Friday, January 8, 2010

The “Patient Push” for Early Birth: A Dangerous Concept or Valid Point?

by Melissa Garvey, ACNM Writer and Editor

Last summer, ACOG officially revised its recommendations on elective labor induction, raising the “safe” gestational age to induce from 37 to 39 weeks. Now a study in the December 2009 issue of Obstetrics & Gynecology examines women’s perceptions of the definition of full term and the safety of birth at various gestational ages. Long study short, nearly half of the 650 women surveyed believe it is safe to give birth at 37 weeks, and almost all believe it is safe to give birth before 39 weeks. (Note: All women were insured and had recently given birth.)

While there are numerous discussion-worthy topics nestled in the article, one in particular piques my interest as an informed consumer. Remember ACNM President Melissa Avery’s post about the startling rise in rates of preterm birth in the US? The number-one reason is labor induction. With that in mind, check out this statement from the Discussion section of the article:
Misinformation about the safety of early deliveries, especially those that are perceived to be “only a little early,” combined with the desire for the pregnancy to be over, likely contributes to a patient “push” for early delivery.
The authors say that recent educational efforts aimed toward providers have been promising in reducing the rate of elective preterm or early term birth, but the role of the patient has not yet been studied. So, my question is should we start looking at women’s role in elective induction or does this sound eerily similar to blaming women for the rise in cesarean section rates?

Bonus Discussion
To fully appreciate the survey results, it’s worth looking at the actual questions that researchers asked women:
  1. “At what gestational age do you believe the baby is considered full term?” (Possible responses ranged from 34 to 40 weeks.)
  2. “What is the earliest point in the pregnancy that it is safe to deliver the baby, should there be no other medical complications requiring early delivery?” (Again, possible responses ranged from 34 to 40 weeks.)
These questions measure the women’s knowledge base, but not where they’re getting that knowledge. Perhaps they’re getting it from the media, the Internet, or their care provider? It’s also worth noting, as the authors point out, these questions do not control for women’s varying interpretations of “full term” and “safe,” nor do they distinguish between spontaneous preterm labor and elective labor induction.


pinky said...

I do not understand how induction could be the number one cause of preterm birth. That has not been my experience. Could you provide a source for me to look up?

Kailah said...

The statement was that it's the number one cause of the RISE in preterm births in the US. Not the number one cause over all.

Melissa Garvey said...

Lamaze explains it best:

“Born a Bit Too Early – Recent Trends in Late Pre-Term Births, a new report from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics documents the growing prevalence of “late pre-term” births, pointing to a 20 percent increase in late pre-term births from 1990 to 2006. A key finding from the report suggests the increase in induction rates is influencing the dramatic rise in pre-term births."

The report is available here:

What has your experience been, pinky?

pinky said...

My experience has been that you can induce at 40 weeks but most prefer to wait a bit after that and most Docs get an early ultrasound in order to keep good dates.

If the Obs I know started inducing at 38 weeks, the Chief of Nicu would have their heads on a platter I think.

Tiffany said...

Pinky, I think it can be confusing but I believe what they are refering to is the inaccuracy of dates. If a women is induced at 38 weeks but her dates maybe weren't so acurate, you could actually be inducing a 36 weeker for example. Someone please correct me if I am misunderstanding this! Basically, providers were inducing women at earlier gestations (37-38 weeks) and discovering that babies weren't term after all.

Knitted_in_the_Womb said...

I know that when I was pregnant with my first child in 1998 I was told that "full term" was 38 weeks. But now women are told--by their care providers--that "full term" is 37 weeks. When I discuss this shift in my classes or with my doula clients I point out that NOTHING has changed about our biology, what has changed is our technology. Technology has changed such that doctors are more "comfortable" with births at 37 weeks because they trust that any "late prematurity" issues that arise can be dealt with by technology.

Michal H. said...

There's probably something to it. We all know that some pregnant women tend to get impatient towards the end, especially if pregnancy is uncomfortable. From my (limited) experience with borderline high blood pressure (just at 140/90), doctors tend to be anxious to "get it over with before there's a problem." That was the opinion of both my OB, and of my husband's cousin who's also an OB. I was induced at 39 weeks, so I shouldn't complain, but I think if I'd taken bed rest more seriously, I could have avoided the induction all together.