An article in the January 22, 2013 Washington Post Health Section, “Health insurers crack down on preterm deliveries that are not medically necessary,” discusses the many reasons why inducing or planning a C-section before 39 weeks is a bad idea.
While most babies delivered at 38 weeks do not end up in intensive care, research shows they are more likely to have feeding, breathing, and developmental problems than those born at 39-40 weeks (Galewitz, Phil. “Insurers attempt to curb early deliveries” January 22, 2013, E1).
The article goes on to discuss financial implications for patients and doctors of early deliveries, but little more is mentioned about feeding issues. Difficulty establishing breastfeeding, however, is a significant health issue with life-altering consequences for both mothers and babies. A baby who gets off to a bad start with breastfeeding is less likely to be breastfed exclusively or for a biologically-appropriate length of time.
Does a week really make a difference, though? As a lactation consultant who has worked with thousands of mothers and babies, I can absolutely answer, “Yes!” While we may label 37 weeks+ “full-term,” as this article points out, anything before 39 weeks gestation is, in fact, early.
The earlier a baby is born, the more likely he or she is to be “sleepy” and difficult to arouse for feedings or inefficient at feeding. He or she then ends up at greater risk of developing jaundice and/or gaining weight insufficiently. This baby may not be able to adequately stimulate milk production, thereby down-regulating the supply which leads to further weight gain issues.
The article mentions an increase in all sorts of health issues for babies born before 39 weeks including respiratory issues. These health issues invariably affect a baby’s ability to feed. Mothers are then forced to try to pump to establish and maintain milk production until their babies are able to do this on their own. Pumping, even with a hospital-grade pump, is a challenging way to establish the milk supply. Unfortunately, many mothers will give up either out of exhaustion or a lack of confidence in their body to produce enough milk.
So if we know that inducing before 39 weeks is not a good idea, why does it happen so often? Sometimes there is a strong medical indication, and the risk is higher if the pregnancy is allowed to proceed. However, when hospitals in South Carolina were offered a financial incentive to decrease early deliveries, they were able to decrease early deliveries by 50% while they also decreased NICU stays! (E4). That is because many early deliveries are for convenience–the mother’s or the doctor’s. The mother may be uncomfortable, and the doctor says the baby is “ready” anyway. The doctor may have scheduled “induction” days and likes to keep to his or her schedule. Sometimes mothers are afraid that their babies are getting too big and the delivery will be more difficult if they wait.
There are many reasons why mothers and doctors may agree to induce or schedule an early C-section. From a breastfeeding perspective, however, these are a bad idea and anything but “convenient.” If you want to breastfeed, then don’t ask for or accept an induction or C-section before 39 weeks, unless there is, medically, no other choice. Better yet, let baby come in his or her own time, and don’t induce at all. According to the article, infant mortality is greater at 37-38 weeks than at 42+ weeks (Center for Disease Control and Prevention 2008) . In other words, it is usually safer to be overdue than to deliver early.
Don’t let convenience for the moment get in the way of your baby’s best start for life.