16 April 2009

37 is NOT the new 40

Call me crazy, but there is probably some sort of reason nature made gestation about 40 weeks, yet it's common practice for a scheduled cesarean (or an induction) to be done at around 37 weeks in spite of many studies that show this is NOT evidence based or best practice. Here's another reason to say no unless your or you baby's life is at risk by staying pregnant longer:

In the newest issue of the APPPH Newsletter (Association for Prenatal & Perinatal Psychology & Health) on birth psychology, a study shows:

Bigger is Better
A baby’s brain at 35 weeks
weighs only two-thirds what it
will weigh at 39 weeks

New research shows that the last weeks of pregnancy are more important than once thought for brain, lung and liver
development, and there may be lasting consequences for babies born at 34 to 36 weeks, now called “late preterm.” Experts
also warn that a fetus’s estimated age may be off by as much as two weeks either way, meaning that a baby thought to be
36 weeks along might be only 34. A study in the American Journal of Obstetrics and Gynecologycalculated that for each
week a baby stayed in the womb between 32 and 39 weeks, there is a 23% decrease in problems such as respiratory
distress, jaundice, seizures, temperature instability and brain hemorrhages. A study of nearly 15,000 children in the Journal
of Pediatrics found that those born between 32 and 36 weeks had lower reading
and math scores in first grade than babies who went to full term. The American
College of Obstetricians and Gynecologists, the American Academy of Pediatrics
and the March of Dimes are now urging obstetricians not to deliver babies before
39 weeks unless there is a medical reason to do so. But it isn’t always easy to tell
which elective early deliveries are done for medical reasons, such as fetal distress
or pre-eclampsia, and which aren’t. “Obstetricians know the rules and they are
very creative about some of their indications—like ‘impending pre-eclampsia,’”
says Alan Fleischman, medical director for the March of Dimes. Why do doctors
agree to deliver a baby early when there’s no medical reason? Some cite pressure
from parents. “‘I’m tired of being pregnant. My fingers are swollen. My mother-
in-law is coming’—we hear that all the time,” says Laura E. Riley, medical
director of labor and delivery at Massachusetts General Hospital. There’s also a
perception that delivering early by c-section is safer for the baby, even though it
means major surgery for the mom. . “The idea is that somehow, if you’re in
complete control of the delivery, then only good things will happen. But that’s
categorically wrong. The baby and the uterus know best,” says F. Sessions Cole,
director of newborn medicine at St. Louis Children’s Hospital. He explains that a complex series of events occurs in late
pregnancy to prepare the baby to survive outside the womb: The fetus acquires fat needed to maintain body temperature;
the liver matures enough to eliminate bilirubin from the body; and the lungs get ready to exchange oxygen as soon as the
umbilical cord is clamped. Disrupting any of those steps can result in brain damage and other problems. In addition, the
squeezing of the uterus during labor stimulates the baby and the placenta to make steroid hormones that help this last phase
of lung maturation—and that’s missed if the mother never goes into labor.


Laura said...

Thanks Kim for this.

Yet another scientific study showing us all how nature works and why it's best not to mess with it and second guess it.

When will conventional medicine actually follow the suggestions of its own science?

About Me said...

Thanks for this Kim, and that's an incredible photo.

Regarding the quote: "Some cite pressure from parents"; I've now heard this notion from doctors defending both inductions and planned c-sections too many times.

I am so sick of hearing the equivalent of "she asked for it" from these doctors!!

It's the most irresponsible, buck-passing, bullshit I've ever heard!

There's a big, big, difference between listening to and emotionally supporting your patients when they are talking about the very real emotional and logistical hardships of the impending entry of a brand-new person into this world, and caving into 'demands' that you KNOW, from your evidence-based, medically "superior" position, are not in the best interests of either the mom or baby.

I mean, are these people feeding their own kids candy and ice cream for dinner, just because "they asked for it"?

Enough with blaming the victim!

Elizabeth Gallo said...

About Me: I bet those people *are* feeding their kids candy and ice cream for dinner -- it's easier. I know someone who routinely lets her not-yet three-year-old daughter drink soda!

I've been fascinated by the differences between my two girls born 13 months apart, the first at 37 1/2 weeks (by Cesarean birth) and the second at 41-ish weeks (by VBAC -- thanks, in great part to Kim). It will be interesting to track this as they grow older.

Sorry to say it, but I grow more and more disheartened with the medical/pharmaceutical/big business world in which we live, and even more so by the people who think it is just fine.

DoulaMomma said...

I absolutely agree about blaming the victim...we're too fat, too posh to push and too spoiled to wait...they are just giving us what we want...BS...what about when I want a referral to a chiropractor? They aren't exactly thrilled to placate me then. But then they don't get to clear the decks at a time that works for them and get paid more either.
How about counseling women to live with the swollen fingers and achy back in exchange for a healthier baby with a bigger brain? I don't know anyone who would choose their own comfort over that.
It's insulting and just another glaring example of the complete lack of informed consent in most cases...

DoulaMomma said...

"When will conventional medicine actually follow the suggestions of its own science?"

it would be funny if it weren't so crazy!

Mrs. T-bone said...

This is a wonderful post! I think this push to control and speed up a natural process is an unfortunate by-product of our "on-demand" society. Pregnancy is no longer seen as a special journey in a woman's life, but a time to get through. Woman are not support during their pregnacies, their Mothers and Sisters and Aunts live far away and the only person they have to rely on is their OB/GYN for advice and counsel, which often lacking. This kind of information should be given to every pregnant woman.