Obstetricians Change Definintion of Full Term

angiek1

https://news.yahoo.com/obstetricians-change-definition-time-delivery-014921022.html

Here are the highlights:
A group of U.S. doctors is now separating deliveries that happen during that span in an effort to improve newborn health.

• Babies delivered between:
• 37 - 39 weeks considered "early term,"
  
• 39 - 41 weeks is "full term"term"
• 41 - 42 weeks is "late term."
• 42 weeks or later is "post term."
• A growing body of research has found babies born before 39 weeks are not as developed as those born later.
• The brain grows by about a third between week 35 and week 39 of pregnancy, according to The College. And a layer of fat to help keep the body warm is added during the last weeks of pregnancy.
• There's also hope the new definitions will help curb the number of women who choose to have an elective delivery for non-medical reasons. The College recommends against induced labor or cesarean section before week 39 of pregnancy.

SOURCE: https://bit.ly/1ibumWD Obstetrics and Gynecology, online October 22, 2013.

I thought this was a very interesting article. I plan to discuss this with my OB at our appointment in 3 weeks. I'm curious is this will become adopted as the norm or if my doc will say that she thinks 37-40 weeks is FT.

If you are looking for some interesting articles to read the actual Journal (use the source link) has a handful of interesting entries.

sugarland726

I think this is a good idea, especially considering how many women don't have an actual clue when they ovulated and therefore conceived. that can make a huge difference in actual fetal age.

PreDempsey

I was just reading this. I think it's great if it will help deter people from inducing early for non-medical reasons.

ac1259

Yeah my doctor mentioned that they were looking into pushing "term" back when we were talking about how early DD was (36 weeks) Hopefully it will help people to not try and induce early without a medical reason!

Deblondie1

I saw this on FB and thought "Awesome!" I don't think it'll deter some of the women who complain after 37 weeks but you can't really fix stupid. I'm excited that there are clear guidlines coming out though, about how important those last few weeks really can be to baby's brain development.

ScarlettDahlia

Glad that they are changing this!

In my MW's office, they have that WomanTV on and there is one "episode" or whatever they are called where they talk about not delivering before 39 weeks unless absolutely medically necessary because of all the development that happens in those last few weeks. 

I always think it's crazy when people are hoping baby will come weeks before their EDD. Not just in a "I'm tired of being pg!" way ... more of a "I'm going to try all the old wives' tales to try make LO come even though I'm not due for another month"

salsamommy

I also agree with the change!! I was 41 weeks when I went into labour with DS and he was a healthy 8lb 4oz!

angiek1

ScarlettDahlia said:

Glad that they are changing this!

In my MW's office, they have that WomanTV on and there is one "episode" or whatever they are called where they talk about not delivering before 39 weeks unless absolutely medically necessary because of all the development that happens in those last few weeks. 

I always think it's crazy when people are hoping baby will come weeks before their EDD. Not just in a "I'm tired of being pg!" way ... more of a "I'm going to try all the old wives' tales to try make LO come even though I'm not due for another month"

Yeah - I really hope that putting the info out there will make women wake up and smell the coffee.  My sister always tried to get her doctor to induce her early and it drove me nuts.  I mean I am excited to meet LO, but I want her to cook until I am FT. 

sugarland726

KaitiMac said:

Yay, OB's! I do not understand why women would want their babies to be born before full-term if it's not medically-necessary. Let nature take it's course so that baby can develop as long as possible!

Not to pull the BTDT card, but the last few weeks of pregnancy suuuuuck. Every morning I woke up and thought, "Damn. Still pregnant." And I wasn't even overdue. It's painful and frustrating. You're not sleeping well, or eating well. Everyone is calling you to find out if you delivered yet. It's a very frustrating period of time. So I see why people want to do things early, but FFS, it should not be done before the baby is done developing.

Unknown

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angiek1

wilburbud said:

Unfortunately this is just one groups recommendation.  Until CMS and insurance companies jump on ship, they likely wont alter their practices.  Most physicians will not deliver before a certain point due to lack of reimbursement (sad, isnt it?)

That is sad.

mommabird77

This is great.  I know that many federal and state run health insurance programs have started to reduce payments for any deliveries done before 39 weeks gestation that are not considered medically necessary.  Unfortunately, it seems some doctors need to see a decrease in dollar signs to do the right thing.

*Editing because that should say induced deliveries, not just deliveries.

bethughknee

sugarland726 said:

KaitiMac said:

Yay, OB's! I do not understand why women would want their babies to be born before full-term if it's not medically-necessary. Let nature take it's course so that baby can develop as long as possible!

Not to pull the BTDT card, but the last few weeks of pregnancy suuuuuck. Every morning I woke up and thought, "Damn. Still pregnant." And I wasn't even overdue. It's painful and frustrating. You're not sleeping well, or eating well. Everyone is calling you to find out if you delivered yet. It's a very frustrating period of time. So I see why people want to do things early, but FFS, it should not be done before the baby is done developing.

What sugar said. The last time I was pregnant, I remember having a harder time remaining "selfless" those last couple of weeks. I remember saying over and over that I was just getting fat for someone else and I wanted time to pass quicker so I could just STOP. I had dreams EVERY NIGHT about things like bikini shopping, laying on the beach with no belly, etc. and then I'd wake up and just stare at my bump with dagger-eyes. I never asked to be induced or anything but I think this time might be a little easier since I have a supportive SO who can remind me how important the last uncomfortable period is when I am feeling stabby and over cooked.

LimeDrops

I noticed that my office had put up a poster this week illustrating the difference in brain development from week 35 to 39. Even as someone who already knew the last weeks are important, it still surprised me that the difference was that pronounced. I admit that when I was pg with my 10lb DS, I was completely miserable and begged to be induced at my 40w appointment, but my office will not induce before 41w without medical indication (they underestimated his size on u/s so they didn't see that as a factor).

mommabird77

wilburbud said:

Unfortunately this is just one groups recommendation.  Until CMS and insurance companies jump on ship, they likely wont alter their practices.  Most physicians will not deliver before a certain point due to lack of reimbursement (sad, isnt it?)

CMS has actually ruled that deliveries before 39 weeks gestation without medical necessity should get reduced payment.  I do know NY has taken action on it, not sure if it has been completely mandated yet.

jhunter89

I think this is awesome! Especially labeling 39-41 as 'full term' and 41-42 as 'late term.' I hope it will change some women's thinking as they get close to the end and want to start harassing their doc for an unnecessary induction. Yes, going past your 'due date' can be frustrating, but you're not really overdue until 42 weeks. 

KatelynEA90

I think this is great!
I get unreasonably irritated when I see a 37 weeker say they are full term so they can have baby now.

2Dash

By this definition my DS#1 would be considered "early term".  I was induced 12 days early for medical reasons and he was born 9lbs 4oz and perfectly healthy!

I wouldn't do anything to induce early as the health of baby comes first (and really those last few days are just painful!) but at the same time I feel this gives ammunition to people who want to criticize you for going early or having a c-section.

Having a full-term healthy baby is the goal but things happen and I can't tell you how many people told me that no one "needs" a c-section and comments like that with DS#1.  It was hard to tell myself that I did all I could and not to feel guilty. 

I hope everyone carries to term and has happy healthy babies but in the end sometimes you just need to know you did the best job you could do. 

SweetPeaKate

I love that "full term" term really goes to 41. AND I like that it is late term...not overdue. Lets put it in terms of cooking maybe...Its like saying: warmed through, lightly browned, cooked throughout, and well done.

Winnieella

I think this is great! I think it is important to let the baby come naturally since as Sugar said, most women don't know when the conceived. That being sad, I am a FTM and have no idea how I will be at the end of my pregnancy. 

MiaMyPuggle

I kind of feel bad that I scheduled my c section at 39w, 1d now. I hope everything is good with no issues.
DS was breech and I had a CS at 39w, 3d and he was as healthy as can be.
Oh well, my dr doesn't like to be too close to 40 weeks with a RCS so as not to go into labor beforehand. The hospital doesn't allow VBACs.

BuckeyeANG

I didn't realize there are doctors who will allow an elective induction prior to 39w. My OB will induce beginning at 39w if the cervix is favorable, but not before then (unless there is a medical reason, of course).

shortstuff15

KatelynEA90 said:

I think this is great! I get unreasonably irritated when I see a 37 weeker say they are full term so they can have baby now.

I don't know if you are a BTDT mom, but for myself personally I have said this because those last couple of weeks, like sugarland said, suck.  Did that mean I was going to ask my doctor to induce me or do things to get myself into labour?  No.  It just meant that I was personally done and if this baby wanted to surprise me by coming early, I was all game.

quidditchcapn1120

Like other STMs+, I want to point out that until you have been 41 weeks pregnant, don't judge too much.  The last few weeks of pregnancy aren't real fun.  I had a double ear infection, one of my eardrums ruptured, I got mastitis, followed by a massive yeast infection since I had been on antibiotics so long for the ear infection and mastitis, and then I ended up with gestational cholestasis (which causes terrible itching).  Never mind that you are uncomfortable anyway, can't sleep, and I was contracting all the time just not making progress.

Did I ask to be induced?  No, I ended up being induced at 41 weeks for medical reasons.  Would I have been ok with delivering naturally at 39 weeks?   Yes, I would have loved to miss out on that miserable last few weeks.

angiek1

quidditchcapn1120 said:

Like other STMs+, I want to point out that until you have been 41 weeks pregnant, don't judge too much.  The last few weeks of pregnancy aren't real fun.  I had a double ear infection, one of my eardrums ruptured, I got mastitis, followed by a massive yeast infection since I had been on antibiotics so long for the ear infection and mastitis, and then I ended up with gestational cholestasis (which causes terrible itching).  Never mind that you are uncomfortable anyway, can't sleep, and I was contracting all the time just not making progress.

Did I ask to be induced?  No, I ended up being induced at 41 weeks for medical reasons.  Would I have been ok with delivering naturally at 39 weeks?   Yes, I would have loved to miss out on that miserable last few weeks.

As a STM I only judge those who get induced for NON medical related issues. The article calls out that induction for medical reasons is clearly a different story. But I think it is good that information like this gets out there. I like being reminded why LO needs to cook.  I hated my last 6 weeks of pregnancy with DD, but reading articles like this remind me why it was good she cooked for as long as she did.  I was induced at 40.5 weeks b/c of medical reasons. 

I don't think women who get induced at 39 weeks (or even earlier) for medical reasons are making a bad decision. At the end of the day each pregnancy is different and people have to make the best decision for their health and for the health of their baby.

JaneW2

This is a good idea, but, here's my but.

The thing is, truly elective early inductions/sections get a lot of media attention, but are actually pretty darned rare.  The other thing is, babies born at 36-38 weeks are more likely to require special newborn care or a few extra days in the hospital, but I haven't seen evidence that they are more likely to die or have serious long-term problems.

These guidelines risk discouraging MEDICAL early deliveries, and sometimes the delay can actually be more dangerous than being born a bit early!  When you've got a situation like our Kvochka, with threatened labor really really early, it's in the baby's best interest to delay birth as long as possible.  Those three extra weeks of gestation that Jacob got possibly saved his life, and definitely made a big difference to his future.

However, since the whole "no deliveries until 39 weeks" thing, there have been a few cases of serious, probably avoidable, harm to mother or baby when labor or complications appeared between 36 and 39 weeks and doctors played that same delaying game.  By 37 weeks, if the baby really WANTS to come out, it's probably safer to let him!

So yeah, no truly elective deliveries before 39 weeks.  But cutting payment or setting up overly strong policies against late preterm delivery might actually make babies LESS safe.

indiana101

JaneW2 said:

This is a good idea, but, here's my but.

The thing is, truly elective early inductions/sections get a lot of media attention, but are actually pretty darned rare.  The other thing is, babies born at 36-38 weeks are more likely to require special newborn care or a few extra days in the hospital, but I haven't seen evidence that they are more likely to die or have serious long-term problems.

These guidelines risk discouraging MEDICAL early deliveries, and sometimes the delay can actually be more dangerous than being born a bit early!  When you've got a situation like our Kvochka, with threatened labor really really early, it's in the baby's best interest to delay birth as long as possible.  Those three extra weeks of gestation that Jacob got possibly saved his life, and definitely made a big difference to his future.

However, since the whole "no deliveries until 39 weeks" thing, there have been a few cases of serious, probably avoidable, harm to mother or baby when labor or complications appeared between 36 and 39 weeks and doctors played that same delaying game.  By 37 weeks, if the baby really WANTS to come out, it's probably safer to let him!

So yeah, no truly elective deliveries before 39 weeks.  But cutting payment or setting up overly strong policies against late preterm delivery might actually make babies LESS safe.

Huh? If babies 'want' to come as you worded it, they will. If they need to come for medical reasons, I can't imagine any medical professional not going ahead with that, especially when the policies talked about are for non-medically necessary inductions.

JaneW2

indiana101 said:

JaneW2 said:

This is a good idea, but, here's my but.

The thing is, truly elective early inductions/sections get a lot of media attention, but are actually pretty darned rare.  The other thing is, babies born at 36-38 weeks are more likely to require special newborn care or a few extra days in the hospital, but I haven't seen evidence that they are more likely to die or have serious long-term problems.

These guidelines risk discouraging MEDICAL early deliveries, and sometimes the delay can actually be more dangerous than being born a bit early!  When you've got a situation like our Kvochka, with threatened labor really really early, it's in the baby's best interest to delay birth as long as possible.  Those three extra weeks of gestation that Jacob got possibly saved his life, and definitely made a big difference to his future.

However, since the whole "no deliveries until 39 weeks" thing, there have been a few cases of serious, probably avoidable, harm to mother or baby when labor or complications appeared between 36 and 39 weeks and doctors played that same delaying game.  By 37 weeks, if the baby really WANTS to come out, it's probably safer to let him!

So yeah, no truly elective deliveries before 39 weeks.  But cutting payment or setting up overly strong policies against late preterm delivery might actually make babies LESS safe.

Huh? If babies 'want' to come as you worded it, they will. If they need to come for medical reasons, I can't imagine any medical professional not going ahead with that, especially when the policies talked about are for non-medically necessary inductions.

I'm referring to women who go into labor at 36-38 weeks and are given drugs to delay labor.  Yes, it happens, and it may or may not be a good idea.  This sometimes is good for the baby, but it can increase the risk of stillbirth.

The guidelines are supposed to only deal with elective early inductions or sections, but some doctors are taking it a bit too far.

[Deleted User]

JaneW2 said:

This is a good idea, but, here's my but.

The thing is, truly elective early inductions/sections get a lot of media attention, but are actually pretty darned rare.  The other thing is, babies born at 36-38 weeks are more likely to require special newborn care or a few extra days in the hospital, but I haven't seen evidence that they are more likely to die or have serious long-term problems.

These guidelines risk discouraging MEDICAL early deliveries, and sometimes the delay can actually be more dangerous than being born a bit early!  When you've got a situation like our Kvochka, with threatened labor really really early, it's in the baby's best interest to delay birth as long as possible.  Those three extra weeks of gestation that Jacob got possibly saved his life, and definitely made a big difference to his future.

However, since the whole "no deliveries until 39 weeks" thing, there have been a few cases of serious, probably avoidable, harm to mother or baby when labor or complications appeared between 36 and 39 weeks and doctors played that same delaying game.  By 37 weeks, if the baby really WANTS to come out, it's probably safer to let him!

So yeah, no truly elective deliveries before 39 weeks.  But cutting payment or setting up overly strong policies against late preterm delivery might actually make babies LESS safe.

Thanks! I also want to add that my OB advised that if I were to become pregnant again, I will be induced by 37 weeks because I had a "classical"
Csection with Jacob (two cuts). I wonder with these studies and changes in the recommendations, whether I would be able to carry longer with my next! I haven't done any research myself on the subject since its all so fresh but this article makes me wonder how it will affect my case specifically.

rowanthefrog

I think this is fabulous. I have an acquaintance who was in medical school. She told me that the OB she was doing her residency with "automatically induced everyone at 37 weeks." I was floored. I think induction is used way too often and for the wrong reasons and that is partially why we have so many C-sections...because baby isn't ready to come out and mom's body isn't ready to let baby out.

Glad they made this change!

A