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Thursday
Nov062008

November is Prematurity Awareness Month


The March of Dimes is raising public awareness of the impact of premature births on babies and families this November with a national educational campaign. Prematurity is on the rise, with more than 525,000 infants were born prematurely in 2005, the highest number ever reported for the U.S. According to the March of Dimes Prematurity Campaign Web site, prematurity is the leading killer of America’s newborns. Those who survive often have lifelong health problems, including cerebral palsy, mental retardation, chronic lung disease, blindness and hearing loss.

 

One of the four items on the March of Dimes’ Petition for Preemies is:

3. We call on hospitals and health care professionals to voluntarily assess c-sections and inductions that occur prior to 39 weeks gestation to ensure consistency with professional guidelines*.

*The American College of Obstetrics and Gynecology recommends that, unless medically indicated, scheduled deliveries should be after 39 weeks. This is because biological variations and uncertainties in estimating the beginning of a pregnancy introduces inaccuracies when assigning the due date. Preterm birth rates can be reduced by performing scheduled deliveries after 39 weeks.

March of Dimes warns against the practice of scheduling pre-term maternal-request Cesareans, which are not to be confused with “elective” Cesareans*:

Cesarean Birth by Request

Some women may prefer to have a cesarean section instead of a vaginal birth, even without medical need. It may be appealing for both the woman and the health care provider to consider cesarean because it helps them plan their schedules. Some women ask for c-section because they are worried about the pain of vaginal delivery.

We do not have enough research to fully compare the risks and benefits of c-section by request with vaginal delivery. Because of this, the decision to have a c-section by request must be based on the individual needs of the woman and her baby.

Concern about pain is usually not a good reason to request c-section. Safe and effective pain management methods are available to help women cope with vaginal delivery. Some of these methods use drugs; others are drug-free.

The Risk of Late Preterm Birth
With any cesarean, it’s important that the surgery be done when the baby is full term: born after 37 completed weeks of pregnancy. C-sections may contribute to the growing number of babies who are born “late preterm,” between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term.

A baby’s lungs and brain mature late in pregnancy. Compared to a full-term baby, an infant born between 34 and 36 weeks gestation is more likely to have problems with:

  • Breathing
  • Feeding
  • Maintaining his or her temperature
  • Jaundice

It can be hard to pinpoint the date your baby was conceived. Being off by just a week or two can result in a premature birth. This may make a difference in your baby’s health. Keep this in mind if you are considering elective c-section.

When a woman is carrying just one baby, c-section by request should be performed only after 39 weeks of pregnancy. The health care provider may also need to check the baby’s lungs to be sure they are mature.

If you are planning to have several children, cesarean section by request is not recommended. This is because the risk of placenta previa and accreta rises with each birth.

If you are considering a c-section by request, talk to your health care provider and be sure you fully understand the risks and benefits.These questions may be useful when you speak to your provider.

  • What problems can a c-section cause for me and my baby?
  • Will I need to have a c-section in future pregnancies?
  •  

    The March of Dimes lists the same risks of late pre-term birth for inductions and encourages dialogue between patient and care provider. Here is their “bottom line” for inductions:

    The Bottom Line

    Induction is sometimes needed to protect the health of both the mother and the baby. But it also has risks. The pregnant woman needs to understand both the benefits and risks. These questions may be useful when you talk to your provider:

    If your provider recommends induction before 39 weeks:

    • Is there a problem with my health or the health of my baby that may make me need to have my baby early?
    • Can I wait to have my baby closer to 40 weeks?

    About induction:

    • Why do you need to induce my labor?
    • How will you induce my labor?
    • Will inducing labor increase the chance that I’ll need a c-section?

     

     

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