I’ve been mulling a post for the past few days after hearing a report on WBUR about changes in how elective C-sections and inductions are scheduled in Massachusetts. However, I’ve been reluctant to write it because the subject skirts dangerously close to questions that arise in the abortion debate, and I’d really like to avoid sticking my foot in that particular viper’s nest. The Internet gods have been awfully kind to me of late, and I’d like to enjoy a few more days of goodwill before lousing things up.
But fortune favors the bold, and what’s the point of having convictions if you’re not willing to say anything about them? So here goes…
First, the policy in question:
Many of us know a mom who chose to have her baby before its due date. There are lots of reasons why one might choose to do this: the health of the mom or the baby, her doctor’s schedule, the demands of her husband’s work, or even to hit a specific birthday. But if that perfect day falls before the 39th week of pregnancy, and there’s no medical reason for an early delivery, many hospitals in Massachusetts are saying no, you have to wait.
The number of early deliveries, from induced labor or C-sections, has been on the rise across the country for more than a decade now, including in Massachusetts. One reason is that we’ve come to expect that babies born “a little bit early” will be fine.
“Before the benefit of the neonatal intensive care unit, people were very conservative and would not induce or do repeat C-sections before 39 weeks,” says Dr. Glenn Markenson, the director of maternal and fetal medicine at Bay State Medical Center in Springfield. “But as they saw how well babies were doing with pediatric care, and they were getting pressured by patients because of social situations, there was a creep down from 39 weeks to 38 weeks, sometimes 37 weeks.”
“Early-term infants have higher rates of respiratory distress. There are also issues with feeding,” says Dr. Lauren Smith, medical director at the Department of Public Health. “The most recent evidence shows that babies born before 39 weeks may also have developmental issues, so when you add up the increased risks and you weigh that against a situation when it’s purely elective, then you really can’t justify it.”
A growing number of hospitals in Massachusetts, and across the country, are saying no to elective inductions and C-sections before 39 weeks. The change is happening quietly and some new mothers don’t like it.
And now the part that got my blood pressure up:
Lisa Coulouris sits on her hardwood kitchen floor with the Moms Club of Reading baby playgroup.
“The bottom line is women should have 99 percent of the say in what happens with their pregnancy and their bodies,” says Coulouris, who delivered twins eight months ago after complications that led to an emergency C-section. She does not like the idea of hospitals telling women they must carry to at least 39 weeks.
“You’re already out of control of your body, so at least to know if you go to your doctor’s office and say, ‘Look, we’re at 37 weeks, and I feel like I’m ready,’ ” Coulouris says, imagining a case in which a mom would not want to wait. “To know that I would have that choice would just make me feel better. But to take it away from me just adds to the pressure of being pregnant.”
I have no idea how widespread Coulouris’s attitude is. For all I know, she’s just one woman with an opinion, and perhaps she doesn’t speak for any new mothers except herself. That said, I find her comments incredibly selfish and the attitude behind them appalling. The risks to a baby born at 37 weeks are measurably higher than for one born at 39, and I really can’t understand how a woman would elect to expose her newborn to those risks based solely on the notion that it’s her body and thus her choice alone. Feeling like one is ready is not sufficient justification, and certainly by the time of near-term delivery there is another person’s welfare at stake in that decision. The policy of stopping elective inductions or scheduled C-sections before 39 weeks is eminently reasonable.
Since I’ve gone this far, I may as well push ahead and express my greatest qualm with the pro-choice movement. The argument almost always seems to boil down to women wanting to have control of their own bodies, which is a sentiment I agree with wholeheartedly. But saying “my body, my choice” is the most blatant and egregious example of question-begging I can think of in contemporary rhetoric. If everyone agreed that it was just about women’s bodies, I don’t think there’d be much room for debate. But not everyone agrees! Many people believe that a developing fetus is an entity separate from (but inextricably linked with) the woman’s body, and that it has its own moral weight.
One can weigh both of these considerations and still favor the right of women to abort their pregnancies. I do, for the most part. But in order for there to be an honest conversation, there must be an acknowledgment that there is more than just the health of women at play when considering it.
Let me conclude with a request, which may prove redundant when nobody reads this post, much less bothers to comment. But if you did read it (thank you), and if you do choose to comment, please keep in mind that there are people of virtue, intelligence and goodwill on both sides of this debate, and keep your comments respectful. I will have a low threshold for removing comments that do not comply.