SHOULD I SCHEDULE MY BABY’S DAY OF BIRTH?
The due date for a baby’s birth is forty weeks from the first day of the woman’s last normal menstrual period, however can range between 37 weeks and 42 weeks and still be considered normal. If the menstrual dates are not certain or not known, an accurate due date is given by an ultrasound done during the first 20 weeks of pregnancy.
However it has become more and more common that women and/or their doctors are choosing delivery dates which are earlier than the 40 week due date. The planning of when a baby is born is becoming a rather routine and casual topic to discuss during prenatal care. Labor induction (using drugs or other methods to start or induce labor) and Cesarean sections are now often scheduled in advance. Here are some things to think about before you decide that you want to schedule the day your baby is born, rather than wait for labor to begin on its own.
There is growing evidence from many sources that babies born more than one week before the due date are more likely to have problems than are infants who are born at and later than 39 weeks. The types of problems for newborns born before 39 weeks include infection, breathing problems, low blood sugar, seizures. or bleeding into the brain. The more time a newborn spends in a Neonatal Intensive Care Unit (NICU) or in a nursery with special care, the more difficult it is for the baby to start and to continue breastfeeding.
There are two ways to plan a baby’s day of birth: by planning to induce labor or by planning to have a repeat Cesarean birth (for women who have already had a baby by Cesarean). If it is a choice by the woman or the doctor to induce labor without a medical need (called elective), or even if there is a medical need to deliver the baby, induced labors more often end in Cesarean deliveries than do labors which start on their own. This is especially true for women giving birth for the first time. A 2009 statement by the American Congress of Obstetricians and Gynecologists indicated that the benefits of inducing labor must be weighed against the risks to both mother and baby when this approach to delivery is used.
Rates of labor induction have more than doubled from 1990 to 2007 in the U.S. In the years 1996-2007 in the U.S., the rate of Cesarean birth rose by 53%. So by 2007, nearly one-third (32%) of all births in the U.S. were Cesarean births (NCHS Data Brief No. 35, March 2010). This is the highest Cesarean birth rate ever reported in the United States. Cesarean delivery is major surgery and thus has higher rates of complications for mothers than does a vaginal birth. As the number of Cesarean births for any one woman increases, so do the rates of complications increase with each delivery, particularly problems with the placenta (afterbirth) and where it grows within the uterus (womb). These problems are dangerous for both mother and baby. Some of these problems end in emergency removal of the uterus (hysterectomy). In 2010, the American Congress of Obstetricians and Gynecologists issued a new statement about having a vaginal birth after Cesarean (VBAC). There is good evidence that most women who have had one Cesarean delivery may safely have a VBAC if the scar on the uterus is the type which allows for a safe labor (low transverse scar). Labors which start on their own and do not include Pitocin (drug to strengthen labor pains) end with successful VBAC more often than labors induced or assisted with Pitocin. Women who have had a vaginal delivery in the past also have a greater chance of a successful VBAC. Success rates for VBACs range from 60-80%. Women giving birth for the first time should especially try to avoid labor induction. Having a Cesarean delivery can also affect the success of breastfeeding, since it is harder to begin nursing after major surgery.
In planning for this pregnancy, you are also making decisions which will impact the health and course of all future pregnancies. Sometimes you have to talk to more than one doctor if you want to find one who will help you to have a VBAC instead of another Cesarean. If you want more information, a good resource is available online at: www.childbirthconnection.org/cesareanbooklet/
The booklet has been endorsed by over 30 organizations.