Clinical Review

Nonmedically indicated early term delivery: Are your patients requesting it before 39 weeks?

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The most common reason given for such a request: “They are just tired of being pregnant,” one VBE member reported.

Family logistics is another frequent justification.

“Our practice provides obstetric services to a large military population as well as a large geographic area,” said E. William McGrath Jr., MD, of Fernandina Beach, Florida. “Military deployment of a spouse and large travel distances are common reasons for induction requests prior to 39 weeks.”

HOW TO MANAGE PATIENT REQUESTS FOR ELECTIVE EARLY TERM DELIVERY

“We are careful to empathize with rather than criticize the patient and her family for the early delivery request,” Dr. McGrath explained. “Our providers cite ACOG guidelines, but we also mention the statements and policies of the March of Dimes, which disallows elective deliveries prior to 39 weeks. The March of Dimes has greater name recognition among the general public than ACOG does. We attempt to make the patient feel good about her request for early delivery, regardless of the reason—and help her feel even better about her decision to withdraw the request once she learns about the potential complications.”

“I tell all my patients that unless there is a maternal or fetal indication or a strong psychosocial indication, I will not induce them,” reported Sabina K. Cherian, MD, of Houston. “It is usually the multiparous patients who have had previous deliveries at earlier gestational ages who request these early inductions.”

“I tell patients that their due date is arbitrary and not an exact date in which we can guarantee that everything is ok,” said Brian Bernick, MD, of Boca Raton, Florida. Accordingly, “I advise them that their baby is not fully developed until at least 39 weeks. An early, unindicated induction puts both the baby and mother at risk. Lastly, I remind them that a healthy baby and mom are worth the wait.”

“I counsel my patients that even normal pregnancies with infants born at 37 to 38 weeks have a higher rate of complications, compared with those born at 39 weeks gestation, and that an earlier induction may also be more likely to lead to cesarean if the cervix is not yet favorable,” said Devin Namaky, MD, of Cincinnati, Ohio.

One simple response to a patient’s request for early term delivery?

It isn’t possible.

Increasing numbers of hospitals are establishing firm policies against elective early term delivery.

“Our hospital has a hard stop,” said Michael Kirwin, MD, of Freehold, New Jersey. “That makes it easy for me to tell the patient, ‘No.’”

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