In 2013, ACOG-American
College of Obstetricians and Gynecologists, updated their definition of
full-term pregnancy. The new guidelines read as such:
"In the past, the period
from 3 weeks before until 2 weeks after the estimated date of delivery was
considered “term,” with the expectation that neonatal outcomes from deliveries
in this interval were uniform and good. Increasingly, however, research has
shown that neonatal outcomes, especially respiratory morbidity, vary depending
on the timing of delivery within this 5-week gestational age range. To address
this lack of uniformity, a work group was convened in late 2012, which
recommended that the label “term” be replaced with the designations early term
(37 0/7 weeks of gestation through 38 6/7 weeks of gestation), full term (39
0/7 weeks of gestation through 40 6/7 weeks of gestation), late term (41 0/7
weeks of gestation through 41 6/7 weeks of gestation), and post term (42 0/7
weeks of gestation and beyond) to more accurately describe deliveries occurring
at or beyond 37 0/7 weeks of gestation."
The reason for the revisions is
stated to be:
"The American College of
Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine
endorse and encourage the uniform use of the work group’s recommended new
gestational age designations by all clinicians, researchers, and public health
officials to facilitate data reporting, delivery of quality health care, and
clinical research."
The need for this revision could
lead us to question how we really know when it is appropriate to induce labor
or allow a near term labor to progress. In other words, how do we know that the
baby of a mother at 39 weeks + 0 days gestation is ready as opposed to 38 weeks
+ 6 days?
In Hunyuan medicine and Hunyuan
birth, we find that it is not the calendar that is most beneficial in
determining the appropriate timing of the onset of labor, but what we call the
strength of her unification or recharging ability and the yin-pivot.
The unification and recharging ability refers to the mother's ability to
maintain strength, vitality and health, or what we call life, while the
yin-pivot is the shared connection between the mother and her fetus that
supports the life of the fetus throughout gestation and birth.
If we examine what needs to
happen before a pregnancy reaches term, there are two aspects that warrant
consideration. The first, and why ACOG revised their definition of full-term,
is that the fetus must be mature and able to sustain his own life outside the
womb. For the entire gestation, this new life was supported by the mother, but
after birth, the newborn must be able to begin life sustaining activities right
away. When fully mature, at birth a newborn will have cleared his lungs of
fluid so he can breathe, he will eliminate waste from his intestines so he can
eat, he will be able to blink his eyes open and closed, and cry to get his
parents' attention. Because of the connection between mother and fetus through
the yin-pivot, the timing of the maturation of the fetus could be affected by
the strength of the mother's unification and recharging.
In addition to the fetus reaching
maturity, the second aspect involved in the onset of labor is the unification
strength and recharging ability of the mother. When a mother is healthy with
good vitality, she has more strength, vitality and life available to give to
the demanding process of birth. If we take the example of sleep, which is a
recharging state, as a parallel-think about a night of being awake all night
unable to fall asleep. When it was time to go to work or school, it was
probably more difficult than the mornings after a good night of sleep, there is
physical exhaustion and sluggish mental faculties, all because of the lack of
recharging overnight. Going into labor presents the same challenge if the
expectant mother is inadequately recharged thus it may be difficult for her
body to build up enough strength for labor to begin at the appropriate time. On
the other hand, if the mother is healthy, with adequate recharging and
unification, her fetus matures on time, and when ready to exist outside the womb,
the mother is strong enough to begin an efficient and timely labor. From the
Hunyuan perspective, this is a labor that beings on time.
For optimal recharging, we
recommend that expectant mothers prioritize sleep, first and foremost. This may
mean cutting back on other obligations or taking naps during the day. In
addition, getting plenty of whole foods and fresh water support recharging and
unification strength. Finally, working on deep breathing techniques to bring
more oxygen into the body will make great improvements in health and life. When
the mother is healthy and recharged, the fetus reaps all the benefit, both
during pregnancy and birth.
For more information, contact Bird & Bee Acupuncture &Birth Services or watch for our presentations in the Hunyuan Academy.
Resources: The American College
of Obstetricians and Gynecologists Committee on Obstetric Practice Society for
Maternal-Fetal Medicine, Committee Opinion, Number 579, November 2013. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Definition-of-Term-Pregnancy
