Clarification: Late preterm vs. Early Term vs. Term vs. Post-term and Inductions

mattandlora

Hi all. This discussion came up on another thread and there's always a lot of questions about when to schedule inductions or c-sections. I thought I'd explain to clear it up a little. To give you some background, I'm a pediatrician, but I'm specialized beyond that and don't work with newborns anymore. However, I keep up with the reading and discuss things with my OB. In summary, when I did my training (2005-2008), it was commonplace to schedule inductions or c-sections for convenience around 37-38 weeks. That is never done anymore. I wanted to go over the ACOG and AAP (American College of Obstetrics and Gynecology and American Academy of Pediatrics) explanations and WHY this has changed recently.

34-36 weeks = Late Preterm

Most of these babies do just fine, but struggle with a few items transitioning from the womb to real life. They may have some trouble breathing, but it usually isn't more than 24 hours. They might need to be woken up to eat because their brain doesn't tell them to yet. They may have trouble stabilizing blood sugar, internal temperature, and may be at higher risk of jaundiced than babies born later. But compared to the things which happen to babies born 23-33 weeks, these kiddos have it pretty easy. If they weigh enough and there are no complications, most go to the term nursery and room with mom. It's common to need an IV for medications, so they may go back and forth between the nursery and mom, but most do absolutely just fine. They may go home a day or two later than mom. The important thing is that the vast majority don't end up in the NICU. Most pediatricians I know breathe a sigh of relief when they hit this stage. 

37-38 weeks = Early Term

These babies used to be lumped-in with the 39+ week babies. Even though they almost always do fine, some still run into the same transition issues that the 34-36 babies have. It is a small minority, but it still happens more than the 39+ babies. This is the reason docs stopped scheduling inductions and c-sections in this stage. Assume if your baby is born at 37-38 weeks that it will do fine and still go home with you, but don't worry too much if there are still a few minor issues. The minor issues shouldn't delay discharge or affect your baby long-term.

39-40 weeks = Term

Standard newborn stuff. This is usually the earliest a doctor will do an elective induction or c-section. Don't expect any issues outside of normal newborn stuff. The doc will calculate something called a Bishop score which predicts the success of an induction. If your Bishop score is too low, there is a high risk of failed induction requiring a c-section. Ask about your Bishop score before agreeing to be induced. It is based on measurements such as cervical dilation, effacement, baby's position, etc. The cut-offs for predicting a successful induction vary depending on prior pregnancies.

41+ weeks = Post-term

When you reach this stage, the OB will start talking about induction. First, the placenta wasn't made to last much longer. It starts breaking down. Second, the baby is getting bigger each day. Each day that goes by puts you at higher risk of needing a c-section for baby's size. Third, there are some newborn complications which start happening when you go much longer. It all reads like the 'normal' newborn complications (jaundiced, blood sugar, polycythemia, etc), but the risk starts going up again as you go past your due dates.

I hope that helps! OBVIOUSLY docs will take whatever measures necessary if there are medical reasons to deliver early - pre-eclampsia, placenta previa, early rupture of membranes, etc. I'm posting this for the "I'm just sick of being pregnant" crowd. (Like myself............)

xuxachi

Thanks!

niknak1208

I'm hoping to be in the early-term category.  

Sharon&Paul

My third DD was in the early term category due to my water breaking at 37w 2 d. She ended up spending 2 weeks in the NICU with several episodes of apnea. I am a firm believer of letting them cook longer. I wish we had the chance with her, because the NICU is very hard. She is perfectly healthy now.

mattandlora

@Sharon&Paul - I hope she's doing fine now! She is the exact reason that docs / midwives / NPs wait until 39 weeks to induce now. It is rare that a baby at 37 weeks has difficulty, but it still happens, and more frequently than the ones who go later.

cneiding

I didn't realize you were a pediatrician.  Do you  have any experience with Meningitis and Encephalitis?  I have a question that relates to those two illnesses!

mattandlora

@cneiding - I had some during my training but nothing recent. Shoot me a message and I'll try to answer. And I'll let you know my limits too

niknak1208

They actually induced me at 37 wks 6 days with DD. I went in for my regular appt. I mentioned that I had some very light spotting. I really wasn't that concerned but they sent me to triage for NST. During the NST, they said I was contracting. I felt uncomfortable but I wasn't certain they were contractions at that point. They admitted me and started Pitocin. They said they couldn't be sure where the spotting was coming from so felt it was better to induce. She was fine. 7lbs 3.5oz. She had zero issues. I, however, hated being induced. Pit was doing nothing but make me contract allll the time. They broke my water which hurt like hell.

jerseygirl227

Thanks for sharing @mattandlora!

KaLikeAWind

What a supremely educational post and I'm very grateful for it. Thank you @mattandlora

MangomamaFL

The normal range for birth is +/- 2 weeks of 40 weeks (38-42 weeks).  As long as my son is born by next Friday I am still within the range of normal. Induction is not risk free. Waiting is also not risk free either.  I am currently choosing to wait.

mattandlora

@mangomamaFL - I've heard (but don't really know) that babies who go as long as 42+ weeks are usually positioned in a way where they aren't putting enough pressure on the cervix. I think most OBs are ok with waiting until 41+6, but start getting antsy if you go much beyond that. I don't really know and leave that to the OB! As a pediatrician, I can let you know what to expect after the cord is cut! But yeah, I totally agree with you, that both waiting and inducing have their risks. Pregnancy has risks no matter what.

cneiding

That was the problem with most of mine...positioning.  They like to remain with their heads very high...not enough cervical pressure.  Perhaps because they are large they don't slide down real low as easily as smaller..maybe because I am tall they have more room they don't get forced down as hard since they have some extra length room.  My last one remained breech to sideways back and forth until her actual due date then turned.  I have tried all the "exercises" for dropping them with no real results.

Sometimes a baby who is not engaged down enough (like my 2nd was for sure) is turned with his/her face going the wrong direction.  This prevents them from popping into place quite right.  There are things that are suppose to get them to roll over. 

sonpetitlapin

All three of my older ones where in the Early category.  All born in the 38th week.  My oldest I went into labor on my own with her.  My younger DD, she was having heart decels and they induced.  My son, I had horrible Gestational Diabetes.  Initially I wanted to go into labor myself but by the time it came, I was so miserable I didn't fight when they scheduled my induction due to his size.  I was 38w on the dot.  I don't know if it had to do with the GD or the gestational age, he couldn't control his sugars, temperature and then developed jaundice.  He was big baby at 9lb12oz.  I will try to wait as long as possible for this one.

MangomamaFL

The wait is over. G.W. Cahalan was born yesterday a little before noon. 8lb 2 oz, 21 inches.