Health Care Providers

Before 39 Weeks, Let Labor Begin On Its Own

Some women may request delivery before 39 weeks of gestation when neither the mother nor the infant is at risk if the pregnancy is allowed to progress. However, research indicates that infants born prior to 39 weeks are at higher risk for more short- and long-term morbidities than those born after 39 weeks. These morbidities are potentially preventable if labor is allowed to begin on its own. 

Clinical evidence also shows that a fetus experiences a significant amount of development and growth in several key organ systems between 37 and 39 weeks of gestation. 

Delivery prior to 39 weeks is appropriate only if medically indicated and with documented fetal lung maturity, as specified by American College of Obstetricians and Gynecologists (ACOG) guidelines.1​

In November 2013, ACOG and the Society for Maternal-Fetal Medicine released a committee opinion replacing "term" delivery with new designations based on gestational age. Babies born at weeks 39 and 40 are now considered "full term." Learn more about the ​new definition of full-term pregnancy​  based on NICHD research.

Health Risks to Mother and Infant

Nonmedically indicated deliveries prior to 39 weeks are associated with increased risks to the health of both mother and infant. 

  • Greater risk of being admitted into the NICU2
  • 20% greater risk of complications after birth, including:
    • Breathing, feeding, and temperature problems3​
    • Sepsis4​
    • Cerebral palsy5​
  • 5% greater risk of developmental disabilities6​
  • 63% greater chance of death within the first year of life7​

Risks to the mother: 

  • Postpartum depression8​
  • Stronger and more frequent contractions9​
  • Needing a cesarean delivery, which carries its own risks, including:10​
    • Increased risk of negative health outcomes for the baby11​
    • Longer recovery time (weeks rather than days)1​2
    • Risks associated with major surgery, including infection13​
    • Increased chance that future pregnancies may require cesarean delivery14​

Watch this roundtable discussion to learn more about the factors contributing to the rising rates of early term and late preterm births, the potential consequences of births before 39 weeks of gestation, and evidence-based guidelines for delivery prior to 39 weeks. The roundtable discussion is moderated by Dr. Catherine Spong, Acting Director, NICHD.

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Recent research findings indicate that delaying delivery until 39 weeks of pregnancy or later—if there is no medical reason to deliver earlier—is not associated with increased rates of stillbirths in the United S​tates. This research, fund​ed by the NICHD and other groups, contradicts findings from an earlier study that waiting until 39 weeks to deliver could lead to more stillbirths.

Citations

  1. The American College of Obstetricians and Gynecologists Committee on Obstetric Practice Society for Maternal-Fetal Medicine. (2013). Nonmedically Indicated Early-Term Deliveries. Committee Opinion Number 561. April 2013. Retrieved November 8, 2015, from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Medically-Indicated-Late-Preterm-and-Early-Term-Deliveries external link
  2. Sengupta, S., Carrion, V., Shelton, J., Wynn, R.J., Ryan, R.M., Singhal, K., et al. (2013). Adverse neonatal outcomes associated with early-term birth. JAMA Pediatrics, 167(11), 1053–1059. Retrieved November 8, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/24080985. 
  3. Sengupta, S., Carrion, V., Shelton, J., Wynn, R.J., Ryan, R.M., Singhal, K., et al. (2013). Adverse neonatal outcomes associated with early-term birth. JAMA Pediatrics, 167(11), 1053–1059. Retrieved November 8, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/24080985.  
  4. Sengupta, S., Carrion, V., Shelton, J., Wynn, R.J., Ryan, R.M., Singhal, K., et al. (2013). Adverse neonatal outcomes associated with early-term birth. JAMA Pediatrics, 167(11), 1053–1059. Retrieved November 8, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/24080985.
  5. MacKay, D.F., Smith, G.C., Dobbie, R., & Pell, J.P. (2010). Gestational age at delivery and special education need: Retrospective cohort study of 407,503 schoolchildren. PLoS Medicine, 7(6), e1000289. Retrieved November 8, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/20543995.
  6. Shapiro-Mendoza, C., Kotelchuck, M., Barfield, W., Davin, C.A., Diop, H., Silver, M., et al. (2013). Enrollment in early intervention programs among infants born late preterm, early term, and term. Pediatrics, 132(1), e61–e69. Retrieved November 8, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/20543995.
  7. Mathews, T.J., MacDorman, M.F., & Thoma, M.E. (2015). Infant mortality statistics from the 2013 period linked birth/infant death data set. National Vital Statistics Reports,64(9), 6.
  8. Vernon-Feagans, L., Cox, M., Blair, C., Burchinal, P., Burton, L., Crnic, K., et al. (2010). Late-preterm birth, maternal symptomatology, and infant negativity. Infant Behavior & Development, 33(4), 545–54.
  9. March of Dimes. (2012). ​ Why at least 39 weeks is best for your baby. Retrieved November 8, 2015, from http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html external link.
  10. Tita, A.T., Landon, M.B., Spong, C.Y., Lai, Y., Leveno, K.J., Varner, M.W., et al. (2009). Timing of elective repeat cesarean delivery at term and neonatal outcomes. Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. New England Journal of Medicine, 360(26), 111–120. Retrieved November 8, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/19129525.
  11. Sengupta, S., Carrion, V., Shelton, J., Wynn, R.J., Ryan, R.M., Singhal, K., et al. (2013). Adverse neonatal outcomes associated with early-term birth. JAMA Pediatrics, 167(11), 1053–1059. Retrieved November 8, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/24080985.
  12. Koroukian, S.M. (2004). Relative risk of postpartum complications in the Ohio Medicaid population: Vaginal versus cesarean delivery. Medical Care Research and Review, 61(2), 203–224. Retrieved November 8, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/15155052.
  13. Liu, S., Liston, R.M., Joseph, K.S., Heaman, M., Sauve, R., Kramer, M.S., et al. (2007). Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. Canadian Medical Association Journal, 176(4), 455–460. Retrieved November 8, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/17296957.
  14. ​Goer, H., & Jukelevics, N.; Lamaze International. (2010). Position Paper: The Risks of Cesarean Section for Mothe​r and Baby. Retrieved November 8, 2015, from http:// www.lamazeinternational.org/p/cm/ld/fid=126.

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