1. Section Editor(s): Freda, Margaret Comerford EdD, RN, CHES, FAAN

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Readers of my editorials and other articles in the literature know that I'm acutely interested in the language we use with our patients. A lot of my research has been about patient education, and what women and families really understand when we teach them. Just recently I wrote an MCN editorial titled "Incompetent. Really?" challenging nurses to confront the use of pejorative, punitive, and degrading language such as "incompetent cervix," "trial of labor," "failure to progress," "failed trial of labor," and other equally offensive language describing women's bodies, labors, or births. Now, I'm happy to say, there is a victory for women and newborns in the form of terminology, and I hope you know about it. This alteration is not one of the sticks-and-stones type of change to rid us of degrading words, but a different type that could actually make a difference in outcome for mothers and infants.


I have worked in the area of preterm birth prevention since the early 1980s, and one of the most difficult issues we have struggled with was the terminology of "term pregnancy." When was a baby at term (and therefore safe from prematurity sequellae)? While officially "term" was designated as a continuum of 37 to 41 weeks, we all knew that providers were even telling their patients that as long as they reached 35 or 36 weeks GA, their babies would essentially be fine. Providers said this not from carelessness on their part, but rather due to their observations that the excellent advances in NICU care were leading to smaller and smaller babies being eventually discharged to home in apparently reasonable health. After all, NICUs had come to be incredibly efficient at saving tiny babies, and wasn't that what we all wanted? Actually, we were shortsighted about this. As the years went on, and scientific research was conducted about real outcomes for babies born at 37 weeks (many by repeat Cesarean or induction), we learned that prematurity was actually being fostered by some of the activities of physicians who induced labor or suggested C/births at or before 37 weeks, thinking that the babies would ultimately be healthy. Now we know better. The science has now shown that the fetal brain is not fully developed until 39 weeks. Now we know that real, critical health problems can and do occur in infants born before 39 weeks, and a movement has bubbled up to stop the all too frequent practice of inducing labor or performing C/births before 39 weeks. The March of Dimes has played a significant role in these changes with their Prematurity Campaign aimed at reducing preterm birth; they have been aggressive in asking providers to "prevent the preventable" and in encouraging women that "Healthy Babies are Worth the Wait." This education and awareness program has focused on both the general public and the world of HCPs. In addition, other organizations such as AWHONN have worked with their members, encouraging nurses to teach their patients to "Go the Full 40." That effort has also been aimed toward teaching pregnant women not to ask for, or accept a suggestion to have their baby any time before 40 weeks unless there is a compelling medical reason for doing so. The National Institute of Child Health and Human Development, ACOG, the Society for Maternal Fetal Medicine, the MOD, and others have now taken the extraordinary step of REDEFINING what we should call a 'term pregnancy.' Here are the new definitions they developed:


* Early term (37 weeks, 0 days until 38 weeks, 6 days)


* Full term (39 weeks, 0 days until 40 weeks, 6 days)


* Late term (41 weeks, 0 days until 41 weeks, 6 days)


* Postterm (42 weeks, 0 days and beyond) (Spong, 2013)



This nomenclature tells everyone concerned that every week of pregnancy up to 39 weeks is important for full development of a baby. Note that 37 weeks is now "early term." A baby is not "full term" until 39 weeks GA.


I hope all of you are using this new classification language both in your patient education and in casual discussions with your friends and families. It's essential that you become conversant with this new language, for the language we use can make a big difference. I've always thought so.




Spong C. Y.(2013). Defining "term" pregnancy: Recommendations from the Defining "Term" Pregnancy Workgroup. JAMA, 309(23), 2445-2446. [Context Link]