"I Want This Pregnancy to Be Over!" But Does Your Baby?
Having your baby too early can be fraught with a myriad of complications.
Posted Jun 17, 2013
It's a familiar refrain: "Hey Doc, can't you get this baby outta me? I want this pregnancy to be OVeR! What do you mean 'forty' weeks? It's thirty-six. Thirty-six! Nine [months] times four is thirty-six!"
Too often this has been an increasing cry of many mothers-to-be who want to have their labor induced two to three weeks before the scheduled due date.
Yes, you enjoyed the "whole pregnancy thing" for a good while. You brought happy news to the family. You've been the center of attention and got to eat what you wanted without too much consternation.
But...you look in the mirror and don't recognize your face...or your body. "Ligament pain" is still causing discomfort. You can't get comfortable at night when trying to sleep. You haven't had great sex since who knows when; and you've made it to 37 weeks...and you want the baby to have the same birthdate as your grandma, or your hubby, or even your pet. So you ask for an early delivery, and all too often, some obstetricians oblige. But what does your baby have to say about all this? In the spirit of self-preservation, if they had a voice and a vote, they'd vote "no." They'd say "Mommy, don't do it."
There is a reason why "forty weeks" is the time given for a full-term pregnancy. The lungs need to mature. The kidneys and other organs need to start working well. The brain is still growing important brain tissue that's needed to think and learn later in life. The baby's neurological instinct to suck and swallow needs to be perfected.
I know we live in a time of pervasive immediacy: "I want it right now; I don't want to wait [for anything]." But some things take time to get "done." That applies to a soufflé; a roast; a cake baking in the oven, and to the unborn fetus incubating inside your body. Having a baby before it's time can be fraught with numerous complications that may last a few days, a few weeks, a month, a few years or even a lifetime.
But too many mothers still ask for, and far too many OB doctors grant, "designer due dates": asked-for dates on which mommies want their child to be born...and labor is induced, or a C-section is scheduled. As an obstetrician-gynecologist, I say, in the best interest of your baby, resist the urge.
The March of Dimes has been working with hospitals and physicians to remind them that a baby born-too-soon is not always a good thing. They encourage mothers not to rush nature; and mainly, to remind doctors that such a medical decision is not to be entered into lightly. It can be harmful to the baby's immediate condition at birth, and even it's abilities in school and later in life.
Do most doctors know not to do this? Absolutely. But (I'll let you in on a little secret of some doctors' psyche): Some doctors may agree to the early delivery because they fear that, if they say no, and make the woman wait for labor, and God forbid, something happens—or the baby dies in utero (due to no fault of anyone)--the patient will say "I told him/her I wanted the baby out. I knew it. I felt it. He/She didn't listen to me"...and then there's a lawsuit.
I'm reminded of a patient who made a few repeat visits to my office so I could check her cervix (she just knew "This is it, Dr. McCloud! I know it is!"). On her third such visit, she said, "Dr. McCloud, if you tell me I'm not ready, I'm going to have a 'Grady fit' right here in your office!" (A "Grady fit" was the casual term applied to people 'acting out' at the local city hospital.) Fortunately (and not because she playfully threatened me; it was so funny!), she was then 3 centimeters and yes, I sent her to be admitted.
There are legitimate medical reasons to have a baby born before your "EDC"—Estimated Date of Confinement—more commonly known of as your due date. Medically-indicated inductions are done when the pregnant woman's pregnancy has complications, and the baby would be better out than in. Some possible complications include, but are not limited to:
• poor fetal growth (IUGR, or intrauterine growth restriction)
• low levels of amniotic fluid
• preeclampsia—the hypertension of pregnancy
• fetal anomalies (abnormal development of any organ such as the heart)
• other maternal illness
• other causes
• poor fetal response to diagnostic tests such as a "non-stress test" or other exam
Plus there are reasons why a pregnancy should not go too long, too far past the due date. In earlier days, most OB docs would patiently, though anxiously, wait up to 42 (maybe 43) weeks for a woman to spontaneously enter labor. During that two week "post-dates" period, however, the woman is undergoing repeat checks of the baby's movements, the volume of amniotic fluid, the baby's size, it's breathing and the baby's response to stimuli. And alas, there are times when a prolonged pregnancy can result in a less than optimal delivery.
The baby may have passed stool (meconium) into the amniotic fluid; this can cause breathing problems and fetal distress, even death if extremely thick and has occupied the babies bronchioles (deep airway tubes). The amniotic fluid levels can get too low. The placenta may literally get old--sclerotic--causing decreased blood flow to the baby and sometimes there may be an IUFD—intrauterine fetal demise.
But in the absence of a legitimate medical reason to induce labor, early induction of labor is not advised. Don't do it. Allow nature to take its course; to do its thing. The "40 weeks" time frame has worked for centuries. Accept it, and focus on having a healthy baby once it gets here at its appointed time.
To help best determine an accurate due date, there are some things you can do:
• Keep track of your period. Know your LNMP—last normal menstrual period--the date it began
• See your doctor before you get pregnant. Have a "pre-conception counseling session" in which you'll review your overall health, current medications, family history, genetic problems (Tay-Sachs, hemophilia, sickle cell anemia), previous pregnancy complications and more
• Begin prenatal care early.
Yes, the pregnancy has lasted a long time. Once you get to 36-37 weeks, you start to get anxious and impatient. But leave the inductions for those babies who are having problems in utero, or the mother's health has become complicated by hypertension and the like. Remember that you won't be pregnant for another forty weeks. It's almost over; and waiting to give your baby it's allotted time to mature in utero...is time well spent.
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March of Dimes: www.marchofdimes.com
American College of Ob-Gyns: www.acog.org