PSA: Elective Inductions & New Term Guidelines 2018
Lately I've seen quite a few posts from women whose doctors recommend an induction before 39 weeks for the sole reason that their baby appears to be measuring small or large. The women who post about this are often concerned about whether or not an induction is truly needed.
I wanted to share some information with all of you that will hopefully help in case this situation arises for you or for someone you know.
There are some important new guidelines that were put into place earlier this year (2018). Search for "ACOG definition of term pregnancy" or ""SMFM definition of term pregnancy" for some more information relating to the new guidelines, but here is the new terminology:
"Early term: 37 0/7 weeks through 38 6/7 weeks
Full term: 39 0/7 weeks through 40 6/7 weeks
Late term: 41 0/7 weeks through 41 6/7 weeks
Postterm: 42 0/7 weeks and beyond"
For comparison, "full term" used to be weeks 37-42. When you think about it, five weeks is a huge span of time when we're talking about fetal development and a lot happens during that time.
There is a lot of research and data out there supporting the new guidelines and I highly recommend you look up the details for yourself. However, let me summarize one key point by saying that an induction before 39 weeks just because "your baby looks small/big on the ultrasound" is absolutely NOT recommended.
Here are few reasons why. Please go online and find the latest research on these points and read it to be informed for your next conversation with your doctor!
1) Induction, especially before 39 weeks - the new start of "full term" - when baby appears healthy (even if they seem quite bit big or small - see point 2) and you don't have any complicating factors (gestational diabetes, preeclampsia, etc.) is not recommended due the increase of various risks to both mother and baby. Such an induction should absolutely be considered elective and not viewed lightly or positively.
2) Ultrasounds estimating fetal size in late pregnancy are commonly off by as much as 400-500 grams!! So your doctors may be saying your baby is small or big, but in reality baby could be a much higher or lower weight and within a healthy range. Also, there is natural variation in baby weight based on genetic and structural limitations and this is not a bad thing! Your baby doesn't have to be born the same weight as every other baby.
(Another point I'd like to make here quickly is that many women are scheduled for c-sections for the sole reason that the doctor is estimating the baby is large - but given the unreliability of ultrasound for estimating fetal size, this is one of the ultimate irresponsible recommendations in my opinion).
3) The risk of baby dying within the first year after delivery by induction between 37 weeks -38 weeks 5 days (in "early term") is increased as compared to when delivered between 39-41 weeks. Nobody wants to risk their baby dying just because the doctor jumped the gun!
4) Inducing labor before the baby and your body is ready increases a number of risk factors, including the risk of getting a c-section. Ask your doctor to tell you what your Bishop Score is (look this up online for details) and if he says anything under 7 or 8, honestly, I wouldn't even consider letting them induce unless you have onset of major complicating factors as mentioned in point 1.
There is a lot of evidence out there now that the status quo in relation to doctors inducing and delivering babies before weeks 39 or 40 with elective inductions and without the presence of life-threatening conditions has done far more harm than good. They've found that those last two to three weeks in the womb leading up to the new "full term" actually contribute significantly to the growth of a healthy baby after they're born.
Please do some research for the things I've mentioned and for anything else that comes to mind. I think once you read the results and guidelines for yourself you'll see why an induction is probably not a good idea unless there is some complicating risk factor (for example, as listed in point 1 - and keep in mind there are many other medical conditions which would indicate induction is the best route).
I recommend asking your doctor if they are familiar with the new guidelines regarding definition of term. Ask your doctor what their track record is with inductions and c-sections (if they induce or perform c-sections at a high rate, unless they are a high risk specialist, this could mean you are at risk for unnecessary procedures and the risks associated with them). Ask them what their approach is in various situations. And never hesitate to see another doctor at another practice for a second opinion!
Good luck everyone!