In 2008, Intermountain Healthcare of Utah discovered that over a third of elective C-sections performed at their hospitals were done before 39 weeks of gestation.
Of these “early-term” babies, those born at 38 weeks were twice as likely to have respiratory problems and FIVE times as likely at 37 weeks. Many ended up with an expensive stay in the NICU and had other complications as well.
Because it occurred fairly infrequently in any given (and presumably small) OB practice, docs weren’t able to clearly recognize this cause and effect; but when analyzed over a much larger population, the evidence was clear: delivering babies voluntarily before 39 weeks was NOT a good thing.
So they shut it down. Want a pre-39 week c-section at one of these hospitals? You better have a darn good reason.
The results were astounding: in one year, they prevented 500 newborns from ending up in the NICU with breathing problems and spared as many parents the frightening sight of seeing their infant hooked up to tubes and wires in an incubator. The measure also saved at least $1 million a year in unnecessary medical costs.
Since then, most hospitals in Oregon have followed suit. Insert a sarcastic “yay logic!” here.
The Last 3 weeks are Important
Just because a mom-to-be has reached the magic number of 37 weeks doesn’t mean that her baby is ready for the world. Nay, important things are still happening in the last few weeks, such as maturation of the brain and lungs.
According to the March of Dimes, babies born too early may have more health problems at birth and later in life than babies born full term. Babies born after 39 weeks are less likely to have vision and hearing problems and can maintain a warm body temperature; meanwhile, their smaller counterparts can have trouble sucking/swallowing properly and often struggle to stay awake long enough to eat.
Believe me, the last thing a new parent wants is the added stress of a baby with feeding or breathing problems. No thank you.
Why so early?
The answer is quite simple: everyone’s interests are aligned; the mom (get this baby out of me!), the *OB (who’d just as soon schedule a c-section so as to not interrupt his dinner plans) and the hospital?
“For-profit hospitals make lots of money from NICU babies, especially the very sick ones,” said an administrator from a major children’s hospital who asked to remain anonymous. “It’s not that we WANT babies to be sick, but we do make an extraordinary amount of money from them, especially now with the increase in IVF in older women, multiple births, etc. And we’re not exactly deterring early deliveries.”
*Aside: I don’t mean to be hard on OBs. They work their butts off, but they ARE human and would – OF COURSE – prefer to deliver a baby during normal business hours than being up all night attending a long delivery. Wouldn’t you? Yes. Onward.
So who are the losers in this situation? Well, the BABY for one, who’s now in a plastic bubble in the NICU, isolated from his parents and missing out on crucial bonding and nursing opportunities. But also? Yup, you guessed it: whichever insurance company is footing the bills. Yet another perfect example of how people who don’t bear the direct cost of their medical care have no incentive to keep their costs low.
A Matter of Convenience
Let’s face it: scheduled C-sections ARE convenient. They’re convenient for moms, docs and hospitals.
“I was able to schedule my maternity leave, my parents coming into town, child care for our toddler, a dogsitter… everything,” said one woman in my mother’s group in San Francisco. “And at 38 weeks, frankly I was sick of being pregnant, so we just got it done! Plus, my OB was going on vacation the following week, so, yeah, we did it early”.
We all know darn well this is how it goes down. This is the reality of life these days.
Not only are c-sections being performed early, the same is true for inducements of vaginal deliveries. The fact is that inducing labor increases the risk that the mother will end up having a c-section. Unbeknownst to many, this can affect subsequent deliveries.
In one study of 7,800 first-time moms, those who were induced were twice as likely to end up with a c-section compared to those who went into labor naturally (Obstetrics & Gynecology, July 2010). In fact, more than 40% of all labor inductions end in a cesarean section.
Once a c-section, always a c-section
C-sections increase the likelihood of complications of subsequent deliveries. The fact is that once a woman has an initial c-section, it’s unlikely she’ll have a future vaginal delivery. This is mainly because many hospitals now refuse to perform VBACs (vaginal birth after cesarean) due to liability concerns and the high cost of full-time emergency surgical staff.
Furthermore, women who have multiple c-sections appear to be at risk of delivering prematurely and having life-threatening complications. In fact, doctors do not generally recommend voluntary c-sections to first-time moms who want to have large families.
Early c-sections and inducements can be very appealing for all involved parties, but may not be a smart idea. This decision can have a cascade effect on future pregnancies as well; so even if your OB is okay with an early c-section or induction, it may not be in your best interest.
Hang in there and keep ‘em cooking! Your baby will thank you.
Sign-up for DrGreene's Newsletter
About once a month we send updates with most popular content, childrens' health alerts and other information about raising healthy children. We will not share your email address and never spam.