Risk: Born After Hours

by Dr. Michele Brown OB/GYN

Paparazzi Baby

baby dressed as the New YearThe countdown to midnight is here, but instead of being in Times Square with millions of others watching the crystal ball drop, imagine being a woman in the final pushes of labor in a delivery room. She is yelling at the top of her lungs, but oddly enough, it's not over the intensity of her labor pains. She is actually yelling at the clock on the far wall which still reads ten minutes to midnight. It seems to her as if the minute hand is stuck in place as she prays that her baby can wait just another few minutes to be the first one born in the New Year!

As if having a baby is not exciting enough, what a fantastic start it would be to have the media snapping photos and praising your baby for arriving first on New Year's Day. New Year's (12:01 a.m.) babies are so exciting, but delivery outside prime time hospital hours has its risks.

But as an OB/GYN, please take it from me that this is not the kind of thing you should be thinking about just when your baby is in the most vulnerable position of life, upside down and trying to be born. Why?

Research

Because research shows that there is an added risk when delivering a newborn in the middle of the night, off hours, or on holiday weekends.

Pasupathy in the British Medical Journal: One such recent study concludes that delivering an infant outside the normal working week hours of Monday through Friday and from 9 to 5 was associated with increased risk. The differences had nothing to do with maternal, infant, or obstetrical characteristics, which hospital you delivered in, or mode of delivery.

Gould in Obstetrics and Gynecology: Another study showed an increased risk for infants born during the late night.

Accounting for These Risks

There may be many reasons for these added risks. Among them are differences in numbers of staff members and decreased availability of senior, experienced staff members at odd hours. Other causes may be due to decreased availability for obstetrical operating rooms, fatigue among staff members working on night shifts and fewer paraprofessionals, such as blood bank staff members, on duty.

Higher Danger for Low Risk Births

Is this finding associated equally with both low risk births and high risk births? No. Interestingly, increased risks were found to be more common in the lower risk births. Why? Because as the research suggests, the higher risk situations have anticipated problems and have the ability to identify and mobilize the needed resources very quickly, while the unanticipated problems that suddenly arise in lower risk pregnancies, may cause delays in getting the appropriate personnel and material to the given situation in a timely fashion. Very low birth weight infants seem to have sufficient and adequately trained staff members at all times.

Your Medical Team's Response

New rules and regulation have been implemented to reduce this risk:

  • Improving the level of care and personnel during off peak hours might decrease the risk of perinatal death.
  • Reducing resident's fatigue could improve outcomes. Future investigation will ascertain whether limiting on-call time will have any effect on the mortality rates.
  • Improve the ability to arrange and transport medically complicated infants who need ventilation or surgery to tertiary or regional care facilities at night when delivered in primary or intermediate level hospitals.
  • Analyze the individual departments such as nursing, obstetric, pediatric, anesthesiology and diagnostic services to discern which of these departments may be contributing to the elevated mortality rate.
  • Compare of the number of vaginal deliveries and cesareans at different times of the day. It is possible that there are more vaginal deliveries at night that would have benefited from cesarean delivery but due to the late hour, delays and postponements occur and proper care is not given.

What You Can Do

This information is not intended to alarm prospective parents if their baby decides not to be born during prime time hospital hours. What I am saying is this; a woman does not have much control over when her baby is born, but there are a few things she can do to help ensure a safe and healthy delivery even if an unexpected situation arises.

  • Be vigilant ahead of time. Find out your hospitals policy regarding night and weekend staff including 24 hour coverage of adequate nursing staff with delivery floor experience.
  • Learn if there is 24-hour access to in-house blood bank facilities as well as in-house anesthesiologists, neonatologists, and pediatricians.
  • Make sure there is a fully functioning laboratory and emergency transport facilities in case the need for these should arise.
  • Ask if the hospital has sleep-in OBs just in case your primary OB's arrival is delayed due to traffic or weather.

Make sure your baby's safety is your first concern and don't worry about being in the limelight because you want your baby to be the first born in the New Year.

New Year's Eve Pregnancy Friendly Beverage

In the meantime, relax and enjoy the following recipe for this wonderful New Year's Eve beverage. It's non-alcoholic and delicious. Pour it into a champagne glass and enjoy these wonderful moments with your friends and family.

Oriental Breeze — serves 6

2 cups sweetened green tea
2 cups cranberry juice
½ cup fresh lemon juice
½ cup rose water
3 T honey

Mix all of the above in a blender with crushed ice. Pour into festive glasses and top with a rose hip, or a rosebud. Cheers!

Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.

Copyright © Michele Brown. Permission to republish granted to Pregnancy.org, LLC.