because of emergencies, says Jay Iams, a specialist in
maternal fetal medicine at Ohio State University, but rather because women
and doctors began scheduling deliveries for convenience — "convenience for
the mother, for the family, for the physician," says Iams. Sometimes, Iams
says, it's because patients say to themselves, " 'I want only my doctor to
be there. I don't want the person who's on call.' "
Having a baby naturally requires lots of planning. But when it comes to the
arrival date of your bundle of joy, experts now say that planning too far
ahead can do more harm than good.
A full-term pregnancy lasts 40 weeks, but elective deliveries are often
planned for two or three weeks earlier. And even though 37 weeks is also
still considered full term, studies show that babies born even a few weeks
too early are at greater risk for health problems than those who are born
later. That has some doctors campaigning to curb the trend of scheduled
labor and delivery.
Pediatrician Ed Donovan of Cincinnati Children's Hospital says data
collected over the past several decades show those babies have an increased
risk of complications compared with waiting until the mother goes into labor
spontaneously.
"It's now really well-documented in national studies that the risk of the
baby having to require intensive care in a neonatal intensive care unit —
even the risk of infant death — is increased when the baby is born as
little as two weeks before the due date," says Donovan.
Organ Systems Maturing At Different Rates
The reasons for this are two-fold. First, without an ultrasound measurement
in the first trimester, a woman's due date could be as much as two weeks off
, making the fetus 35 weeks instead of 37. And second, Donovan says the
brain, heart, lungs, and immune system all mature at different rates — and
some may need a little more time than others.
"Just because the lungs are mature doesn't mean that the other organ systems
are mature," says Donovan. "A baby born three weeks early with mature lungs
may not be ready to eat because the brain's not fully developed."
According to Donovan, doctors realized they simply weren't very good at
determining which babies were ready and which weren't. And Iams says the
large numbers of sick babies made many doctors begin to think differently
about early deliveries.
"Thirty-seven weeks is term, but they became the most common occupants of
neonatal intensive care nurseries," says Iams. "And the pediatricians
naturally said, 'They could have waited.' "
Still, many women and even many obstetricians remained unaware of the risks
because it didn't fit with their experience.
"People see their friends having babies early, and sometimes women go into
labor on their own at 37, 38 weeks — and that's not unusual and those
babies are fine," says Jennifer Bailit, an obstetrician at Metro Health
Medical Center in Cleveland. "But those are babies that have told us that
they're coming and that they're ready."
Convincing Mothers It's Worth The Wait
Bailit is part of an effort led by Iams and Donovan to reduce the number of
scheduled deliveries before 39 weeks across the state of Ohio. Bailit says
that she often has to explain to women the importance of those last few
weeks — and that the discomfort is normal but something that needs to be
endured for the sake of the baby.
"It's tough to be pregnant, and sometimes when you're in the moment it's
hard to keep the big picture in mind," Bailit says. "When we guide people
toward that kind of thinking it really helps them say, 'I'm doing this for
my baby; it's worth it.' "
In addition to helping doctors like Bailit educate pregnant women, Iams and
Donavan asked doctors at the 20 largest hospitals in the state to document a
medical reason every time a woman was scheduled to deliver before 39 weeks.
And much to their surprise, Iams says in under 15 months the rates of those
deliveries dropped from 15 percent to under 5 percent. And more important,
the number of babies admitted to neonatal intensive care also decreased.
And the idea is catching on across the country. The March of Dimes has taken
what began in Ohio and a few other select states and extended it nationwide
in a campaign it's calling "Healthy Babies are Worth the Wait." Alan
Fleischman of the March of Dimes says the rate of elective births in the
hospitals the organization has surveyed is about 30 percent.
"Most hospital leaders don't believe they have this problem until they
actually measure it," says Fleischman. "And when they do, they're surprised."
As in Ohio, their preliminary data show that in only a short period of time,
even hospitals with very high rates of scheduled deliveries are able to
reduce them to about 5 percent or less by making a few simple changes — and
in turn, increase the likelihood of a healthy baby.
Although inductions at 39 weeks and beyond are considered safe, some doctors
feel that unless there is a medical reason to deliver early, the best labor
plan for women is an old-fashioned one: Hang in there and wait until labor
starts on its own. [Copyright 2011 National Public Radio]
http://www.npr.org/2011/07/18/138473097/doctors-to-pregnant-wom
Doctors To Pregnant Women: Wait At Least 39 Weeks
by Gretchen Cuda Kroen
- (null)
In her living room, Caroline Nagy introduces the newest member of her family
— the 6-week-old infant in a striped onesie cradled in her arms. "This is
Alex Joseph. He was born May 24th — my birthday," she says.
Their shared birthday wasn't entirely a coincidence. Two weeks before her
due date, Nagy was swollen, and uncomfortable. So she asked her doctor for
relief.
"I was just miserable. It was like uncomfortable to walk; I couldn't sit on
the floor and play; I felt like I was neglecting my first kid because I just
couldn't move and I couldn't do anything," says Nagy. "So I asked, 'Is
there any way I can speed this up and have a baby earlier?' "
For Jackie McGinty, it wasn't discomfort but timing that caused her to
schedule her daughter's birth by C-section eight years ago. McGinty's first
child was delivered by C-section for medical reasons, and although this time
around she had hoped to deliver naturally, she had just moved out of state
and wanted her family nearby to help with the baby.
"My mom was coming out and she was only going to come out for a few weeks. I
needed her to be there after the birth. ... So having the option to
schedule it was good for us," says McGinty.
Harm In Planning Too Far Ahead?
Stories like these are common. Statistics show that from 1990 to 2006 the
percentage of women who induced labor more than doubled, and nearly a third
of women were having cesareans.
The increase wasn't because of emergencies, says Jay Iams, a specialist in
maternal fetal medicine at Ohio State University, but rather because women
and doctors began scheduling deliveries for convenience — "convenience for
the mother, for the family, for the physician," says Iams. Sometimes, Iams
says, it's because patients say to themselves, " 'I want only my doctor to
be there. I don't want the person who's on call.' "
Having a baby naturally requires lots of planning. But when it comes to the
arrival date of your bundle of joy, experts now say that planning too far
ahead can do more harm than good.
A full-term pregnancy lasts 40 weeks, but elective deliveries are often
planned for two or three weeks earlier. And even though 37 weeks is also
still considered full term, studies show that babies born even a few weeks
too early are at greater risk for health problems than those who are born
later. That has some doctors campaigning to curb the trend of scheduled
labor and delivery.
Pediatrician Ed Donovan of Cincinnati Children's Hospital says data
collected over the past several decades show those babies have an increased
risk of complications compared with waiting until the mother goes into labor
spontaneously.
"It's now really well-documented in national studies that the risk of the
baby having to require intensive care in a neonatal intensive care unit —
even the risk of infant death — is increased when the baby is born as
little as two weeks before the due date," says Donovan.
Organ Systems Maturing At Different Rates
The reasons for this are two-fold. First, without an ultrasound measurement
in the first trimester, a woman's due date could be as much as two weeks off
, making the fetus 35 weeks instead of 37. And second, Donovan says the
brain, heart, lungs, and immune system all mature at different rates — and
some may need a little more time than others.
"Just because the lungs are mature doesn't mean that the other organ systems
are mature," says Donovan. "A baby born three weeks early with mature lungs
may not be ready to eat because the brain's not fully developed."
According to Donovan, doctors realized they simply weren't very good at
determining which babies were ready and which weren't. And Iams says the
large numbers of sick babies made many doctors begin to think differently
about early deliveries.
"Thirty-seven weeks is term, but they became the most common occupants of
neonatal intensive care nurseries," says Iams. "And the pediatricians
naturally said, 'They could have waited.' "
Still, many women and even many obstetricians remained unaware of the risks
because it didn't fit with their experience.
"People see their friends having babies early, and sometimes women go into
labor on their own at 37, 38 weeks — and that's not unusual and those
babies are fine," says Jennifer Bailit, an obstetrician at Metro Health
Medical Center in Cleveland. "But those are babies that have told us that
they're coming and that they're ready."
Convincing Mothers It's Worth The Wait
Bailit is part of an effort led by Iams and Donovan to reduce the number of
scheduled deliveries before 39 weeks across the state of Ohio. Bailit says
that she often has to explain to women the importance of those last few
weeks — and that the discomfort is normal but something that needs to be
endured for the sake of the baby.
"It's tough to be pregnant, and sometimes when you're in the moment it's
hard to keep the big picture in mind," Bailit says. "When we guide people
toward that kind of thinking it really helps them say, 'I'm doing this for
my baby; it's worth it.' "
In addition to helping doctors like Bailit educate pregnant women, Iams and
Donavan asked doctors at the 20 largest hospitals in the state to document a
medical reason every time a woman was scheduled to deliver before 39 weeks.
And much to their surprise, Iams says in under 15 months the rates of those
deliveries dropped from 15 percent to under 5 percent. And more important,
the number of babies admitted to neonatal intensive care also decreased.
And the idea is catching on across the country. The March of Dimes has taken
what began in Ohio and a few other select states and extended it nationwide
in a campaign it's calling "Healthy Babies are Worth the Wait." Alan
Fleischman of the March of Dimes says the rate of elective births in the
hospitals the organization has surveyed is about 30 percent.
"Most hospital leaders don't believe they have this problem until they
actually measure it," says Fleischman. "And when they do, they're surprised."
As in Ohio, their preliminary data show that in only a short period of time,
even hospitals with very high rates of scheduled deliveries are able to
reduce them to about 5 percent or less by making a few simple changes — and
in turn, increase the likelihood of a healthy baby.
Although inductions at 39 weeks and beyond are considered safe, some doctors
feel that unless there is a medical reason to deliver early, the best labor
plan for women is an old-fashioned one: Hang in there and wait until labor
starts on its own. [Copyright 2011 National Public Radio]
