When my grandmother was born she was so small that her head could fit into a tea cup. She was very premature and born at home just after the turn of the last century. They kept her in a dresser drawer lined with blankets - probably the warmest, quietest, and snuggliest environment they could think of. The 1903 equivalent of the high tech isolettes that line our neonatal intensive care units.
My grandmother grew up strong and healthy. But just because she survived a strenuous and harrowing birth process, doesn't mean that this was the best way for her to start off life. It's a good story because it was amazing that my grandmother lived. Most babies born that early at that time would have died.
A news report by WCPN, our local public radio station, highlighted a new effort by Ohio State University doctors to strongly discourage women from having planned C-sections before the scheduled due-date of their babies.
The full report is available both in text and via live streaming here. If you - or anyone you know - is thinking about scheduling an elective early c-section delivery, or trying to induce premature labor through rough sex, exotic teas, or rides on dirt roads in the back of a truck with bad springs, PLEASE LISTEN TO IT.
Why the rush?
Planned early deliveries are on the rise. From 1990 to 2006, induced labors more than doubled. More than 30% of babies are now born by cesarean section - up from fewer than 5% just 30 years ago. Although there are many reasons for this rise, a major reason is convenience. Women are inducing labor or scheduling c-sections prior to their due date not because they have to, but because they choose to do so.
Women want to schedule deliveries early for a number of reasons.
- The last few weeks of pregnancy are uncomfortable. That bowling ball sized skull bouncing up and down on your bladder is not anyone's idea of a good time. And it's hard to snuggle your wiggly toddler when there's barely a lap there for them to sit on.
- There's a lot of things to schedule! Many new parents look forward to having family come visit and help out with the new baby. But when they're coming from across country, they need to buy plane tickets well in advance. Normal deliveries can easily go 2 weeks forward or a week or so back from a 'due date'. Scheduling a delivery makes it easy to plan. Worksites can want a specific date to bring in a temp or to schedule maternity leave. If you want all the time of your leave to be with your baby and not pacing the floor, a fixed date can be really helpful.
- People want the doctor they want. Your midwife or the doctor you've been working with is going on vacation and you want THEM and not another person who happens to be on call. The friend who will be holding on your hand needs to go on a business trip the week of your due date.
- Mothers get tired of waiting. Need I say more?
Medical technology is really good. What's the harm in having a baby a little early?
A lof ot harm. We've been working for years to try to ensure that all babies are born full term at full weight. Why? Because full term babies come home from the hospital faster, spend less time in intensive care units, need fewer medical interventions, cost less to deliver, are healthier, and are less likely to die.
Did you catch that last reason? They are less likely to die.
- Do you REALLY know exactly when your baby was conceived? 'Forty weeks' is what we usually list as the normal gestational period of humans. That's how practioners set the date. Actually, it takes 38 weeks from conception for a baby to develop. We say 40 weeks because we don't normally know when women conceived - we calculate the date from the first day of the last normal menstural period the mother had.
But that's just an average. Some women have 3 day periods beginning 28 days apart. Others have 7 day periods 43 days apart. Others are shorter or longer, closer together or irregular. Some people know EXACTLY when their period started. Others have kind of a vague notion. Because of this variation, conception occurs within a range of dates after that last recorded menstrual period. But unless careful measurements were done very early in xpregnancy (and your baby was 'typical'), your baby could be two weeks older or two weeks younger than you think it is. So a baby born by scheduled c-section at '37 weeks' could actually be 35 or 39 weeks old - and their age from conception might vary even more.
- Brains, fat, and lungs develop last. Prenatal development is an absolutely amazing process, carefully coordinated with incredibly delicacy. During the last trimester of pregnancy, major developments occur in laying down fat (incredibly important in maintaining body temperature and easing stress between feedings), developing the lungs' ability to absorb oxygen, in the development of the intestine's ability to absorb nutrients, and in brain and neurological development. Those processes occur naturally, most efficiently and with least stress to the infant and least risk of problems INSIDE THE MOTHER.
- Normal delivery is triggered by the baby (not the mom) when the baby has developed enough to be born. In normal deliveries, it is the baby's hormones that trigger childbirth - not the mom's. Sometimes this happens too early, because the baby releases hormones early or mothers' bodies are very sensitive to them. Sometimes this happens late, for similar reasons. Sometimes various risk factors make it less risky for the baby to be born early (or late) than to stay in a womb. Lots of babies are born prematurally for natural reasons. And there can be good reasons to induce labor or perform a c-section before labor begins.
Thankfully, we've invented many ways to keep babies alive and healthy when that happens. BUT IT SHOULDN"T HAPPEN BY CHOICE.
We all know that after babies are born, they develop at different rates - some faster some slower. It's not all by the clock. We don't expect every baby to walk at exactly 48 weeks.
Same thing prenatally. When maturation occurs, you've got to trust that the baby's body - and yours - will know what to do.
There are many medically necessary reasons for mothers to delivery early. But that's just it - they are MEDICALLY NECESSARY and usually, both mothers and doctors are working hard to delay premature childbirth as long as possible.
Parenting is a process that requires patience and where many, many things are a little bit out of your control. And sometimes, the best results happen when you give things a little time and trust yourself, your child, and the process.
Childbirth is just the first of these.