Early Elective Birth

Early elective birth refers to making a choice to have a baby before the time the baby is due. The length of a pregnancy is 9 months, or 40 weeks starting from the beginning of a woman's last menstrual period (LMP). Most women naturally go into labor around 40 weeks. A "full-term" pregnancy is considered between 37 and 42 weeks gestation age. Currently, early elective births can take place sometime after 39 weeks. Most caregivers practice within the guidelines of delivering a baby no later than 42 weeks and no earlier than 39 weeks. There are always exceptions to this time interval, and the risks involved to the mother and baby need to be considered in those cases.

Induction of labor refers to the use of medicines to bring  about  contractions. "Labor" is when the cervix starts to widen (dilate). "Active labor" is when there are contractions and the cervix has dilated to at least 4 cm. Often times, the earlier a mother is in her pregnancy, the longer it takes to get induced. When the cervix is ready (dilated and soft), an induction may take less than a day. However, when a cervix is far away from being ready (long, closed, and firm), it may take days in a hospital for labor to start.

Currently, 39 weeks is considered the earliest a caregiver should start the induction process. This is because the longer the baby stays inside the uterus, the lower the risks are to both the baby and mother. However, sometimes there are very good reasons for a pregnancy to be induced before 39 weeks gestation. These exceptions are specific to each individual pregnancy and need to be considered on a case-by-case basis. A good reason to induce one pregnancy  may not be good a good reason for another pregnancy.

REASONS FOR ELECTIVE BIRTH

It may be safer to induce labor before 39 weeks if:

  • A woman is carrying more than 1 baby. Current standards are to deliver twin pregnancies at 38 weeks.

  • A woman is having complications, such as:

  • High blood pressure caused by pregnancy (preeclampsia).

  • Bleeding.

  • Infection.

  • There are conditions affecting the baby's health, such as:

  • Intrauterine growth restriction (IUGR), where the baby is not growing well.

  • Having abnormal fetal heart rate patterns on the monitor (nonreassuring tracing).

  • Having a lack of fluid that surrounds the baby (oligohydramnios).

  • Having placental issues.

  • Fluid that surrounds the baby (amniotic fluid) is leaking. 

There are many other safety reasons that a pregnancy may need to be induced early.

REASONS AGAINST ELECTIVE BIRTH

Sometimes early elective birth is not the best choice. It may not be a good idea if:

  • An early birth is just more convenient.

  • You want the baby to be born on a certain date, like a holiday.

  • You are more likely to need a cesarean delivery before 39 weeks.

A cesarean delivery can lead to other problems. Problems include infection, bleeding, and not having enough iron in your blood (anemia), which can cause weakness.

Babies born early (34 to 37 weeks premature):

  • May need special care at the hospital or in a special care nursery.

  • Are at a greater risk for:

  • Brain damage.

  • Feeding problems.

  • Breathing problems.

  • Slow physical and mental development.

  • May need special care in a neonatal intensive care unit (NICU), but this is rare. The length of the baby's stay in the hospital will depend on how quickly he or she progresses to a safe level of care.

  • Are at a greater risk for:

  • Infection.

  • Bleeding inside the brain.

  • Dying during their first year of life.

REDUCING EARLY ELECTIVE BIRTHS

Carrying a baby longer than 42 weeks is not good for the baby or the mother. A full-term pregnancy is best for baby and mother. Anything earlier can be risky for you and your baby. Remember:

  • An early elective birth may lead to a cesarean delivery. This can lead to other problems for the mother and baby.

  • An early elective birth can result in developmental problems for your child.

  • A baby's brain continues to develop while in the uterus.

  • A baby's body continues to develop. The baby will be better able to breathe and eat when he or she is born near the due date.

  • A baby who stays in the uterus longer responds better. The baby will also bond better with you.