Pregnant after 35
mattandlora
member
Clarification: Late preterm vs. Early Term vs. Term vs. Post-term and Inductions
mattandlora
member
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............)
**siggy warning**
Current Age 35, DH 33
Married 9/2011
BFP 8/2012, Miscarried 9/2012
BFP 9/2012, DS 6/2013
BFP 6/2014, Miscarried 7/2014
BFP 7/2014, DD 4/2015
This discussion has been closed.
Re: Clarification: Late preterm vs. Early Term vs. Term vs. Post-term and Inductions
**siggy warning**
Current Age 35, DH 33
Married 9/2011
BFP 8/2012, Miscarried 9/2012
BFP 9/2012, DS 6/2013
BFP 6/2014, Miscarried 7/2014
BFP 7/2014, DD 4/2015
**siggy warning**
Current Age 35, DH 33
Married 9/2011
BFP 8/2012, Miscarried 9/2012
BFP 9/2012, DS 6/2013
BFP 6/2014, Miscarried 7/2014
BFP 7/2014, DD 4/2015
Birth is safe as life gets - Harriette Hartigan
**siggy warning**
Current Age 35, DH 33
Married 9/2011
BFP 8/2012, Miscarried 9/2012
BFP 9/2012, DS 6/2013
BFP 6/2014, Miscarried 7/2014
BFP 7/2014, DD 4/2015
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.
Birth is safe as life gets - Harriette Hartigan