The controversial practice of early planned births has come under the spotlight recently as the potential risks of early elective delivery are acknowledged. This has led to the recommendation that pregnancies should continue until at least 39 weeks gestation unless there is a medical or obstetric reason justifying earlier intervention (ACSQHC 2021).
Early planned birth is when a baby is born before 39 weeks of pregnancy by planned caesarean section or induction of labour without the mother going into spontaneous labour (Pip 2021).
It’s a practice that has been growing steadily over the past couple of decades, and until recently, it was thought that there were no long-term risks to babies born a few weeks early. However, a growing body of evidence now suggests that not only does planned early birth carry significant short-term risks, it also places babies at risk of long-term developmental delay by the time they reach school age.
The timing of birth is critical to ensure the best outcomes and a healthy baby, yet, many babies are needlessly being put at risk because they are delivered too early, without any medical purpose (News Chant Australia 2021).
For optimal development, especially of the fetal lungs and brain, it’s known that babies should remain in utero until at least 39 weeks of pregnancy unless there are medical or obstetric reasons for planning birth earlier (ACSQHC 2019).
Until recently, it was believed that early delivery carried no significant risks to either mother or baby, and whilst a great deal of research has focused on the potential harms of premature birth, there has been little research until now exploring the consequences of early birth (Morris 2021).
It could be argued that because the definition of a ‘term’ pregnancy is the period between 37 and 42 weeks gestation, there has been little thought given to the risks babies might face by being born just a little early. In the light of recent research, however, those assumptions are now changing as both short and long-term risks are finally being recognised.
As reported by The Fourth Australian Atlas of Healthcare Variation (2021), the ranges of state and territory rates for caesarean sections performed without a medical or obstetric reason in 2017 were recorded as follows:
It’s been suggested that this steady rise in early planned births is due to concerns over the mother or baby’s welfare, or, less commonly, for convenience. Whatever the reason, it’s now recognised that unnecessary delivery before the 39th week of pregnancy brings with it increased risks of harm, primarily for the baby.
Delivery before the 39th week of pregnancy is known to be associated with both short-term risks such as respiratory problems and long-term risks such as cognitive deficits and a higher risk of attention deficit hyperactivity disorder and learning difficulties (The Fourth Australian Atlas of Healthcare Variation 2021).
Even after fetal lung maturity has been confirmed, babies born by early planned birth without a medical or obstetric indication have significantly worse respiratory outcomes, and poorer overall neonatal outcomes than full-term babies (ACSQHC 2019).
Mothers are also placed at greater risk from early planned birth, with increased risk of complications such as:
(Pip 2021)
In another study, it was also noted that the risk of babies being 'developmentally vulnerable' increased with decreasing gestational age (Science Daily 2016). Furthermore, Bentley et al. (2016) make the point that fetal brain development accelerates after 32 weeks gestation, so infants born before 39 weeks have an increased risk of poor development.
Now that the risks of early planned birth are being openly acknowledged, the question arises about how to reverse this policy.
Based on recommendations by The Fourth Australian Atlas of Healthcare Variation (2021) the following strategies have been recommended:
In general, it’s recommended that pregnancies continue until at least 39 weeks gestation unless there is a medical or obstetric reason justifying earlier intervention. Health service organisations are also being encouraged to work with maternity services and establish policies to stop booking planned births without a medical or obstetric indication before the 39th week of gestation (ACSQHC 2019).
It’s been suggested that one of the reasons early planned births have become so common in recent years is that pregnancies have traditionally been considered to be at-term from 37 weeks onwards.
However, in the view of Pip (2021), this definition is outdated and not supported by clinical evidence. With current research indicating that every week a baby is born before 39 weeks carries an increased risk of respiratory difficulties, it is perhaps time to re-think the policy of elective early planned birth. Even when problems such as maternal hypertension or diabetes threaten the well-being of the pregnancy, the aim should still be to get as close to 39 weeks of pregnancy as long as it’s safe to do so.
As Bentley et al. (2016) remind us, early planned birth is associated with an elevated risk of poor child development, which means that delaying birth for an additional week, or more, can have significant long-term benefits.
New strategies and interventions are now needed to support and encourage more judicious decision-making, allowing optimal time for fetal development and consequently ensuring optimal childhood health and development.
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