The 39-Week Initiative - Redefining a Term Pregnancy

Courtney Legum-Wenk, DO
Commonwealth Ob/Gyn Specialists

Are you pregnant, or do you know someone who is pregnant? Is the final due date approaching? Do you ever wonder what this means, exactly?  Keep reading to learn what the final weeks of pregnancy really entail, and the optimal time to have a baby. In humans, singleton (one baby) pregnancy lasts, on average, 40 weeks, or 280 days from the first day of the last menstrual period, and this is how we determine the estimated due date. By comparison, elephants can be pregnant for up to 2 years!

Until recently, anyone between 37-42 weeks of pregnancy was considered “term” and safe to deliver. This conventional wisdom existed because it was believed that the outcomes for both the baby and the mother during this interval of time were uniform and good, or safe with few risks. However, a large amount of research has now shown this is not uniform during these five weeks, and great risks exist from both a maternal and neonatal standpoint. As a result, in 2012, a group of professional societies convened and redefined what exactly “term” means, and provided recommendations regarding delivering for medically indicated and non-medically indicated circumstances.  In addition, national initiatives now exist to decrease complications to babies and the mothers when delivery occurs too early without a medical reason.

In defining term pregnancy, it is now recommended to use the following: EARLY Term is between 37 weeks through the 38th week, FULL term is 39 weeks through the 40th week, LATE Term is 41 weeks up to the 42nd week, and POST term is greater than 42 weeks. These definitions are supported by The American College of Obstetricians and Gynecologists, The Society for Maternal Fetal Medicine, and many neonatal and pediatric societies as well.  These definitions are important because research shows that adverse neonatal outcomes, especially regarding respiratory issues, is the lowest among uncomplicated pregnancies delivered between 39 weeks of gestation and through the 40th week. Lung development continues into early childhood, and elective early term deliveries increase the incidence of Respiratory Distress Syndrome, ventilator use, infections such as Pneumonia, respiratory failure, NICU admissions, low blood sugar, decreased APGAR scores, and possibly infant mortality. Unless one enters labor naturally, or a medical reason exists for early term delivery, elective delivery prior to 39 weeks is discouraged.

What does all of this new data really mean for your pregnancy? Unless delivery is medically indicated before 39 weeks, including natural labor, elective deliveries before this gestational age should be discouraged and/or avoided, thus reducing the amount of elective inductions and unplanned cesarean sections.  Be prepared that the desire for delivery on or by a certain date, or because things are getting difficult and uncomfortable is not a reason to welcome your new bundle of joy early into this world. Following these updated recommendations should only contribute to a more successful and healthy delivery for both mother and baby, which is the outcome all involved providers desire.

One final issue to consider when examining the changing delivery landscape is the impact of insurance coverage. In this era, as new systems of coverage are defined, obstetrical care is changing. At the time of this article, at least one state Medicaid agency has stopped reimbursement for non-medically-indicated deliveries before 39 weeks. If there is a medical reason for you to be delivered, or you go into labor on your own, this does not apply to you. However, if neither of these requirements exist, you may be financially responsible for much more of your care than anticipated.  Although this currently only applies to one agency, out of many, it’s something to consider, and will ultimately affect health care providers, obstetrical practices, midwifery, and hospitals.

In conclusion, the last couple of weeks of pregnancy are exciting, but exhausting, and you really want to meet your new addition to the family. Yet, remember to be patient and think about the benefits of a little delay in meeting those ten tiny fingers and toes, if everything is progressing normally. We all want a healthy and beautiful outcome, and if your body is telling you that you need a little more time, take those last days to rest and relax.  Always communicate with your practitioner, and if there are medical conditions, which support recommendations to deliver, then be confident in the research governing such recommendations. When patients and health care providers are on the same team, it provides a positive delivery experience and better outcomes for all. 

For further inquiries about pregnancy, obstetrics, or general gynecology, contact Dr. Courtney Legum-Wenk of Commonwealth Ob/GynSpecialists at 804.285.8806.