Many patients reach week 36 gestation and begin to complain about common discomforts that occur in late pregnancy. It often goes something like this: “I can’t sleep. I pee every five minutes. My feet are swollen. My back hurts. My pelvis aches. I am ready to be done.”
This condition is well known in the obstetric community as “TOP,” or tired of pregnancy.
At this point many women begin to look toward their due date and wonder just how much longer they have to wait to meet their baby and be done with pregnancy. Between 36 and 38 weeks gestation many moms start to inquire about labor induction. Some even ask about elective cesarean sections.
Our practice follows strict guidelines based on recommendations from the American College of Obstetricians and Gynecologists (ACOG). We do not schedule elective labor induction prior to 39 weeks gestation. Even then, a woman’s cervix must meet certain criteria (Bishop score of 7 or more) in order to qualify for the elective procedure.
Without a medical indication or a favorable cervix, we reassure the patient that it is best for mom and baby to wait until 41 weeks gestation before inducing labor.
Thankfully, elective c-sections are rare in our practice. When they are performed, we require the procedure be scheduled for 39 weeks or later unless there is a medical indication to deliver the baby earlier.
The affects of the ACOG guidelines are far reaching — in June the National Center for Health Statistics reported the rate of c-sections stabilized between 2009 and 2011 after increasing for 12 consecutive years. C-sections performed at 38 weeks decreased from 2009 to 2011, but increased at 39 weeks, representing a push away from elective c-sections.
There will always be pregnant women suffering from TOP It is our responsibility as healthcare providers to explain to our patients just how valuable the last few weeks of gestation are for baby’s brain and overall development.
I recommend the March of Dimes public service campaign Healthy Babies are Worth the Wait. A patient education toolkit is available free to all healthcare providers who register in the Prematurity Prevention Resource Center.
Educate your patients about the physiology of labor and fetal development, and do your part to continue to restrict elective delivery before 39 weeks gestation.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.