Fewer moms having C-sections before 39 weeks
Research indicates that delivery should not be scheduled before 39 weeks of gestation, the CDC says.
April 10th, 2013
03:53 PM ET

Fewer moms having C-sections before 39 weeks

Moms can be convinced to change their minds about having their babies before they are at full term, according to a study released this week in the journal Obstetrics & Gynecology.

For years, medical groups have been encouraging moms to wait until their baby has remained in utero for 39 weeks. At the same time, the number of women choosing to induce labor or have an elective cesarean section for nonmedical reasons has been rising.

Just last month, the American College of Obstetricians and Gynecologists reiterated its recommendations, encouraging moms to avoid early elective deliveries.

The study

Twenty-five hospitals in California, New York, Florida, Illinois and Texas implemented what's called the Big 5 State Prematurity Initiative, a program that used a tool kit designed to help hospitals eliminate elective deliveries of babies before 39 weeks of gestation unless medically necessary. Thirty-eight percent of births in the United States occur in these five states.

In just one year, there was a remarkable decrease. "These 25 hospitals overall saw an 83% drop in early-term deliveries," said Dr. Edward McCabe, a pediatrician and medical director for the March of Dimes Foundation, which developed the tool kit and partly funded the study. In January, nearly 28% of babies were born at 37 or 38 weeks, but by December, that number had dropped to 5%. There was a corresponding increase in births at 39 to 41 weeks, McCabe said.

This table shows the drop in early-term deliveries.

A cultural change has to occur for more hospitals to help mothers wait just a little longer, he said. With this tool kit, labor and delivery nurses were empowered to tell moms-to-be if there was a medical reason to deliver the baby before 39 weeks.

Why women deliver early

Often it can be a matter of convenience. A doctor may be going out of town, and the mother may want to ensure that doctor delivers her baby. Or grandma and grandpa may be coming a little earlier than the due date. Some couples may even try to have their baby before the end of a year, so they can claim a tax credit.

They may think that it's OK, because they've been told or have heard that 37 weeks of gestation is full term.

What is full term?

"It wasn't until recently that we recognized that there are more complications and mortality at 37 weeks," McCabe said.

"Important growth and development occur throughout pregnancy - all the way through the final few weeks," according to the Centers for Disease Control and Prevention. "If the mother is healthy, current research indicates that delivery should not be scheduled before 39 weeks' gestation."

According to a 2007 CDC study, infant mortality risk for babies born at 37 or 38 weeks is 1.5 times higher than babies born at 39 to 41 weeks.

"That's a 50% higher risk of infant mortality," McCabe said. Mortality at 39 to 41 weeks is very low, he said.

In 2009, researchers showed that delivering a baby a week or two before 39 weeks, or even three or four days before that milestone is reached, can have a significant impact on the child's health. For one, babies need every extra day for their lungs to mature.

McCabe said he hopes more hospitals will consider banning elective inductions and C-sections unless medically necessary. One way for this to change is to make it clearer what full term really is.

"The nomenclature is changing," he said. "Thirty-seven and 38 weeks are now considered 'early term.' It's not yet official, but there is a movement toward calling 39 to 41 weeks full term. It's in the literature; people are using it."

It's hard to say exactly how many women choose to induce labor before 39 weeks. In 2008, 23% of babies were born because the mother's labor was induced, according to the American College of Obstetricians and Gynecologists. It's unclear, however, how often labor was induced before full term, as the data is gleaned from medical records that don't specify at what gestational age a baby is born.

Data from a 2006 report from the National Institutes of Health found an estimated 2.5% of all babies in the United States were delivered by C-section at the mother's request.

For more information, click here to visit the March of Dimes.

soundoff (27 Responses)
  1. J Walker

    THAT is a BABY!

    April 10, 2013 at 18:38 | Report abuse | Reply
  2. KS

    I had to have a c-section due to failure to progress in labor (24 hours after water broke, only 3cm dilated). It was what I wanted least. I can't imagine volunteering to have your baby CUT out of you at any point if you didn't have to. Glad they're finally pushing back on this, do what's best for the health of mother and baby!!

    April 10, 2013 at 20:54 | Report abuse | Reply
  3. dyfts

    There is no data here showing that the reduced pre-39 week delivery rate increased infant outcomes for this population. They showed statistics from other populations, but not this one. If women who had mitigating factors were encouraged to hand onto a pregnancy longer, there could actually have been poorer outcomes in this population.

    I really don't understand who is getting induced or having an elective C-section early anyway. This doesn't make sense. But pressuing a woman to hang onto a pregnancy at 37 weeks when she is having complications is dangerous. This whole idea of 40 weeks is term is just and estimate anyway, and different races have slightly different gestation rates and studies have even showed that boys and girls have slightly different gestation rates. This one-size-fits all medical care does not help patient health.

    April 11, 2013 at 09:00 | Report abuse | Reply
    • whorhay

      Just curious if you actually read the study? This is after all just an article written about the study by a reporter that is going to pick and choose what they include and may not be enough of an expert in the field to know what all is relevant.

      I think the article was pretty clear though in that this is about situations where it is not medically necessary to induce or have a csection. 40 weeks is actually the average, give or take a couple weeks. So a significant percentage of babbies should be born in the 38th and 39th weeks, although the same should be true for the 41st and 42nd weeks. Personally I was a 44th week baby, such a thing today is pretty much unheard of as most OB's will start pushing for interventions after the 40th week, if they let you go a day over 40 weeks that is.

      April 11, 2013 at 09:25 | Report abuse |
  4. Karen

    I wish they'd written about what triggers labor naturally–the baby does! When his or her lungs are fully mature, a chemical is produced that induces labor. In addition, baby's develop their iron stores for the first year during those last weeks. If more parents knew these things, then I think they'd be less eager to force an early delivery.

    April 11, 2013 at 09:01 | Report abuse | Reply
    • Karen

      Sorry, meant to say babies not baby's–time for coffee!

      April 11, 2013 at 09:04 | Report abuse |
  5. EastCoast trapped Inland

    How frequently does this truly happen? I've heard of moms electing to give birth 3 weeks early (at 37 weeks), but I've never known someone who actually did this. Whether or not it's frequent, I think we should be careful when using the term "elective." A friend of mine came to find out that her c-section was noted as "elective" in her medical records (resulted in a struggle with her health insurance company). Her doctor had noted it as elective because after being given all the possible outcomes of her very unexpected, but medically necessary, early delivery, she and her doctor conceded that a c-section had the best possible outcome. So according to her records, she elected to have a c-section at 34 weeks. And yes, her records state the medical necessity for the decision, but just that word "elective" apparently triggered red flags for the insurance company, regardless of the rest of the information. Does this research noted in the article also make the same mistake? In other words, how often does it truly occur that a mom elects an early induction or c-section without some sort of medical necessity?

    My twins were born by c-section at only 28 weeks. I would have given anything to keep them in utero for at least 37 weeks. I can't imagine a mom choosing to evict baby(ies) before they're ready without reason.

    April 11, 2013 at 09:47 | Report abuse | Reply
    • cali girl

      It was a Hollywood thing for a minute. Christina Aguilera was one, something about "less damage to her body" if she could have the baby early. A few did this following the same guidelines.
      What needs to change is the patient taking over their health decisions and let the Doctors do their work, what they went to school for and trained for years to do.

      April 11, 2013 at 14:10 | Report abuse |
  6. Erin

    I also have never heard of or known anyone who elected to be induced at 37 weeks. I don't know of any doctor who would do that. It seems much more common for women to be induced because their doctors tell them they are overdue or looking at big babies. I agree that it's really the baby who should decide when to make an appearance unless there is REAL indication that induction is medically necessary. I went into labor with my first daughter without induction right at 37 weeks and my baby was clearly ready to be born - she took just 3 hours of labor and weighed 7 lbs, 6 oz. I just think due dates are pretty loosey goosey and she was ready. Makes me wonder though - what if her due date had been off three weeks in the other direction, and she was induced at 40 weeks? She'd have been born too early. I say let baby do the talking unless he/she/mom is in medical distress.

    April 11, 2013 at 15:16 | Report abuse | Reply
  7. PregoLady

    I am 33 weeks pregnant and I'm being induced at 37 weeks but for medical reasons. I've had chronic leukemia for the past 3 years and it is in my best interest to have the baby ASAP with minimal risks to the baby so that I can get back on my meds since my leukemia has returned. As other have said, the study and this article need to do a better job with the definition of "elective." Yes, I am technically "electing" to have my baby at 37 weeks as a could I technically go to 39, however there are severe consequences to my health if I don't deliver sooner than later. And yes, 2 to 4 weeks does make a big difference in the treatment of my cancer.

    Studies and articles such as this need to do a better job of distinguishing why some one would choose this instead of attempting to lump everyone in a single category. That's just my 2 cents for whatever it's worth...

    April 12, 2013 at 10:16 | Report abuse | Reply
    • ahayesCNN

      Thanks for your comment. By "elective" the study authors - and we - did not mean those who opt for a C-section for medical reasons. We attempted to make that clear. Sorry if it wasn't. Good luck to you and your baby. Ashley H., CNN

      April 19, 2013 at 16:03 | Report abuse |
  8. Christine

    On a side note, I would also question what is in medical records. They don't even have the time of my first son correct in there. My first was an emergency c-section at 41 weeks. It was after over 30 hours of labor (water broke at the beginning), and finally, a lowering fetal heart rate. When my husband asked for clarification on something, they listed him in the medical records as being resistant to the c-section. Just because he asked a question. I noticed they didn't put in the part where they initially thought the heartrate had dipped, but it was because their monitor had fallen out.

    I wanted to have a VBAC for my 2nd, but it was clear that OBs would not let me go past my due date (gestational diabetic – the only reason my first was born a week late was because my OB was more laid back and knew that my numbers were under control so he wasn't as stressed as many typical American doctors – he was from another country). Anyway, my OB wouldn't let me go past my due date bc of the gestational diabetes. And then later, I was annoyed that my c-section was labeled as "elective" when it was not what I would have picked. (And they would not induce because of the prior c-section.)

    April 12, 2013 at 12:36 | Report abuse | Reply
  9. D

    I had my baby at 37 weeks. The c-section was not elective but I fought for that date. My previous pregnancy ended in a stillbirth at 39 weeks. I wanted my baby ALIVE at 37 weeks (whatever other consequences there might have been) rather than dead at 39.

    April 12, 2013 at 13:33 | Report abuse | Reply
  10. AbbyJ

    I went to an OB office that had multiple doctors on staff. More than a week before my due date, one of the doctors wanted to already schedule my induction for the day after my due date, just in case I hadn't had the baby by then! No medical reason, the only reason was the date.

    Luckily the doctor I considered to be my main doctor was supportive of me waiting to go into labor naturally. My baby was born 6 days "late" (40 weeks 6 days), I was prepared to go as long as they would let me without inducing, the maximum allowed would have been 42 weeks.

    Women should realize 40 weeks is the AVERAGE, not a magical number. And according to Harvard, it should be 41 weeks 1 day, not 40 weeks. If there's no medical reason to induce, let the baby come when he/she is ready!

    April 19, 2013 at 10:55 | Report abuse | Reply
    • AbbyJ

      And yes, I realize this article was about c-sections, but being induced increases the risk you'll have a c-section.

      April 19, 2013 at 10:57 | Report abuse |
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