Why do early elective delivery rates matter, and what does that even mean? In an early elective delivery, births are planned so the baby is born on a specific date before the due date. The mother gives birth after inducing labor on the scheduled date, and may deliver by cesarean section or vaginally. So a hospital or birth center’s rate of early elective delivery can reflect on the facility’s overall maternity care.
A hospital with low early elective delivery rates suggests that the doctors and staff appreciate the importance of a full-term pregnancy. Look for providers that have rates of 5 percent or lower, as that signals that care providers aren’t unnecessarily intervening in the labor process.
Are some elective deliveries necessary?
As the term “elective” implies, these deliveries are not medically necessary. Whereas a doctor may recommend an early delivery via C-section to a woman who has health issues, has a high-risk pregnancy, or is carrying multiples, there is no medical reason for a healthy mom to deliver a healthy baby early. Yet a 2010 study found that 17 percent of babies in the United States were delivered before 39 weeks, and a further 2011 analysis of more than 13,000 elective cesareans found that almost 36 percent were before 39 weeks.
So what gives? The explanation is multifaceted: Common reasons for early elective delivery include intolerable maternal discomfort, a poor previous pregnancy outcome, convenience for the family’s or physician’s schedule, patient preference for a specific healthcare professional, a gap in understanding in what constitutes full term and the associated health benefits, and a desire to limit the risk of cesareans, thanks to new study findings.
For each hospital listed in the Motherfigure directory, we include the early elective delivery rates to help women make informed, empowered decisions about their pregnancies. In this piece, we’ll unpack early elective pregnancies.
The importance of a full-term pregnancy
What is a full-term pregnancy? The exact definition of a full term has been disputed. According to the Leapfrog Group, the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine, a full term is defined as anywhere between 39 weeks to 40 weeks and six days. More specifically, ACOG breaks it down as:
- Early term: 37 weeks through 38 weeks and six days
- Full term: 39 weeks through 40 weeks and six days
- Late term: 41 weeks through 41 weeks and six days
- Postterm: 42 weeks and beyond
Unless carrying to 39 weeks poses health risks to the mother or baby, doctors advise women to wait until labor begins on its own. Critical development happens during weeks 37 through 39 of pregnancy, which is why babies born before 39 weeks might have a higher risk of having trouble breathing, feeding, and regulating their body temperature, among other complications.
A remarkable amount of growth happens in those final weeks of pregnancy: As Baby and Company reports, a baby’s brain at 35 weeks is only two-thirds developed. The lungs, liver, and other vital organs also experience crucial development at the final stage of pregnancy.
The longer a baby can remain in the mother’s uterus, the more time it has to grow. Babies who are born at 39 weeks, or even later, have fewer health problems than their premature counterparts.
How early elective delivery hurts the baby
Babies born early tend to be at a higher risk of both short- and long-term health issues. These include:
- Increased NICU admissions
- Increased transient tachypnea of the newborn (TTN)
- Increased respiratory distress syndrome (RDS)
- Increased ventilator support
- Increased suspected or proven sepsis
- Increased newborn feeding problems and other transition issues
How early elective delivery hurts the mother
Early elective delivery also hurts the mother. This is because the majority of early elective deliveries are carried out via C-section, a surgical procedure in which the baby is removed by an incision made in the mother’s abdomen and uterus.
In the United States, it’s estimated that one in three women gives birth via C-section. Although this procedure is commonplace, it’s still a major surgery—with major risk of complications. AC-section requires a much longer recovery time than vaginal birth. It can also cause the following problems for the mother:
- Infection at the wound site or internally in the uterine lining
- Hemorrhaging during or immediately after delivering
- Blood clots and deep vein thrombosis
- Injury to the bladder and/or bowels
- Increased risk of complications in future pregnancies
- Pain or discomfort while lifting, squatting, or driving after giving birth
What’s ARRIVE got to do with it?
Complicating matters was that in 2018, the results of the ARRIVE trial came out: Researchers were trying to determine if elective induction of labor during the 39th week of pregnancy would result in a lower rate of death and serious complications for babies, compared to waiting until at least 40 weeks and 5 days for elective induction, which had been common guidance. The researchers also wanted to see if early elective inductions had an effect on the risk of cesareans.
The headline? Inducing labor at 39 weeks did not improve the primary outcome of death or serious complications for babies—but it was linked to a lower rate of cesareans compared to those assigned to expectant management and a lower chance of developing pregnancy-induced high blood pressure. Mothers in the early induction group labored longer but spent less time in the hospital postpartum. So that finding has led some providers to start recommending scheduled inductions around 39 weeks. But here’s the thing: ARRIVE does not mean that elective induction at 39 weeks lowers the risk of a cesarean for every individual.
Ultimately here at Motherfigure, we’re all about empowering women with knowledge so they can make informed choices for themselves. Find the early elective delivery rates for your local hospital in the Motherfigure directory and become informed about this important issue.