Baby, Let’s Wait

An initiative to delay inducing Labor until 39 weeks lowers the number of NICU babies

As any woman who’s experienced it knows, pregnancy is filled with uncertainties. To narrow down the unknowns, many people try to plan everything they can, including the day their baby will be born. A woman may schedule her baby’s birth in order to provide time to tie up loose ends at work, make sure the obstetrician of her choice is available, or because she’s just tired of being pregnant.

For these and other reasons, the number of women who choose to induce labor has increased dramatically in the last two decades, almost doubling by some accounts. Pregnant women and their physicians often schedule elective inductions as early as the 37th week of pregnancy — when a baby is considered full term.

However, an increase in babies requiring admission to neonatal intensive care units (NICU) has led the Louisiana Department of Health and Hospitals and the March of Dimes to create the 39-week initiative, which discourages hospitals and physicians from performing elective inductions before 39 weeks. The initiative is designed to minimize stays in the NICU and allow more babies to spend their first nights in the company of their parents. So far, it’s working.

East Jefferson General Hospital (EJGH), one of the first in the state to implement the 39-week initiative, has seen a decline in NICU admissions. According to the EJGH Nursing Annual Report, babies born into NICU have decreased 20 percent since the program was implemented in 2010.

“The crux of the problem is that even with ultrasound, we can be off on the due date by two weeks, plus or minus,” says Dr. Ann Chau, a maternal and fetal medicine physician with EJGH. “So if a mother is induced at 37 weeks, she could actually only be 35 weeks pregnant.”

The difference in fetal development between 35 and 40 weeks can be substantial. According to the March of Dimes website, “A baby’s brain at 35 weeks will weigh only a third of what it will weigh at 39 to 40 weeks.” The March of Dimes also reports that preterm (any birth before 37 weeks gestation) babies tend to be smaller and may have trouble staying warm. Furthermore, they may have difficulty sucking, swallowing, and staying awake long enough to eat. Other complications associated with preterm birth include low birth weight, underdeveloped organs, and the potential for lower cognitive function.

Chau names underdeveloped lungs as the primary cause for preterm babies being admitted into the NICU. This is especially true for Asian and Caucasian male babies, whose lungs develop more slowly than those of female infants and babies of different races. “Two-point-five percent of babies born between 37 and 38 weeks are born with respiratory complications, even though (some are) minor,” Chau says. “Only 1.25 to 1.5 percent of babies born between 38 and 39 weeks have the same respiratory complications. These may seem like small numbers, but it takes a huge emotional toll on parents. Not to mention, a stay in the NICU can be quite expensive. That is a financial burden for parents and the health care system as a whole.”

Early induction also can result in the need for a cesarean section. If a physician makes labor start before the cervix has properly thinned and opened, labor could be prolonged and the risk of a cesarean could increase. This means a longer recovery period for the mother. It may affect her ability to have a vaginal delivery in the future, and there is potential for infections. Costs also increase with a C-section, typically extending the mother’s hospital stay from two nights to four.

There are times when a mother goes into labor naturally prior to 39 weeks or when it is necessary to induce labor for the sake of the mother and child’s safety. When that happens, physicians and nurses who specialize in preterm birth are prepared to help even very early babies become happy, healthy children and adults.