Expert: Catherine Beier MS CBE - 8/9/2009

Question
Hi there,

I turned 38 weeks yesterday. I had an Amino on Friday at 37 weeks and 6 days. The test came back "transitional" (46). They were thinking they were going to take the baby yesterday, but now have moved me out another week. Basically I will be 38 weeks and 5 days when they deliver. I am having a planned c-section due to prior c-section and acute gestational diabetes. I have been having several issues with high glucose readings and the baby is measuring over 9 lbs already. I have excessive fluid and don’t think I my uterus can handle much more.

What exactly is the risk at this point and why did the doctors want to wait another whole week? I thought at 38 weeks your baby's lungs were already fully developed with less than a 1% chance of RDS? Can’t high glucose readings affect the amino results? What is the % of risk to have delivered the baby yesterday as suppose to next week? What about my health? Does it have anything to do with my state medical coverage???


Answer
Taira,


You're correct that you don't understand the risk to your child.  There is absolutely no truth that all babies' lungs are fully developed at 38 weeks.  I'm not sure where you came up with this.


The amnio isn't fully reliable at determining lung maturity and your test didn't even suggest the baby's lungs were fully developed.  Aminos have a high rate of false positives, meaning the lungs aren't fully developed, even when the test states they are.  


Any late term fetal weight assessments are also notoriously inaccurate, with a margin of error of +/- 2 pounds.


ACOG guidelines recommend that as many inductions/c-sections as possible should be scheduled after 39 weeks to prevent respiratory distress and prematurity.  The leading cause of preventable infant mortality and NICU admissions in the US is due to c-sections/inductions that are scheduled too early.  Once this guideline was implemented, these rates began to drop immediately.


So, at this point, despite whatever discomfort you may feel, the best place for your baby is in your womb, not out.  Staying pregnant as long as possible is the safest option for your baby.  You've indicated no other concerns with your health that would indicate another week would be detrimental to your health.  


And, no, this has nothing to do with your state health coverage - they're concerned about your baby's best interest and are trying to ensure the best start possible for your child without compromising your health.


Best,
Catherine