You’ve probably seen the warnings on cigarettes: “SURGEON GENERAL’S WARNING: Smoking By Pregnant Women May Result in Fetal Injury, Premature Birth, And Low Birth Weight.”

Perhaps a nearly identical warning would be appropriate at the front desk of every OB office or L&D ward: “SURGEON GENERAL’S WARNING: Scheduled Delivery May Result in Fetal Injury, Premature Birth, And Low Birth Weight.”

A recent article on Fit Pregnancy talks about an insurance company that told their providers to “curb the practice” of scheduling deliveries after they “found that 48 percent of newborns admitted to the NICU were from scheduled deliveries, many of them before 39 weeks.”  Lo and behold, they “saw a 46 percent decline in NICU admissions in just three months.”

So I have an idea: let’s save those NICU beds for the babies who really need them, and let the healthy babies stay inside the healthy mamas just as long as they need to stay.  An estimated due date is just that, an estimate–not an expiration date.  Not every baby walks at 12 months exactly; some are ready sooner, and some later, and the only way we know is to see them do it. Not every adult male is exactly 170 pounds, and the only way we know how big our sons are going to grow is to watch them do it.

In other words, parenting is about patience.  Let’s remind our care providers that our parenting starts with pregnancy, and not every baby is ready to be born at 40 weeks (much less 39 or 38), or at 8 pounds (much less the 7 or 6 pounds that a third-trimester ultrasound “measurement” of 8 pounds can mean).  In fact, let’s review those two often-stated reasons for induction: “overdue” baby, and “big” baby.

“You’re OVERDUE!” Remember, no medical practitioner should consider a baby “overdue” until 42 weeks.  Recommending induction the moment you’ve gone past your “due date,” or some even earlier arbitrary “safe” delivery date, arrogantly assumes that the practitioner knows better when your baby is ready to breathe than nature or God does (depending on your own point of view).  And since induction creates additional risks for mother and baby, early induction without urgent medical reason is not only arrogant, it’s impatiently irresponsible.

If you’ve gone past 42 weeks and would still like to avoid unnecessary induction, especially if you have any doubt of your conception date or have a family history of healthy babies waiting until past 42 weeks to be born, you can do your research and then work with your practitioner on using expectant management and monitoring YOUR particular situation rather than working from statistics that may or may not apply to you and your baby.

“Your baby is getting BIG!” Isn’t “Let’s just go ahead and induce/schedule a c-section” really saying “Let’s just go ahead and deliver your baby prematurely”?  If low birth weight is a dangerous side effect of smoking, let’s stop giving credence to the idea that iatrogenic low birth weight is optimal for ease of birth or for baby’s health.  Scheduling a delivery at 38 weeks for a “big” baby is just as foolhardy as scheduling that early delivery for a baby who’s measuring 6 pounds.  We simply do not know how big that baby needs to get–and more importantly, how long her lungs and brain need to develop–until labor begins on its own.  (Research for mothers with diabetes, especially gestational diabetes, seems to be inconclusive, which to my mind means expectant management is still a wise option.)  And with mother-friendly care during labor and during birth, a 10- or 11-pound baby born vaginally is more than possible, it’s NORMAL.

For instance, I’m 5’4″, 125 pounds not pregnant, and I delivered a 9-pound 6-ounce baby at 40 weeks.  If the average growth rate is a quarter to half a pound a week during the last weeks, that means he hit that dreaded 8 pounds somewhere between 34 and 37 weeks.  Let me tell you, the “extra work” of pushing another couple of pounds of baby fat into the world was well worth having a baby who was ready to breathe on his own, nurse effectively, and maintain his own temperature as well as any newborn can.  (The question of whether bigger necessarily means harder to deliver is a topic for another post.)  I know at least three women whose babies were premature due to unavoidable circumstances and who spent weeks visiting their babies in the NICU.  I think they would agree with me that there is nothing “convenient” about a premature baby struggling to adjust to the outside world.  Don’t put yourself in their position voluntarily, and don’t let a pushy doctor put you and your baby there just for the false “convenience” of a scheduled delivery or a smaller baby.

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