Lori Hilldrup loved being pregnant. Even on her due date, she was perfectly content when she did not go into labor.
“I was very lucky in my pregnancy, so I was ready to soak up a few more days,” she said. “I wanted him to cook as long as he wanted to because I wanted nature to take its course. I felt like my body knew what to do, he knew what to do and not messing with that seemed more logical to me than stepping in.”
It paid off for Hilldrup, a Chesterfield County resident. She and her husband welcomed their new baby, Oliver, on May 2 — four days after his due date — with no major complications.
Now, more babies in Virginia are being born just like Oliver and likely are having better birth outcomes as a result.
As of the end of 2016, Virginia had the lowest rate of early elective deliveries in the country, according to federal government data. The state’s rate was 1.3 percent, compared with the nationwide rate of 2 percent.
An early elective delivery is an induction or cesarean section delivery between 37 and 39 weeks that is not medically necessary.
Until about 10 years ago — when awareness of the importance of waiting until 39 weeks grew — many believed 37 weeks gestation was enough time for a baby to develop completely.
“Research shows that there is a tremendous amount of growth that occurs in those last weeks of pregnancy,” said Dr. Vanessa Walker Harris, director of the Virginia Department of Health’s Office of Family Health Services.
Along with the Department of Health, a number of groups have pushed to reduce the early elective delivery rate in recent years, including the Virginia Hospital and Healthcare Association and the March of Dimes, a national nonprofit focused on improving health for mothers and babies.
In 2012, Virginia’s rate of early elective deliveries was 8 percent, according to VHHA.
“Reducing early elective deliveries is important to improving birth results, birth health and can have lifelong benefits,” said Dr. Stephen Bendheim of Virginia Physicians for Women during a recent VHHA press conference. “This achievement is something to be very proud of and to remain vigilant about as time goes on.”
VHHA has encouraged hospitals across the state to adopt policies that help mothers understand the dangers of choosing to deliver too early, as well as dissuading physicians from scheduling early elective deliveries in the first place.
Babies born before 37 weeks are at higher risk for respiratory distress syndrome, sepsis and infant morality. They may also risk inadequate development of their brain, lungs and liver.
“Brain volume actually increases quite a bit in those last few weeks of pregnancy,” Walker Harris said.
Ashley Mirmak, a certified nurse-midwife with VCU Health System — where Hilldrup delivered Oliver — said that around 39 or 40 weeks, the baby’s brain is a third larger than it was at 35 weeks.
“So that’s a whole third of their brain that will grow in those last couple weeks,” she said.
Those babies born before 39 weeks may also have lower birth weights, feeding problems and longer stays in neonatal intensive care units, according to the National Institute for Health Care Management Foundation.
Waiting can be beneficial to mothers, too. If they wait to deliver the baby naturally, Mirmak said “moms have additional bonding time with their babies.”
“They also have a less likely chance of having to use a (breast) pump because their babies usually feed better when they get to 39 or 40 weeks,” she said.
Midwives at VCU Health do not induce mothers when not medically necessary until 42 weeks, she said.
According to federal Hospital Compare data, VCU Health did not have any medically unnecessary early elective deliveries in 2016.
But sometimes, inducing between 37 and 39 weeks is necessary for the baby’s well-being.
After a placental defect, Henrico County resident Mary’s first son was stillborn at 28 weeks. When she became pregnant with her second son, she was filled with anxiety over what would happen, and because of her history, her doctor chose to be cautious, inducing her at 37 weeks.
But for her third pregnancy, she and her doctors worked together to come up with the plan that was best for her. She said she went in with no expectations and scheduled her induction for after her due date.
Her son Ryan arrived naturally in the early morning hours of his due date at HCA Virginia’s Henrico Doctors’ Hospital. There were no major complications and she was only in labor for about four hours.
The policy at Henrico Doctors’ Hospital is not to do any early elective deliveries, allowing a first-time mother to induce only at or after her due date and mothers who had children before to induce after 39 weeks.
“I feel very blessed,” said Mary, who declined to share her last name for safety reasons. “The third time’s the charm, as my husband said.”