Elective Delivery: Think Twice Before Scheduling Birth

You’re moving closer to your due date but feeling impatient while waiting for your labor to start on its own. You’re exhausted from getting up in the middle of the night to pee. You’re so swollen you’ve got “cankles” for the first time in your life. Add to that, heartburn, hemorrhoids, and hot flashes and you may be tempted to say “I’ve had enough!” Thoughts of scheduling an elective delivery via an induction or cesarean start to enter your mind.

How convenient would it be to pencil in your baby’s birth date in your calendar rather than live with the uncertainty of when labor will start or the discomforts of late pregnancy? Sounds like a good idea to get this pregnancy thing over with and move on to birthing your baby, right?? Well, think again…

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Elective delivery refers to deliveries performed for low-risk pregnancies due to the woman’s or provider’s choice, not for medical reasons. One can accomplish an elective delivery via an elective induction or an elective cesarean. Naturally, some women will schedule an induction or cesarean for medical reasons but elective deliveries are generally scheduled for patient or provider convenience.

Risks of Elective Delivery

The problem with elective delivery is that inductions and cesareans present risks to the mother and baby. When the risks associated with a medical issue outweigh the risks of these interventions then it makes sense to induce or perform surgery; however, for a normal, healthy mom and fetus it does not. According to the American College of Obstetricians and Gynecologists and Society for Maternal Fetal Medicine consensus report, Safe Prevention of the Primary Cesarean Delivery, increases in the cesarean rate have not decreased mortality and morbidity rates for mom or baby which suggests overuse of cesarean. Patient preference is one of the factors that has influenced the increase in the cesarean rate. Yet studies have shown that cesarean carries higher risks for moms including bleeding, infection, blood clots, and more. Furthermore, there are placental complications associated with repeat cesareans that can cause bleeding issues which threaten the well-being of both mom and baby. Avoiding that first cesarean will help prevent one from going down that path.

In addition, every week of development matters for your baby. Your baby’s brain at 35 weeks weighs only 2/3 of what it will weigh at 39 – 40 weeks and other organs are also developing right up until the due date. March of Dimes’, Healthy Babies Are Worth the Wait campaign, recommends waiting until at least 39 weeks for delivery, when possible, as babies born before 39 weeks can exhibit short and long term difficulties typically associated with preemies, such as low blood sugar, respiratory distress, infection, hearing and vision problems, low birth weight, jaundice, difficulty sucking/swallowing and extended hospital stay. Association of Women’s Health, Obstetric and Neonatal Nurse’s Go the Full Forty campaign takes it a step and recommends waiting for labor to start on its own, as long as the pregnancy remains low risk. Your baby will determine the right time to enter the world when he or she is ready, which may even be several days beyond the due date which, remember, is only an estimate.

To educate yourself on your options, use evidence-based resources, such as those provided by March of Dimes and AWHONN. Compare induction and cesarean rates between providers, practices, and birth sites within your area to see which has the lowest. If you have a low-risk pregnancy, consider choosing a midwife for your care and delivering at a birth center where you have the best of all worlds: a provider dedicated to helping you labor and birth without intervention (unless medically indicated) and who also has physician back-up, if necessary; and, a birth site that gives you the comforts of home (and more!) but is close to a hospital in case transfer is needed or requested. Optimize your options for the best care and the best birth experience!

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