BOSIRE: Why doctors won’t give in to pleas to deliver baby earlier

As the expected day of childbirth nears, the pregnant woman grapples with fatigue, breathlessness, joint pains and waddling about. PHOTO| FOTOSEARCH

The 40-week pregnancy journey is not for the fainthearted, even though it begins with the excitement of finding out about the baby, with multiple pregnancy test kits lined up in the bathroom.

This is followed by the nerve-wracking first trimester with its attendant morning sickness, bloating, acne and poor appetite.

For many mums, the second trimester brings remarkable relief. They settle into pregnancy and life returns to normalcy. For those who are petite, the pregnancy may not even be obvious and they may not require a wardrobe change just yet. They remain energetic and are able to go about their usual business with ease.

Then comes the third trimester. It starts with the excitement of shopping for cute baby clothes, baby bottles, bassinettes and a cot, and the visibly pregnant woman is accorded VIP treatment. There is virtually no queueing and everyone trips over themselves to assist. There is even a running joke that one can never fail an exam during this period, however tough the paper is.

As days move along, there are baby showers with wish lists, theme colours and fabulous cakes, and women get together to dish out astounding snippets of advice on motherhood.

Fathers, on the other hand, find themselves on the receiving end of food cravings and become miracle workers overnight to contain the demanding palates.

FATIGUE

As the expected day of childbirth nears, the pregnant woman grapples with fatigue, breathlessness, joint pains and waddling about. The feet begin to swell, calling for a shoe size or two bigger, and despite being very tired sleep becomes uncomfortable and the woman takes over all the pillows in the house in the search for a relieving sleeping position.

At this point, the mum yearns to have the baby out of her womb. She is tired, fed up of the pins and needles in her feet at the end of the day and in her fingers in the morning when she gets up. She has outgrown the bras she bought just last month and can’t imagine buying yet another batch of new ones. She’s also out of clothes that fit.

She has ticked all the calendars around her – on her desk at work, on the fridge and on her smartphone – and has packed, unpacked and repacked her baby bag for the umpteenth time. It rides with her in the car to work in the morning, and back home in the evening.

She has her obstetrician on speed dial and she has had a dry run with her cab driver, from her house to the hospital in high traffic to reassure her that in the absence of her spouse, she will still make it to the labour ward in good time.

She’s done all these and is more than ready for it, but D-day seems to float farther away despite the clock ticking steadily in the right direction.

Mummy hits breaking point and negotiates with the baby to put her out of her misery and show up already. She nags the doctor at every visit to compromise and get the baby out a little earlier. She is at wits’ end.

RELUCTANCE

So why do doctors dig their heels in and stick to the famous estimated date of delivery (EDD), which is 40 weeks from the date of the last period prior to conception?

A baby delivered between 37 weeks to 38 weeks and six days is an early term baby. The ones born at 39 weeks to 40 weeks and 6 days are full term babies. Those who ‘refuse’ to be born at term move into late term at 41 weeks to 41 weeks and 6 days. Those who go beyond 42 weeks are post-term.

Early term babies carry a relative risk of complications of prematurity, especially with respiration, as compared to their full term counterparts. This is why there is reluctance to deliver them unless there is a clear medical reason. After all, why deny them an extra week or two of weight gain and extra nutrient storage?

At full term, most mothers go into labour spontaneously and 70 per cent of babies are born then. If there is a planned Caesarean section, it is scheduled at 39 weeks.

Beyond 41 weeks, the little one has overstayed his or her welcome in the womb and is handed an eviction notice. Labour is induced to help him come out.

Once the pregnancy reaches term, the placenta has completed its normal lifespan. It starts to age and its capacity to provide for the baby starts to wane. This is why the baby is delivered when the placenta can still support it throughout the rigorous process of labour.

When complications arise and babies must be delivered before term, every effort is made to buy at least a day to help mature the lungs. The mother is given steroid injections to help with this process.

Labour may be delayed or arrested with the help of medications to buy a precious few hours. This intervention may draw the line between the survival of the little one, giving them a fighting chance, and infant mortality.

For this reason, as bourgeois as it may seem to mums who want to decide their baby’s birthday to suit their lifestyle, it is well worth noting that no amount of technology in a newborn unit can rival the womb in nurturing the baby to maturity.

As my wise professor always said, the best incubator is the uterus!