Archive | May 2012

If an Induction or Planned Cesarean is needed, When is a good time to schedule it?

Needing to schedule an Induction or Cesarean for medical reasons?

 

This info might help you and your baby …

 

Different doctors and midwives have different dates they think are appropriate for scheduling a planned cesarean or  induction – usually around 38 or 39 weeks in pregnancy. Most people have been told that babies have done most of their development by about 37 weeks, so inducing or scheduling a cesarean at 38 weeks is no big deal. The reality tells a different story.

The number of babies admitted to neonatal nurseries for problems of prematurity has been steadily increasing along with the increasing rates of inductions and cesareans done before labour can start on its own. Babies induced or cut out at 38 weeks are more likely to have problems than babies induced or cut out at 39 weeks. If planning a cesarean for medical reasons, it`s even better to wait til labour starts naturally on its own and then do the cesarean because then you can be totally sure that it is ready to be born. Of course, that may not fit neatly into obstetricians schedules, so you may have to be a bit more determined to make that happen if that`s what you decide.

In the natural process of birth, labour starts on its own when both mother and baby are ready. Normally, baby will send mom hormone signals when all the systems in the baby are fully developed for life outside the womb – eyes, lungs, brain, liver etc. and it is ready to be born. When mom is feeling ready for birth, her body will also produce hormones that can trigger the start of labour. So both of these hormones need to be present for labour to begin – mom`s and baby`s.

We all know about problems of severe prematurity, but what this article is about is called Late Preterm. That means that baby is past 37 weeks gestation, but it is not yet fully ready to be born. It may have a higher chance of having respiratory problems at birth, asthma later in childhood, eyesight problems in childhood, smaller brain size, lower birth weight, increased risk of severe jaundice (when the liver cannot cope with processing the blood), and breastfeeding difficulties.

Because doctors have believed that inducing or scheduling cesareans at 38 weeks was safe, the rates have skyrocketed. But a new study has confirmed what many believed – that 39 weeks is safer. Read Ohio Hospital moves induction dates to 39 weeks. The study shows how changing hospital the hospital policy of a safe date for inductions or planned cesareans to 39 instead of 38 weeks prevented approximately 500 admissions to neonatal intensive care units and 34 infant deaths. In addition, this project has saved approximately $27 million in health care costs through avoided NICU (neonatal intensive care unit) admissions. 

Of course, the safest option is to wait for labour to start on it`s own, but there may be some medical situations where waiting may pose risks as well, for example high blood pressure, pre-eclampsia, Cholestatis etc. In these situations, to make a decision, you have to weigh the risks and benefits of each option. What are the risks of waiting compared to the risks of early induction. high blood pressure, for example, may not carry as serious risks as pre-eclampsia, and so you may want to wait longer if an induction is recommended, preferable past 39 weeks. You can still get regular fetal monitoring done to make sure baby is still doing fine.

Tips to help you make an informed decision

If your doctor or midwife is suggesting scheduling an induction or a cesarean, you can ask these questions :

1. Is this really necessary?

Now that you know the risks of causing your baby to be born before it is ready, is it worth it? Do you really have a serious problem that can justify the risks of induction or cesarean? You would be surprised how many are done for non-serious issues eg. past 40 weeks, mom is 40 years old and so is considered old, mum has borderline high blood pressure, suspected gestational diabetes and many more reasons. These may not be serious issues. Have a discussion with your care provider and find out more information.

2. If you have determined it is necessary, can it be delayed as long as possible, with regular monitoring of baby`s heart rate to make sure it is still doing well?

3. If planning a cesarean, is your doctor willing to wait till your labour naturally starts on its own? If not, are you willing to change doctors?

4. If that is not possible, State that you would like the procedure to be done past 39 weeks instead of 38 weeks. 

This information may very well save you and your baby a lot of unnecessary stress and problems. I hope you have found this useful. If you have any questions or comments, please leave them in the box below, or contact me at 604 809 3288.