So you’ve reached you “due date”…what exactly does that mean anyway? Due dates are inherently ambiguous for a variety of reasons. First, it is calculated based on your last menstrual period but it assumes that all women ovulate on day 14. This however is not the case for MANY women. Calculating you due date based on a known day of ovulation or conception is certainly more accurate. More importantly, your “due date” is merely the median point during the period of time you are likely to deliver. A NORMAL pregnancy lasts anywhere from 38-42 weeks. A PREGNANCY LASTING LONGER THAN 40 WEEKS IS NOT PATHOLOGICAL.
So where does all of the worry and concern come in? There is a big distinction between being POSTDATES and POSTMATURE. Postdates simply means that you are more than 42 weeks pregnant (counting from your last menstrual period). Postmature is a clinical condition where the placenta beings to beak down, the amniotic fluid level decreases and the baby becomes malnourished. Complications can result including fetal distress, lack of oxygen for the fetus, meconium aspiration, and brain and organ damage. Because of the concerns around postmaturity, inductions have been on the rise, often occurring at or around a women’s “due date”.
But consider for a moment... If you and I were to both bake a cake it may be done in 59 minutes in my oven and 64 minutes in yours. There is not necessarily a problem with either oven or the cake. However, if you get impatient the only result will be a runny cake!
Several tests and minor interventions have become the standard of care for pregnancies at or beyond 40 weeks. Here’s a look at what to expect:
Some OB’s or midwives may “strip your membranes” while doing a vaginal exam. This is done by inserting two fingers into your cervix and separating the bag of waters from the cervix in the hopes of stimulating contractions and thereby labor. Many women experience this as painful. Most will experience cramps and/or minor bleeding for the next few days. Many women who were “on the brink” of labor anyways will start labor within the next day or two. This procedure is often done without first asking mom so if you wish to avoid this intervention make your wishes explicitly known or forgo the vaginal exam all together.
Sometime between 40 and 41 weeks you will probably be asked to do a nonstress test. Your OB/midwife will probably want to continue nonstress tests twice weekly until your baby is born. Your OB or midwife will attach a fetal heart rate monitor and a monitor to track contractions. You will also be given a button to press when you feel fetal movement. You will be monitored for about 30 minutes and they are assessing contractions, fetal heart rate over time, fetal movement and fetal heart rate response to movement. If you choose to have this test done be sure you eat well before you go in and drink a glass of juice right before the exam. A sleepy baby can give an artificial finding of distress.
Sometime between 40 1/2 and 42 weeks your care provider will probably order a biophysical profile. This consists of the same nonstress test as above and an ultrasound which looks for : fetal movement, breathing motions, muscle tone and amniotic fluid volume. Each category is scored (0-2) and the score totaled (a possible total score of 10 including the nonstress test) to determine how well the baby is functioning. If you choose to have this test done drink extra water for a few days leading up to it and again eat well and drink some juice before going in for the exam.
Any of these tests are likely to result in an indication for induction. Sometimes it is well founded, sometimes your tests will falsely indicate fetal distress and you will be put through an induction unnecessarily. If your OB or midwife suggests an induction ask a lot of questions.
Why is an induction necessary?
What specifically did the test reveal?
How serious is the fetal distress?
What method of induction is planned?
When does your care provider recommend the induction?
What happens if you wait?
Then, I highly suggest you go home for a bit. Tell your care provider you need to get your bags, feed the dog, call the sitter, whatever it may be. Then go home for an hour, a day, a week, whatever you feel most comfortable doing. Take this time to research your options, do some soul-searching, pray or meditate on the issue and call your doula. Especially if you plan to go in for the induction, spend some time with your baby. Prepare him or her for what is to come and tell him/her how excited you are to meet him/her. If you choose, explore options such as herbs, homeopathic remedies or acupucnture to either start labor or at least prepare your body for an induction. But most of all, remember that being past your “due date” is not, in and of itself, a problem. However, genuine postmaturity can lead to serious complications for your unborn baby. It’s always a matter of finding a balance between allowing nature to take it’s course and avoiding interventions with assuring the health and safety of your baby.