Taken From: East Orlando Sun April 11, 2012
"If you are a new mother or recently pregnant, chances are you have felt the wisp of air that follows the pendulum of modern medicine as it swings by yet again. The topic this time: elective deliveries before 39 weeks of gestation. Prior to taking a hard look at outcomes, the consensus in the medical community was that 37 weeks was considered “term” and deliveries after that point are deemed safe. So off we went and phone calls funneled into labor and deliver wards to schedule elective deliveries.
“Her husband is getting deployed.”
“Her mom is flying in from Texas to help with the sibling.”
“She’s miserable. We are heading for the finish line.”
In 1990, 10 percent of deliveries were electively performed before 39 weeks. Until recently, they accounted for nearly 25 percent of all deliveries. With the emphasis of evidence-based medicine, the pendulum is now swinging the other way and we, as a community, are learning that there is true merit to the saying, “patience is a virtue.” So what is the big deal?
It has become apparent that babies born between 37 and 39 weeks are more likely to have respiratory problems and simply put, they have more growing to do. The brain and liver continue to develop between 39 and 40 weeks. Perhaps most evident is the increased trouble they have with feeding because the coordination required for sucking has not matured. On the maternal front, there is a higher rate of C-sections in this patient population as well. This mode of delivery inherently carries increased risks including infection, bleeding and post-delivery pain.
And if this isn’t reason enough to shy away from early elective deliveries, there is also a significant economic impact as a result of this practice. C-sections are more expensive to perform and lead to longer hospitalizations. Infants that are not fully mature can require intensive neonatal care and that is costly. A study last year estimated that reducing early-term births to 1.7 percent could save close to $1 billion annually.
I personally have found that after appropriate counseling, patients are supportive of whatever delivery plan is best for their baby. Not only is an elective induction before 39 weeks against my practice’s policy, but it is also against hospital policy. Increased awareness of the dangers associated with preterm births is on the rise thanks to initiatives such as the March of Dimes Prematurity Campaign. Hospitals in multiple states, including Florida, have stopped elective deliveries — inductions and cesarean sections — before 39 weeks.
This information wouldn’t be complete without offering a few points for clarification. Health care professionals do not hesitate to recommend delivery before 39 weeks if there is a medical reason to proceed. These indications could include, but are not limited to: a mother sick with preeclampsia, uncontrolled diabetes and concerns for baby's health, such as small size. Patient care in these situations is very individualized, and the risks of continuing the pregnancy can outweigh the benefits.
This subject leads me to reminiscence about my interview days before residency. A wise physician sat in front of me, looked at my resume, and then pulled his reading glasses down on his nose to look me in the eyes. He then asked, “Can you tell me three attributes that make a good obstetrician?” As I paused and shifted uncomfortably in my chair, much to my relief, he proceeded, “A good obstetrician is a team player, decisive and perhaps most importantly… is patient. We are the only docs that wait 9 months for something to happen. Don’t rush things in its final stages,” advised Dr. Keith Stone. Coming from a physician who has long felt the breeze from the ever-swinging pendulum of medicine, I take great heed in his guidance. And from our experiences, we’ve learned. It is time to be patient and let Mother Nature do the planning."
*Dr. Pamela Snook is a board-certified obstetrician and gynecologist who completed her residency at Shands at the University of Florida. She has been a practicing physician for more than seven years and has garnered a special interest in high-risk obstetrics, infertility and minimally invasive gynecologic surgery. She practices at Contemporary Women's Care, 2111 Glenwood Drive, Ste. 208 in Winter Park. Call 407-478-OBGY(6249) or visit http://www.myobgynorlando.com/
"If you are a new mother or recently pregnant, chances are you have felt the wisp of air that follows the pendulum of modern medicine as it swings by yet again. The topic this time: elective deliveries before 39 weeks of gestation. Prior to taking a hard look at outcomes, the consensus in the medical community was that 37 weeks was considered “term” and deliveries after that point are deemed safe. So off we went and phone calls funneled into labor and deliver wards to schedule elective deliveries.
“Her husband is getting deployed.”
“Her mom is flying in from Texas to help with the sibling.”
“She’s miserable. We are heading for the finish line.”
In 1990, 10 percent of deliveries were electively performed before 39 weeks. Until recently, they accounted for nearly 25 percent of all deliveries. With the emphasis of evidence-based medicine, the pendulum is now swinging the other way and we, as a community, are learning that there is true merit to the saying, “patience is a virtue.” So what is the big deal?
It has become apparent that babies born between 37 and 39 weeks are more likely to have respiratory problems and simply put, they have more growing to do. The brain and liver continue to develop between 39 and 40 weeks. Perhaps most evident is the increased trouble they have with feeding because the coordination required for sucking has not matured. On the maternal front, there is a higher rate of C-sections in this patient population as well. This mode of delivery inherently carries increased risks including infection, bleeding and post-delivery pain.
And if this isn’t reason enough to shy away from early elective deliveries, there is also a significant economic impact as a result of this practice. C-sections are more expensive to perform and lead to longer hospitalizations. Infants that are not fully mature can require intensive neonatal care and that is costly. A study last year estimated that reducing early-term births to 1.7 percent could save close to $1 billion annually.
I personally have found that after appropriate counseling, patients are supportive of whatever delivery plan is best for their baby. Not only is an elective induction before 39 weeks against my practice’s policy, but it is also against hospital policy. Increased awareness of the dangers associated with preterm births is on the rise thanks to initiatives such as the March of Dimes Prematurity Campaign. Hospitals in multiple states, including Florida, have stopped elective deliveries — inductions and cesarean sections — before 39 weeks.
This information wouldn’t be complete without offering a few points for clarification. Health care professionals do not hesitate to recommend delivery before 39 weeks if there is a medical reason to proceed. These indications could include, but are not limited to: a mother sick with preeclampsia, uncontrolled diabetes and concerns for baby's health, such as small size. Patient care in these situations is very individualized, and the risks of continuing the pregnancy can outweigh the benefits.
This subject leads me to reminiscence about my interview days before residency. A wise physician sat in front of me, looked at my resume, and then pulled his reading glasses down on his nose to look me in the eyes. He then asked, “Can you tell me three attributes that make a good obstetrician?” As I paused and shifted uncomfortably in my chair, much to my relief, he proceeded, “A good obstetrician is a team player, decisive and perhaps most importantly… is patient. We are the only docs that wait 9 months for something to happen. Don’t rush things in its final stages,” advised Dr. Keith Stone. Coming from a physician who has long felt the breeze from the ever-swinging pendulum of medicine, I take great heed in his guidance. And from our experiences, we’ve learned. It is time to be patient and let Mother Nature do the planning."
*Dr. Pamela Snook is a board-certified obstetrician and gynecologist who completed her residency at Shands at the University of Florida. She has been a practicing physician for more than seven years and has garnered a special interest in high-risk obstetrics, infertility and minimally invasive gynecologic surgery. She practices at Contemporary Women's Care, 2111 Glenwood Drive, Ste. 208 in Winter Park. Call 407-478-OBGY(6249) or visit http://www.myobgynorlando.com/
