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.