Culture of Fear around Postdates Birth

[PTmorgan]

According to US I'm due May 5th. According to LMP I'm due May 12th. Midwife and OB are sticking with May 5th.

Midwife wants me to start going for non-stress test amniotic fluid check at 40w 6d from her date. I gave in and said OK, and have it scheduled for Monday. I told her I'm comfortable going a couple of weeks late, but that I sense she is getting antsy. She said "I've seen some bad things when women go late." However, I've been doing a lot of thinking since I saw her earlier today. Here are my rambling thoughts:

I'm normally a very assertive woman who does extensive research into whatever I'm involved in. So why do I cave so easily in the OB/midwife arena? I think deep down "I must keep them happy with me, so they don't see me as a problem patient." They are going to have me vunerable during labor. I don't want them to see me as so argumentative that they will be wondering if I'm a sue-happy type of person, and practice CYA medicine. (I'm not at all.)

I see the nervousness in the staff, not just the midwife, when I go past their EDD. Suddenly the cheerful comforting energy is gone. She is constantly saying "Hopefully you will go into labor this weekend. I gave you the list of natural things you can do to get things kick-started if your body is ready." I don't get a sense of confidence or calm about being pregnant for 41 or 42 weeks. It's frustrating for me to be on the receiving end of this. I'm calmer than they are! And I'm fighting the urge to buy into the idea that something is wrong.

Almost all the OBs and midwives I know got into this business because they love it - mommies, births, babies. So what happened? I think it's sad that they now have a constant culture of fear at the pinnacle of the process, the climax. It must be so stressful for them.

I can empathize from their side. However, from a selfish viewpoint, I don't want their fear to invade my space.

OK, enough rambling. Anyone else think along these lines?

[russianthistle]

Well, I'm 41w 5d today and I understand much of what you mean.

I do not sense the nervousness about the staff at the office or with my mw's. I'm just being told, simply, that I am unable to go beyond 16 days beyond my due date...16 days is Mon. and induction w/ cervadil is the first step. I do feel like the baby will be born soon and before the appt. for induction; nevertheless, I am challenged by this date....I mean, who says what the due date really is? some average of all women everywhere??? no an average of some women in some places...

I do think that this is a cultural problem that is probably not found as readily outside the US (perhaps North America?).

[lightheartedmom]

I am 40w4days by my own due date. There's maybe a few days range where I could be off (like I could be due today or tomorrow instead of last Sunday). I skipped my appointment this week for this very reason. I already endured a bunch of unncessary testing last week and I felt like I was becoming too vunerable and letting the medical establishment get into my head a bit too much. All the MW's at the practice i'm seeing have been great, supportive of my goals and non-intrusive to an almost unexpected (in that setting) extent. But there is a point where I can tell they are still less trusting of the process than I am...this whole business of being overdue is a challenge enough for me, learning to trust my body (after an induction the first time around for pre-e) and realize that it will do what it needs to do. I'm watching out for danger signs, of course...but the baby's heart rate has been consistently fine, my measurements are great (no problems w/ low fluid), my blood pressure has been normal throughout and I'm getting great, consistent movement from the baby every single day. As long as those things continue, I'm trying to rest and be content w/ the baby staying as long as it needs to.


I completely know what you're talking about though...I worked for an OB practice before having kids and I saw a pretty serious lack of faith in the human body there. Definitely, we saw some of the worst case scenarios (HELP syndrome, placental abruptionl, etc), but those are such a rarity and it's a shame to treat all patients with those rarities as the model. Yes, things can and do go wrong, but more often than not, they don't. We wouldn't have survived as a species if they did go wrong as often as doctors act like they do.

The reality is that there are indicators that we can monitor to make sure that you're safe continuing your pregnancy until your body goes into labor naturally. BP, fluid levels, baby's movement, etc. If those are fine...why mess w/ the process?? This is why even some full term babies born via induction still have respiratory problems. Sometimes they just need a little more time to cook.

But yeah...I get it. I'm trying to not let the static impact my trust that my body was created to do this work and that my baby is created to know when it's time to come out into the world.

[lightheartedmom]

Originally Posted by russianthistle

I do think that this is a cultural problem that is probably not found as readily outside the US (perhaps North America?).

My cousin who lives in France (and is an MD there) recently had a baby, and from comparing notes w/ her about birth in that country, I've been surprised that it seems like the attitude of management is the SAME if not more than here in the US. In France, you are required by law to have ultrasounds at 12, 22 and 32 weeks from lmp. According to her, most women give birth with epidural anesthesia and homebirth is something done only by a very strange and narrow group of women. Maybe that's her medical background talking...but it does seem that the attitude towards dates and medical intervention is pretty similiar to what we find here in the US.

(Incidentally, France is not the only European country that *requires* ultrasounds...there are some that require them at every single OB appointment!!)

[twins+1]

I can see if you think your dates could be more like May 12th to wait it out, but I think there is something to the concern of post-dates as well. My friend is a nicu nurse and she sees some pretty awful and devastating situations with post-date babies. I don't feel comfortable personally going too far post-date. I kind of feel, just like the human body can have preterm labor, there can be some reason why the body doesn't go into labor on its own as well. I'd do the stress tests, BPPs, etc to be safe. Sorry, I err on the side of caution like the Dr's.

[Full Heart]

I'm 41 weeks 2 days by my dates (I was charting) and 42 and 2 by LMP. By u/s I am 43 weeks. Now I am used to going post dates, have every time regardless of how I calculate my edd so I look at my dates now and figure it doesn't matter if I am 43 or 41 weeks right now; I am done.

I feel if a woman is fine going on longer, the baby looks good, momma is healthy there is no reason to induce. Once things start turning its probably better to get the baby out. I've seen truly post dates babies at only 41 weeks. I have seen babies at almost 43 weeks look early. Doing kick counts is important. Monitoring fluid levels is important. Keeping healthy is important (lots of water, etc). If they know the risks with waiting and the risks with induction she should be free to make her own decisions.

Of course that said 30% of ob malpractice claims are from going past the due date. You know...if dr had only induced. So they do have a right to be scared of someone suing. How do they know it won't be you?

[Ldavis24]

I guess the problem I have with inducing at a certain, 42 weeks for my MW is that I have made it very very clear. I have absolutely no idea when DD was conceived. My periods have always been extremely irregular and I couldn't even remember when my last period was prior to realizing I was pregnant. So how would I know my due date is actually my due date. I am measuring 38 weeks, but am at 37 supposedly. I could be more or less but 42 week rule still applies although I will put it off as much as possible if it comes to that.

I know I'm not the only woman who doesn't know at all when she conceived and yet we are on this time table that makes it not so fun toward the end because of fear of being induced or having to battle your HCP

[thismama]

I would think LMP would be more accurate than u/s, no?? I mean what are the chances you got pg like 5 days after your period (or thereabouts, depending on your cycle). If you're bleeding, you're bleeding. You weren't pregnant then or immediately after, by all the likelihood in the world. A date estimate by a picture should be a distant second in determining due date. I would talk with the midwife about that.

That said I am comfy going to 42 weeks, personally. There is no extra statistical risk to the fetus until 42 weeks, so that is when I would induce and not before. I do the non stress tests, but under the condition that I would make no decision to induce at the hospital environment should the result not be favourable, but would go home and consider and talk to my midwife.

My girls were born at 41w6d and 41w1d respectively. Natural labours both times, apgars 9 and 9 for both of them. I myself was born 17 days postdates. I think the due date hysteria is a little out of control and it can really rob the birth experience, and also a baby's right to come in at the time that is right for it spiritually/astrologically/all of that stuff. Induction for a medical reason I can certainly understand, but for hysteria or a doctor's schedule (mine wanted to induce me coz he was going on vacation)... emphatically no.

[Ldavis24]

The 42 week marker doesn't bother me at all. In the sense that I am more than willing to go past it. I love my MW and really don't want to fight her on it. However, if (hopefully not) I get to that point I am going to tell her that I am not simply allowing an induction at 42+1. There better be a good reason. I will do all the monitoring they want but would rather wait until 43 weeks (at which point I would do an induction). It isn't a problem for me yet but it is constantly on my mind!

[thismama]

Here you can homebirth up to 43 weeks attended by a midwife.

[Ldavis24]

Originally Posted by thismama

Here you can homebirth up to 43 weeks attended by a midwife.

I'm impressed!

[Quate]

Originally Posted by thismama

I would think LMP would be more accurate than u/s, no?? I mean what are the chances you got pg like 5 days after your period (or thereabouts, depending on your cycle).
\

Depends on your cycle. If you regularly ovulate on day 14, then LMP is an accurate predictor. Otherwise, less so.

[Smithie]

IMNSHO, this is a "look at the patient, not at the chart!" scenario. If the calendar says the woman is at 41 weeks, but she measures 39 on a consistent non-stalled growth pattern and the baby and placenta look great and the blood and pee look great, CYA medicine does not serve that particular mama/baby pair very well.

That said, I prefer the risks of slight prematurity to the risks of slight postmaturity, so I would not choose to go postdates. But it should be MY choice, not a bullying situation, because this is an issue where two reasonable people can make vastly different choices.

[Asher]

Originally Posted by Quate

Depends on your cycle. If you regularly ovulate on day 14, then LMP is an accurate predictor. Otherwise, less so.

It also depends on the date of the ultrasound. I would trust a very early ultrasound for dates, but absolutely not a later one.

My 20wk u/s had my due date a bit sooner and what I originally thought it was...my LMP had me 3 days later by their "wheel" (which I hate b/c every wheel in the office seems to be different! I won't start on that, though! ). Not a big time frame, but I could totally see it being a problem if it were. Midwife agreed to go by the wheel b/ I am sure of my LMP and I know I'll probably need more time going by my past pregnancies.

With that said, DS#1, we had an early u/s b/c I had severe pain and they wanted to rule out an ectopic pregnancy. That was around 6 weeks along, I think? That put my due date 5 days later than my wheel/LMP date. DS was born on that day (when I was due according to the early u/s), but late according to wheel/LMP. My periods were very regular, too, 28 days, etc.

Everything is just so variable. It's like saying a baby born at 37 weeks is "full term" and therefor would have no issues. It's not a hard and fast rule. That's why "full term" is considered 37-42 weeks. All of my babies have been late according to the wheel, between 5 and 14 days. None had any issues at all at birth, none looked overdone, none had any problems, we did the NST's when I went overdue to please the. They all did wonderfully on them and they all came when they were ready. (2 of them came out the night before they were due to be induced. )

to all dealing with this!

[thismama]

my baby measured 8 days? i think? ahead according to our first ultrasound. i knew exactly when i conceived tho, used a donor so no doubt about it. aren't they only accurate within a window of a week, or two weeks or something like that? even very early?

[~Katie~]

With DS I had really unpredictable cycles if any at all so we ended up guessing on his due date. He consistently measured one week ahead on every ultrasound I had (I ended up with 4) but we stuck with the original EDD and he was born naturally at 40 weeks, 1 day. He was a 7lb. baby and no way was he 41 weeks let alone 40 based on how he appeared and behaved after birth. Just another example of how variable it can be, but he could have definitely benefited from another week or two had my body not decided to evict him before then. This time around my cycles were extremely predictable and based on charting with OPK's my date and the u/s date matched up perfectly. I am very curious to see how each baby compares. I agree that its better to look at the person rather than the calendar.