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Tue December 10, 2013
Docs Encourage Moms To Delay Inductions
Doctors in Sioux Falls are working to keep babies growing as much as possible before being born. Physicians say an effort to prevent unnecessary inductions results in more healthy newborns.
In early October of last year, Emily McNamara had no idea how many monitors and breathing machines would surround her in a matter of hours. She was on bed rest at fewer than 33 weeks pregnant when her blood pressure suddenly skyrocketed.
"Through a night of terror, I found out I had severe preeclampsia with the HELLP syndrome, which is the worst preeclampsia that you could ever have, and the HELLP syndrome is just a heightened, more severe case of that," McNamara says. "They said that I’d have the baby that night."
McNamara welcomed a daughter she named Nora. The baby was born at a fragile three pounds, two ounces. McNamara was so sick that she couldn’t visit Nora in the Neonatal Intensive Care Unit for 24 hours. When she did connect with her daughter, McNamara took a photo of the tiny baby
"She was the size of my hand with my fingers. That was when she was two days old," McNamara says. "As you see in the picture, she was on a c-pap device, which helped her breath in. When she graduated off of that, then she went on to kind of an assisted air flow through a nasal cannula, which goes through their nose."
Off the machine, the baby’s brain wouldn’t always remind her to breath. Nora’s spent 37 days in the NICU. Now, at 13 months old, she’s catching up to the growth milestones. McNamara is grateful for her energetic, rambunctious toddler, but she mourns the way her baby arrived.
"I didn’t get to have that normal pregnancy. I didn’t get to have that normal birth," McNamara says. "Since it was so high-risk and everything just went so fast, you get left out of having that and having those bonding moments with your child. Whereas normal pregnancies, health pregnancies get to have that."
Any baby born before 37 weeks is considered pre-term. Those little ones often end up in the NICU. One of the doctors who cares for the tiniest of lives at Avera McKennan is neonatologist Katherine Wang.
"You’re trying to finish off what nature started, and unfortunately no one is as nature," Wang says. "The uterus, the placenta, the in utero environment has been perfected over thousands of years and no matter how hard we try, there is nothing that is as good as staying in utero, in mom’s tummy."
Doctor Wang says health professionals try to artificially replicate what they think happens during those weeks of pregnancy.
"Let’s say a baby is born at 35 weeks; they’re not even supposed to be breathing on their own. They’re really supposed to be having mom’s placenta do all that work for them. That way they can devote all their energy to growing and developing," Wang says. "Well, now they’re having to do a lot of work on their own that they shouldn’t have to be doing, and that’s energy that’s taken away from development."
The neonatologist says babies born before their time run higher risks of infection and developmental problems. They also have higher death rates.
"Really young babies can get brain bleeds. They can have problems with their gut where they actually get a perforation in the gut, and that can lead to a really bad infection, and those are all setbacks that now you have to come back from, and you’re adding that on to already being underdeveloped because you came early," Wang says.
Wang says NICU doctors face the challenges of prematurity every day, and she stresses the incredible advantages to keeping mom and baby growing together until full term. Clinicians break the normal nine months that takes into weeks to track development from embryo to baby.
"A 'term' birth is now considered from 39 weeks until 40 weeks and six days, and 'early term' birth is now from 37 weeks to 38 weeks and six days," Doctor Amber Soloum says.
The OBGYN says doctors at Avera and across the country are enacting policies against elective inductions before a baby is full term. That wasn’t always standard practice.
"I think it’s probably some convenience for the doctor. So if your doctor is going to be out of town when you’re ready to deliver, they might decide to induce you the week before," Soloum says. "Whereas 10-20 years ago, delivering a baby at 37 weeks didn’t seem like that big a deal. But now we just have more information and know that it really does matter."
Soloum says another factor is that moms ask about inductions well before full term. Women are often most uncomfortable during the last month of pregnancy. But Soloum says those last few weeks are critical.
"Even though technically a baby is not considered to be at as high a risk after 37 weeks, they can still have some trouble with breathing, have trouble maintaining their temperature, have trouble feeding," Soloum says. "So really outcomes are a lot better if we can prevent those births and wait until that 39 week mark."
While doctors work with pregnant women to avoid elective inductions before babies are ready, not all moms get the chance to carry their babies to term. Mom Emily McNamara, who delivered her daughter before her 33rd week of pregnancy because of a medical emergency, says she blamed herself.
"I endangered her. I didn’t know what was going on with my body and what else could I have done? Obviously I found the answer is that I couldn’t have done anything else than what I would have. Would I have loved to be huge and at 40 weeks? Absolutely. I would have loved to have kept her in until 40 weeks, but unfortunately that wasn’t the plan for us," McNamara says.
McNamara doesn’t pretend to understand the misery of swollen, aching moms at 37 or 38 weeks of pregnancy. She just knows, from watching her preemie daughter struggle, that babies have the best opportunity to grow on the inside.