A Due Date is an Estimation, not an Expiration
The final weeks of your sacred pregnancy often seem to drag on. You’re heavy and tired. You’re eager to meet your baby. You feel like you have been, and will be, pregnant forever and… ugh. Then you feel guilt for feeling the “ugh” because you are supposed to be grateful. And you are grateful. Grateful to be pregnant and growing a healthy baby, but you seem to be forever expanding, discomfort is the new normal and, well, sometimes it’s just plain tough to wait. You're preparing for natural birth, but when your doctor says your labor will need to be induced if your child doesn't come by 41 weeks (or whatever expiration they have given to your pregnancy), it can be tempting to put yourself out of your misery. Add your doctor’s vague implications that your baby’s health may be at risk and you no longer feel like you have a choice. So, the induction is scheduled—doctor’s orders.
Hold up.
What happened to all that trust my baby, trust my body talk?
Let’s talk about due dates.
The due date set during pregnancy is an estimation of when baby (or babies) will be expected. Initially, this date may be set based on your last menstrual period (LMP) and will be calculated as 40 weeks from your LMP’s first day. This method assumes that your cycles are 28 days long and that you ovulate on cycle day 14 (the first day of your last period is cycle day 1). It tags that ovulation day as the time of conception, then estimates the actual gestation time as 38 weeks. Similar calculations are made if you become pregnant via IVF or IUI, but in those cases the date of conception is more accurate.
Next, you might be sent for what is often referred to as a "dating ultrasound." The fetus is easier to measure when it is small, and age can also be predicted based on development—so early ultrasounds are more accurate at estimating fetal size and age. Most people will see their due date change following this ultrasound. Even if you only had sex on one day in the last three months, and therefore know when you conceived, your due date may change based on your baby’s development at your dating ultrasound.
Throughout your pregnancy, you may have your expected due date change multiple times. Some child-bearers find their due date changing by as much as two weeks. Clear as mud? Exactly.
What does all this mean?
Due dates are an educated guess about when your baby might be born. Average babies that are born at term (37-42 weeks) may range from 5lb 8oz to 8 lbs 13oz. Combine that with the fact that estimates about fetal weight obtained by ultrasound (especially after 23 weeks) can be inaccurate by more than a pound in either direction and you don’t exactly have the most reliable system for establishing when a baby will be prepared for birth.
Like most everything in life, every baby grows a little differently, will be healthy at a different size, and may need more or less time to make their entrance. Some people also have a repeated tendency to have shorter or longer gestation periods—that’s why “at term” encompasses a five-week window.
So, with all of that said, is it really a good idea to decide that a baby should be evicted from the womb based on a loosely guesstimated day?
Risks of induction
Inducing labor carries risks. Depending on the method of labor induction used, the dangers include:
Premature birth. Due to the inaccuracy of ultrasound technology, there is always a chance that your baby could be born too early if your labor is induced.
Infection. Labor induction can increase your risk for infection.
Reduced oxygen supply to your baby. Oxytocin (also known as Syntocin, Synthetic Oxytocin, or Pitocin) may cause too many intense contractions, impacting your baby’s oxygen supply and lowering their heart rate.
Umbilical cord accidents. If your baby's head is not engaged in your pelvis, labor induction increases the chance that the umbilical cord can fall into the vagina before baby does. This Umbilical Cord Prolapse can compress the cord itself and cut off the baby's oxygen supply.
Hemorrhage after delivery. Labor induction increases the risk that you will experience uterine atony, which occurs when the uterus does not contract after giving birth and leads to excessive bleeding.
Uterine rupture. Pregnant women who have had a previous Caesarean section (C-section) or another major uterine surgery are at an increased risk of having the uterus tear along the old scar tissue. Uterine rupture is a life-threatening situation where another emergency C-section will be required to save the lives of both birther and baby.
An increased risk of surgical birth. Interventions typically lead to more interventions because the body isn’t given a chance to adapt and soften as labor progresses. So, labor induction increases the chance of needing to give birth by C-section. First-time pregnancies and those with an unfavorable cervix (meaning the cervix has not begun to soften, thin, and open) are at further risk.
Each of the above dangers carries its own risks. C-sections, for example, are a major surgical operation and have all of usual concerns associated with surgery, including an increased risk of death. Surgical birth further impacts postpartum recovery, bonding, and breastfeeding relationships. And due to a higher probability of these risks, labor induction is not an appropriate option if:
you have had a prior C-section with a classical incision
your placenta is blocking your cervix (Placenta Previa)
your baby is transverse (lying crosswise in your uterus)
you have an active herpes outbreak.
Some pregnancies are just longer. According to a Swedish study published in 2013, your genetics have an impact on how long you gestate a pregnancy, as well as how long your baby needs to be gestated. Your partner's genetics will also have an impact on how long your pregnancy will be. You may also experience longer pregnancies if:
your Body Mass Index (BMI) is high before pregnancy.
you gain more weight than normal while pregnant.
there is a long time between ovulation and implantation.
this is your first pregnancy.
your baby is male.
your mother experienced longer pregnancies.
your baby measures small for their date on an ultrasound done between 10 and 20 weeks of gestation.
you have experienced environmental stress between 33 and 36 weeks of gestation.
What about the risk of stillbirth?
Usually, the mention of stillbirth sends us all into a bit of a panic. No one even wants to discuss the possibility of stillbirth, let alone experience it. Sometimes, doctors and midwives throw around phrases like "your baby is more likely to be stillborn if you don't get induced before 41 weeks,” and that can sound pretty scary.
Stop.
Take a breath.
Even later in pregnancy, the incidence of stillbirth is very small. You can talk to your primary care provider about absolute risk and make an informed decision. Unfortunately, the current information and research that is available is not high quality.
What about too little amniotic fluid?
Once a certain date is reached, many doctors will say that the amniotic fluid is low, and that this is reason enough to induce. Further research shows us that is not the case:
There is no evidence that inducing labor for isolated oligohydramnios [low amniotic fluid] at term has any beneficial impact on mother or infant outcomes. Based on the lack of evidence, any recommendation for induction for isolated oligohydramnios at term would be a weak recommendation based on clinical opinion alone.
Rebeccaa Dekker, from Evidence Based Birth, says that it is extremely difficult to get an accurate read on the amniotic fluid through ultrasound. Read the full article here.
When I studied with Ina May Gaskin, international midwife, she spoke of this scare tactic that is often used. In her community where natural birth is the norm, her clients often go well over their due date with no problems. She says that low amniotic fluid can be solved easily usually by making sure mom stays hydrated. She recommended extra water, cucumbers, watermelon, coconut water and any other foods with a high water content for mothers in their last few weeks of pregnancy.
Babies release a protein signaling that they are ready for life outside the womb.
Babies have a natural intelligence that signals mothers that it is time to go into labor. Recent findings show us that a specific protein, surfactant, is released from babies' lungs that essentially communicates to mom: "I'm ready to breathe outside of your womb!"
"Drs. Carole Mendelson, Jennifer Condon and Pancharatnam Jeyasuria published findings that a substance secreted by the lungs of a developing fetus contains the key signal that initiates labor.
The protein released from the lungs of a developing mouse fetus initiates a cascade of chemical events leading to the mother's initiation of labor. This research, which has implications for humans, marks the first time a link between a specific fetal lung protein and labor has been identified, said Mendelson, professor of BioChemistry and Obstetrics and Gynecology and senior author of the study." ---(See full article here)
Why not try trusting instead of worrying?
I like to give women the example of a fruit ripening on the tree. If you've ever had an apple tree in your garden, you'll understand the importance of waiting until something is ripe to pick it. You can feel as you gently tug on the apple that it wants to stay on that tree just a tad longer. You patiently wait some days more and as you reach up for it again, it practically falls into your hand, resulting in a perfectly sweet and crispy ripe apple.
Nature's pretty good at what she does. We usually don't need to rush her. There are occasional emergencies, and we are blessed with technology in those cases. But they are rare. The current induction rates do not reflect true emergencies.
If you are at the end of your pregnancy, anxiously waiting, can you invite yourself to trust and relax? Can you tap into your intuition to see if you really need to worry? Are you hydrated? Is baby still moving? Are you feeling healthy? Chances are, then, things are totally fine. You've made it this far mama. Don't let fear overcome you and ruin your plans for a natural, sacred birth.
You do not have to consent to an induction based on your due date.
You have many choices should your pregnancy last longer than 40 weeks. You can choose to wait until your baby is born naturally and continue with regular checkups, or you can decide to have your doctor actively monitor your baby and your pregnancy more than usual. Regardless of what you choose, you should not be bullied into doing anything that doesn’t feel right to you. This is your pregnancy, your body, and your baby—you have the power to say no.