Scheduling Birth
Is This a Good Option for Me?

“My husband will be back from Afghanistan for just two weeks, so we want to schedule the baby to come while he’s home.”  “My doctor said the baby is getting really big, so we are going to induce this week.”  “I feel so huge and uncomfortable!  The doctor said it’s ok if I want to have the baby just a little early.”  “We are scheduling the c-section; I can plan my maternity leave that way.”  “My doctor wants me to deliver on his shift, so we are scheduling it.” 

All of these statements have been used as non-medical, or “soft”, reasons for inducing labor early or scheduling a c-section.  While we understand a mother’s desire to be comfortable; or a doctor’s desire to deliver a baby while he’s on shift, these “soft” reasons don’t take into account the needs of the baby.  Regardless of why you schedule early, there are serious risks involved in any early delivery.

So, what do we mean by early?  According to a 2008 study 51.4% of women polled choose 34-36 weeks gestation as safe for delivery but only 7.6% selected 39 to 40 weeks as full term.  The right answer – full term is defined as between 38-42 weeks gestation. This shows a strong need to further educate women to help protect the health of their babies. 

Due dates are based on your last menstrual period.  They give us a ballpark estimate, not an exact date.  In fact, only 5% of babies are born on their due dates! So saying baby is “late” if you are 40 weeks 2 days is not correct.  You are considered “late” or “post-dates” after 42 weeks gestation. Even if you schedule your birth for your due date, you can still have a baby who is 38 weeks gestation, rather than 40 weeks.

All of the reasons listed above are non-medical reasons, and therefore should not be used to schedule birth. The most common non-medical reason is “big baby."  Ultrasound estimated fetal weight is notoriously inaccurate. Some studies show the inaccuracy to be as much as 1.5 lbs more or less than what the baby actually weighs. The other considerations with “big baby” are baby’s head size, baby’s position in the womb and the shape and size of mom’s pelvis.  These multiple factors influence whether or not baby is “too big to fit." By only looking at one aspect of size and position, there simply isn’t enough data to determine that baby is “too big."  Therefore, “big baby” is not a valid medical reason for a scheduled birth.

So, what is a good reason to schedule birth?  There are certain medical indicators for an early scheduled birth. They are:  maternal medical conditions, preeclampsia, problems with the placenta, fetal compromise (problem with the baby), infection and overdue (42 weeks). These and other medical indicators for a scheduled birth will be assessed and determined by your doctor or midwife. 

What are the risks with scheduling an early birth?  In August 2009, the American Congress of Obstetrician and Gynecologists (ACOG) changed their recommendations for scheduled births to no earlier than 39 weeks gestation.  This is because babies’ lungs aren’t often fully developed until 39 weeks.  It’s also been determined that a 37 week baby has the same risk of complications as a 34 week baby, with regards to lung and other organ development, hearing problems, vision problems, feeding issues, low birth weight, and brain size.  Although relatively rare, the risk of newborn death is 50% higher in those babies born before 39 weeks.  So it is important that, barring medical complications, babies come on their own schedule. 

All of this leads us to Lamaze’s Healthy Birth Practice 1: Let Labor Begin on Its Own

When labor begins on its own, at term, we know that your baby, your uterus, your hormones and your placenta are all ready.  This is one of the best ways to prevent unnecessary medical interventions, and avoid a c-section.  It also helps a mom to have more confidence in her own body’s ability to birth the baby. 

Many hospitals around the country are now banning scheduled birth before 39 weeks.   Hospitals in Colorado, Arizona, Oregon, Utah, and Illinois are sharing in the campaign by the March of Dimes to end premature birth.  It is important to understand that the choice to have an early scheduled birth is not just driven by the mother.  In many cases, it is the care provider who suggests an early birth.  So you should fully understand the medical reasons behind an early scheduled birth.  It is also important for a mother to advocate for herself and express her concerns regarding an early scheduled birth to her doctor or midwife. 

If you have a valid medical reason to schedule an induction or a c-section, then you can be confident you are making an appropriate choice by weighing the risks of prematurity against the risks of the current health situation.  If you have a “soft” reason for scheduling your birth, such as convenience for you or your care provider, you may wish to reconsider to preserve the health of your baby.  Ultimately, the decision to schedule your birth, or to let labor begin on its own, should be a mutual one between you and your care provider. 

Editorial provided by Deena Blumenfeld RYT, RPYT, LCCE, a prenatal yoga instructor, Lamaze Certified Childbirth Educator and owner of Shining Light Prenatal Education, LLC.

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