Baby and Toddler -April 2009
Thinking of delivering early? Know the risks
By Elizabeth Heubeck
Your due date is three weeks away. But the weight of the baby is getting
exhausting, and your favorite physician in your OB/GYN’s practice leaves for an
extended vacation in two weeks. This is your second child, and the first was
delivered via cesarean section (c-section). You feel fairly confident that your
physician will schedule an elective c-section for next week if you push for
one. Should you?
Before you respond, you may want to consider some new research that highlights
the risks to babies born just a few weeks shy of their due date.
Compelling data published in the Jan. 8, 2009, issue of the New England Journal of Medicine (NEJM)
found that delivering infants at 37 or 38 weeks of gestation via elective
repeat c-section dramatically increases newborns’ risk of certain medical
complications. The study, which included more than 24,000 infants, concluded
that this type of delivery at 37 weeks—just two weeks early—doubled
newborns’ risk of breathing problems, bloodstream infections, and other
complications at birth. Elective repeat c-sections done at 38 weeks, just one
week early, increased the aforementioned risks by 50 percent.
Not surprisingly, the earlier infants are born, the more likely they are to
face medical complications. One recent report, cited in the Feb. 23, 2008,
issue of the Chicago Tribune, stated
that up to 34 percent of all infants born between 34 and 36 weeks suffer at
birth from breathing problems, jaundice, feeding difficulties, low blood sugar,
unstable body temperatures, and other medical problems.
These risks pose a greater concern today than ever—the number
of preterm births (defined as before 37 weeks gestation) in the U.S. have
risen significantly since 1981. In fact, they are at an all-time high, and now
constitute 31 percent, or one out of every eight, births.
Worth the Wait
When you consider the flurry of last-minute activity that takes place in utero,
it’s easy to understand why preterm births increase the potential for medical
In the late stages of gestation, the fetus is busy doing the following: building
up fat to maintain body temperature outside the womb, maturing the liver so it
can eliminate the toxin bilirubin from the body, and developing the lungs to
exchange oxygen when the umbilical cord will no longer provide it.
Given the significant growth that takes place in utero during the final weeks
of pregnancy, coupled with newfound knowledge of the risks that often coincide
with early delivery, the increasing prevalence of early elective deliveries
begs the question: Why?
Clearly, certain medical reasons such as preeclampsia and fetal distress
warrant preterm elective deliveries. But anecdotal evidence suggests that, for
more and more mothers-to-be, convenience has become the primary driver behind
early elective deliveries. And, in many cases, it seems that doctors are
following their patients’ orders.
Catherine Spong, M.D., is chief of the Pregnancy and Perinatal Branch of the National
Institute of Health's Eunice Kennedy Shriver National Institute of Child Health
and Human Development in Bethesda. She’s also co-author of the NEJM study that proved that even one
week in utero can make a difference to an infant’s health at delivery. She hopes
that women who are eager to deliver early will reconsider when they learn the
“It’s important to be able to counsel both women and physicians that delivery
at 37 weeks essentially doubles the risk of these medical complications. Even
when you’re at 38 weeks and 6 days, your risk remains 20 percent higher than at
39 weeks,” says Spong.
The bottom line?
According to Spong, “You want to wait until it is really safe to deliver.” BC
Risks of Early Elective C-Section
Elective c-section delivery of infants at either 37 or 38 weeks (compared
to 39 weeks gestation) increases the following risks to newborns:
Newborn sepsis (or signs and symptoms of infection during the first four weeks
Hypoglycemia (or having a lower than normal level of blood glucose)
Admission to the neonatal intensive care unit (NICU)
Hospitalization for five or more days
Source: “Timing of Elective Repeat Cesarean Delivery at Term and Neonatal
Outcomes,” NEJM, Jan. 8, 2009.
© Baltimore’s Child Inc. April 2009