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September 25, 2014

The Red Herring: Why 39 weeks Isn’t Enough

This graph shows what happens when a hospital is part of a pilot program to reduce non-medically indicated births. Notice, this isn’t a program that is designed to do anything other than stop NON MEDICALLY INDICATED births. The March of Dimes piloted this program due to the exponential rise in using non-medicine to control birth in order to fit it into nice, neat practice management patches with fewer lawsuits. This rise didn’t reflect safety for mothers or babies, in fact, it did the opposite, it endangered them.

http://health.usf.edu/publichealth/chiles/fpqc/past_projects.htm

So why isn’t it enough? Why is it a red herring?

Because ACOG has now renamed all of the “term” pregnancies that used to be 37-42 weeks in order to help “reduce” pre-39 week nonsensical obstetrical procedures but does NOTHING for all of the non-medically indicated procedures after 39 weeks, zero days. In effect, we are still forcing thousands, if not millions over time, of mothers and babies to undergo procedures they do not need and often do not want. And now, we’re forcing hospitals and doctors to not do it before 39 weeks so they are reloading their case load to meet moms and babies at 39.1 and 40 and still with no medical need. This may mean that babies come off better but we’re still increasing both morbidity and mortality well above normal.

There is another casualty in this ACOG redefinition as well. That of the Non-Bell Curve mother. If you go past 41.0, you are now in some imaginary place called “late term” and 42.0 is “post term”. These numbers and dates are going to move across obstetrical systems such as homebirth midwifery where they have no place being. Where now, midwifery laws have used “42” as if it’s some arbitrary cut-off wherein moms and babies become dangerous, who knows where ACOG and other hospital-based obstetrical groups or legislative groups will try to push those lines.

Box 1. Recommended Classification of Deliveries From 37 Weeks of Gestation

  • 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

Data from Spong CY. Defining “term” pregnancy: recommendations from the Defining “Term” Pregnancy Workgroup. JAMA 2013;309:2445–6.

Ultimately, all of these concerns are played out on mothers but they are not considered when decisions are made. Safety of mothers and babies are not the overriding concerns of these kinds of recommendations that are given the force of law and regulations. Individual accountability, informed decision-making, none of these come up as the rights of mothers and babies are stripped away based on a professional organization’s opinion pieces.

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