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Delivery at 39 weeks – Becoming the Standard of Care

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Delivery at 39 weeks – Becoming the Standard of Care

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39 weeks full termResearch showing that fetal outcomes are improved if a mother waits until 39 weeks to deliver is changing obstetrical care. The March of Dimes, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists are uniform in defining a full term delivery as one that occurs at 39 weeks. Although babies were once considered full term at 37 weeks, fetal development continues in the final weeks of gestation. Lungs, liver, eyes, ears, and brain tissue mature in the last weeks of pregnancy.

What do mothers think is full term?
A majority of women in 2009 did not understand the definition of full term. Six hundred and fifty women who had recently given birth were asked to define when pregnancy reached full term. Twenty four percent said 34-36 weeks. Fifty one percent said 37-38 weeks. Just 25% said 39-40 weeks.

Patient’s choice versus dollars and cents
Should it be the “patient’s choice” as to when to deliver? The timing of delivery has been based at times on the convenience of the mother and the obstetrician. Even if the patient wishes to assume the risks, she may not be able to find a hospital that is willing to allow the delivery to occur. Many facilities have programs in place to stop elective early deliveries. No more – some facilities, such as Memorial Regional Hospital in Hollywood Florida require the obstetrical department chief to approve an elective delivery before 39 weeks, which has not happened. Neonatal intensive care units (NICU) are seeing fewer patients, and hospitals are saving the approximately $70,000 it costs for a neonatal intensive care unit stay. Millions are being added to hospital budgets.

NICUs won’t disappear as long as there are medical reasons to induce a pregnancy, such as pregnancy induced hypertension. And there are risks of a late delivery at 41 weeks or more.

Implications for attorneys
The standard of care requires physicians to provide informed consent. With the narrower definition of full term, an obstetrician would be medical-legally wise to go into detail as to the risks of an elective delivery before 39 or 40 weeks. And don’t be surprised if the next push is to define full term as 40 weeks. It is coming.

Sources
Advance for Nurses November 18, 2013, Mid- Atlantic and Lower Great Lakes, page 13
USA Today October 23, 2013, page 4D

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