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Rethink 'scheduling' baby's birth

The rising trend of expectant mothers being involved in every aspect of planning their births has had an unintended consequence -- a rise in pre-term deliveries.

"It never would have occurred to me or anyone I knew to think you had any kind of control over when the baby would come out," said Laura Crawford, who gave birth more than a decade ago.

Crawford recently produced a documentary for Kentucky Educational Television called Born too Soon, which explores the increasing incidence of what is called late pre-term births -- babies born between 34 and 36 weeks gestation.

Prematurity rates in the nation have increased quietly over the past two decades to 12.7 percent, according to public health officials.

Among the reasons for the increase: A rise in scheduling births.

It's just within the last three or four years that the scope of the problem has become apparent, said Dr. Ruth Shepherd, division director for maternal and child health in Kentucky's Department of Public Health.

Ideally, she said, babies shouldn't be delivered before 39 weeks.

Often, there are legitimate reasons for early delivery, especially if the health of mother or child is at risk.

"But you have to draw the line and think of when something is really done electively," she said.

Increasingly, choices are made for reasons other than health. Delivery might be scheduled to coincide with grandparents' dates of arrival from out of town, or before Dad must ship out for Iraq.

"It's clearly a different attitude than we've had in the past," she said.

There are several complicating factors, Crawford said. The documentary states that people tend to underestimate the impact of premature births, especially late pre-term births. They tend to overestimate how accurately a due date can be determined.

Shepherd said there can be real consequences. They can include immediate physical challenges, including underdeveloped lungs and long-term problems involving learning and behavioral disabilities, for example.

And even if a mother gets an ultrasound within the first 16 weeks -- the best way to accurately determine the due date -- the date can be off by two weeks either way.

Those two weeks can be crucial, she said.

"It's an issue of planning and control," she said. Planning is good. But, "You can take it too far if you don't pay attention to the science."

She said the science dictates that the best practice is to not give birth before 39 weeks.

Mothers, tired at the end of even the most ideal pregnancy, need to get support from their doctors and their families that "if it is at all possible, you need to go to your due date."

"If people know how important it is they would make different decisions," she said.