A few weeks can mean a big difference for unborn babies

Even late in pregnancy, an unborn baby still has growing to do.

The lungs and brain continue developing. The baby’s body fat reaches a level to help maintain body temperature. The placenta provides antibodies to help the baby fight off infections during the first few months of life.

It’s important development. And when a delivery occurs prior to 39 weeks, the baby misses out on this development and could have a harder time breathing, nursing and even just staying warm.

The March of Dimes and obstetricians around the country have been working for 10 years to educate expectant mothers about how important it is to carry their baby for at least 39 weeks.

The national effort was a response to an increase in scheduled deliveries where labor is induced rather than spontaneously occurring. Southeast Alabama Medical Center in Dothan recently launched its own local effort – the 39 Weeks Project, an initiative to educate women on the importance of not scheduling an induction or Caesarean section prior to 39 weeks of pregnancy when there are no medical reasons to do so.

“Non-medical deliveries less than 39 weeks have an increased risk for their babies,” said Dr. Larry Veltman, a retired Oregon obstetrician who now works as a perinatal safety consultant, who recently spoke to doctors and staff at SAMC. “There’s brain development late in pregnancy that merits waiting.”

There are multiple reasons women choose to schedule their deliveries – family schedules, doctors’ schedules or even a matter of comfort during the later weeks of pregnancy.

“Women don’t recognize that it’s not as safe to deliver earlier than waiting until term,” Veltman said.

There are medical reasons for labor to be induced. The baby may have stopped growing, the mother may have health issues such as high blood pressure or it may be a pregnancy involving multiple births.

“There are some legitimate reasons that have to be balanced against safety issues of doing deliveries earlier than Mother Nature wanted to happen,” Veltman said.

On a local level, doctors may not see the increased risk because the numbers of early births with complications is small when looking at an individual medical practice. But nationally, the numbers are larger. And even if a local doctor only has one preterm baby out of 100 who experience complications, the parents of that one baby won’t care about small numbers, Dr. Guy Middleton said.

“Whenever you put the patient first, quality follows and the outcome is better,” said Middleton, a Dothan obstetrician and gynecologist. “So even though the risk may be small, the patients are worth it.”

The national education effort could be working.

The preterm birth rate in the United States is about 12 percent of all births based on the most recent figures from 2008, according to the Centers for Disease Control and Prevention. The late preterm rate, those between 34 and 36 weeks of gestation, is 8.8 percent.

According to the CDC, the rate of late preterm births rose by 25 percent between 1990 and 2006. However, between 2006 and 2008, the percentage of infants born between 34 and 36 weeks dropped by 3 percent. The percentage of early preterm births, those less than 34 weeks, also declined. This was the first decline in the rate of preterm births in three decades.

Confusion occurs for women because they’re told that 37 weeks is considered a full-term pregnancy. Should an expectant mother go into labor at 37 weeks, doctors do not attempt to stop the delivery.

Middleton would like to see the American Congress of Obstetricians and Gynecologists go ahead and define full-term as 39 weeks.

The problem, Middleton said, is a situation where a baby delivered after labor occurs spontaneously at 37 weeks is different from a baby delivered at 37 weeks when labor is induced. Typically, when labor naturally occurs in later preterm weeks, both the baby and the mother’s body are ready.

“Nature knows best,” Middleton said. “Doctors aren’t God. We don’t know God’s plan. Unless there’s good evidence we’re improving things by inducing, we should do it.”