Is 41 weeks the "new" 42?

[KGB]

In most everything I've read and heard, OBs usually "allow" women to go into their 42nd week before scheduling induction. However, today my wife's OB told me that current research has shown that waiting longer than 41 weeks increases the risks involved and the potential for a C. Thus, the clinic will not let her deliver past 41 weeks.

She didn't really quote her research or mention any specific journals. Is this commonly the case today? Are OBs using 41 weeks as a cutoff instead of 42 now?

[sharr610]

Is your wife over 35? There was some study done recently that talked about advanced maternal age and stillbirth after 41 weeks that has some OB's freaked out. Granted, its a SMALL increased risk, but thats all many OBs need in order to fear monger.

[rhiOrion]

It does seem that way. We were just discussing this in my birth class. Two of the women in the class were 39 weeks when the midwives were already stripping membranes... even though there were no complications and no reason to think they'd go way overdue. They were also being told to start black/blue cohosh, and that they'd move to castor oil soon. Our birth class teacher was very taken aback at just how much the "cut off" has been moved back. And this was at a midwife staffed stand alone birth center.

[KGB]

Originally Posted by sharr610

Is your wife over 35?

She's 30.

[sharr610]

I'd ask her to quote her research next time you see her. Doesn't need to be antagonistic or anything, just politely say, "Hey, I'd like to understand more about that, do you have any articles or studies you can refer me to?"

[wombatclay]

In my region (upstate NY) even the midwives use 41 weeks as their cut off. I'm a vbac mama and when I was interviewing providers for my most recent birth I was given the 41 week cut off by every provider I spoke with... the homebirth midwives were required to transfer care to the hospital at 41 weeks, one practice routinely scheduled inductions or rc/s for between 40-41 weeks, and the hospital midwife practice I finally went with also uses 41 weeks as their cut off because that is the policy of the hospital they deliver at (they let me fudge my dates a bit).

So yes, I think many care providers use 40 weeks as their "normal length", making 41 weeks "overdue" in their minds. Groups like the March of Dimes are concerned about the trend towards more and more preterm and premature births and while there are a LOT of factors, I think this idea of 41 being the new overdue plays a part.

[MegBoz]

yes, many practices are saying 41W is the cutoff. i find it particularly idiotic considering the meta-analysis done by Mittendorf in the 1990s revealed that the average length of "uncomplicated gestation" was 41W + 1 D for 1st-time mamas who are white. (other ethnic groups were slightly less, but still over 40W.) So... yeah... what's "normal" (average) is "dangerous"? Mull that one over!

However, yes, there is a SLIGHTLY increased risk of stillbirth if you go past 41W. I don't think I read about it being a stronger association with mamas over 35 YO.

Ironically... the induction increases the risk of CS! The stat I've come across here on MDC is that they'd need to induce 500 women to eliminate 1 stillbirth. That's 499 unnecessary inductions. And of THOSE inductions, the risk that they'll turn to CS is very high.

Personally, my hospital-based MWs required NST + AFI twice weekly at 41W 0D. I went for 2, DS was doing well, I was comfortable waiting. (I did finally decide to have my membranes stripped at 41W4D & he came that day.) My hospital doesn't have a "routine" policy of induction until 42W. I would have gone beyond though, had DS continued to be looking good on the NSTs.

Bear in mind through all this that the whole 40W, 41W, etc. counts from last menstrual period! If your wife didn't ovulate until after day 14, the baby could actually be cooking for less time than you all think! Sorry I don't have a million links, but from having BTDT, I think the fear of going beyond 41 or even 42W is overrated & silly. (Again, if all else is going well!)

[GOPLawyer]

Yep, it unfortunately is.

Thankfully, we have every legal right to tell the HCP what to do with their "deadline". They cannot force an induction or c/s.

[Juvysen]

Originally Posted by wombatclay

In my region (upstate NY) even the midwives use 41 weeks as their cut off. I'm a vbac mama and when I was interviewing providers for my most recent birth I was given the 41 week cut off by every provider I spoke with... the homebirth midwives were required to transfer care to the hospital at 41 weeks, one practice routinely scheduled inductions or rc/s for between 40-41 weeks, and the hospital midwife practice I finally went with also uses 41 weeks as their cut off because that is the policy of the hospital they deliver at (they let me fudge my dates a bit).

So yes, I think many care providers use 40 weeks as their "normal length", making 41 weeks "overdue" in their minds. Groups like the March of Dimes are concerned about the trend towards more and more preterm and premature births and while there are a LOT of factors, I think this idea of 41 being the new overdue plays a part.

Huh... I think I'm seeing the same homebirth midwives that you mentioned but I was told 42 weeks (and i have a friend who went past that with the same midwives). I wonder if it was because you're a vbac? Strange.

[beckyand3littlemonsters]

I think they do seem to be wanting you induced as soon as you pass your edd although i told my mw when i was pregnant with my ds caden that i wouldn't concider even a stretch and sweep till i was at least 42 weeks as this is when you are actually over due as a normal pregnancy is 37-42 weeks and she said that was fine as long as agreed to monitoring if it came to it and i would still be able to have my hb. luckily for me i only went 6 days over though.

[GoBecGo]

Where is the new study for stillbirth risks? Anyone have it - here they keep re-hashing the 1960's study which found an increase in stillbirth for babies born past 41+3, but which didn't control for when foetal demise occurred. Which means that all those women whose babies died at 38 weeks but declined any sort of induction had the stillbirth blamed on the gestation at birth, often some weeks later.

I seem to remember the risk of being overdue was similar to the risk of being born at 37weeks. It's funny how doctors are happy to induce a baby then and subject it to those risks on their own terms, but unwilling to let the baby "risk" it on Nature's terms by staying in until it's properly cooked.

[jessica_s]

My midwives had moved up their date from 42 weeks to 41 weeks and 4 days, so that's better than some of you guys! I asked why and they said it was because of insurance reasons. Of course.
So now they are routinely doing dating sonos (unless you decline) to give everyone a fair shake. They also do not question a LMP at all so if you know that you ovulated later than CD 14 your best bet is to move forward your LMP giving you the extra days you should have. If you were charting or know when you ovulate that's your best bet.

[k9sarchik]

According to my DH's 93 year old grandmother, my father-in-law was born 44 weeks past due and weighed 14lbs! He was the largest baby born in Sweden at the time. Born naturally and no complications.

[AustinMom]

Medical Myths VS. Research Realities is a great book, that has a section on this. Most MW have a copy in their practice, it's expensive to buy, but if anyone reading this thread has a copy, if you don't mind summing up what that part says.

I think it's crazy to limit a mom to 41 weeks. Most moms don't have their due dates right, and during a second trimester u/s (which most moms have) the due date, if sooner than previously set, is moved based on that u/s. Dr.s, it seems, want the earliest date possible. Then, on top of that, you have to keep in mind, that first time moms, on AVERAGE go 10 days past their EDD. So, that puts all 1st time moms in the inductions group, and as well all know, especially with 1st time moms, inductions often lead to a cesarean, and then with subsequent babies, you have to fight for a VBAC. It's a sick cycle. Most Dr. now offer 39 week inductions, and if you catch a mom, who is uneducated of the real risks, on a bad day during her prenatal, and offer this, or scare her in believing her "placenta is aging" or "baby is too big", then you can catch her hook line and sinker. It's so sad.

[GOPLawyer]

Originally Posted by AustinMom

Medical Myths VS. Research Realities is a great book, that has a section on this. Most MW have a copy in their practice, it's expensive to buy, but if anyone reading this thread has a copy, if you don't mind summing up what that part says.

Obstetric Myths versus Research Realities by Henci Goer?

(wish I had a copy...awesome book!)

[KGB]

Originally Posted by GOPLawyer

Obstetric Myths versus Research Realities by Henci Goer?

Thanks for the recommendation, guys. I looked it up and it has glowing reviews. I just bought the Kindle Edition for less than $6.

[AAK]

That really sucks! All my babies were post date, one 4, 9, and 10 days post date. On their own, I might add. One mw required a non-stress test at 41 weeks. The other said that is seemed like my pattern and trusted my body. All three were born healthy. Placenta looked good each time too.

Amy

[AustinMom]

Originally Posted by GOPLawyer

Obstetric Myths versus Research Realities by Henci Goer?

(wish I had a copy...awesome book!)

Thanks for correcting me, yes, awesome book. I will most likely end up buying it down the road.

[kltroy]

Yes unfortunately 41 weeks is the "new 42 weeks". HOWEVER, best evidence suggests that you would have to induce between 500 and 1000 women to prevent one still birth. It all comes down to risks. Inductions have risks and waiting also has risks.

Risks of waiting:

• stillbirth risk doubles, from 1.5/1000 to 3/1000 from week 41-42. Note this is still only a 0.15% increase. Absolute risk is very small.
• complications are more common - believe it or not, there seems to be higher risk of shoulder dystocia, need for c-section etc the longer the pregnancy goes beyond 40 weeks.

Risks of inducing:

• pretty much kills any chance of having a natural labor/birth - you need continuous monitoring, pitocin contractions are often much harsher than natural ones, risk of fetal distress, typical cascade of interventions leading to c-section
• baby may not be fully cooked, though at 41 weeks if your dates are good this is less of a concern

Alternatives:

• non-stress test has good predictive value about 3 days out, so at 41 weeks, and then at 41.5 and 42 weeks you could opt for a NST
• membrane sweep - repeated (weekly) membrane sweeps starting around 39 weeks can help prevent going too far past 40 weeks
• sex - at least 2x/week starting at 36 weeks is linked to a significant reduction in going past 41 weeks, though it's no guarantee (as I can personally attest!)
• could try a pitocin-only induction and simply ask to turn it off if it looks like things aren't progressing after a few hours. As long as the baby is still healthy there's no reason you can't walk away from that and come back anotherday.

SO... I suggest you and your wife ask lots of questions about the benefits, risks and alternatives - I may have missed a few and I don't have the numbers for many off the top of my head. At the end of the day you should be able to make your OWN informed decision and the OB shouldn't have a problem with that decision as long as there is not a documented medical need to get the baby out. Of course, if a NST is non-reassuring, this would be a good reason to induce. If baby is not growing well, etc, your wife's BP shoots up, etc, these are all going to change the circumstances.

[MiaMama]

Originally Posted by kltroy

Yes unfortunately 41 weeks is the "new 42 weeks". HOWEVER, best evidence suggests that you would have to induce between 500 and 1000 women to prevent one still birth. It all comes down to risks. Inductions have risks and waiting also has risks.

Risks of waiting:

• stillbirth risk doubles, from 1.5/1000 to 3/1000 from week 41-42. Note this is still only a 0.15% increase. Absolute risk is very small.
• complications are more common - believe it or not, there seems to be higher risk of shoulder dystocia, need for c-section etc the longer the pregnancy goes beyond 40 weeks.

I often see this... and I wonder about provider bias. It would not be plausible to do a double-blind study. I am not suggesting that they are intentionally sectioning moms to alter the stats. BUT, if the doctors/care providers view the situation as more risky, then interventions may begin earlier and be more aggressive, and the relative risk of c-section would go up.

I put more stock in the finding of higher risk of shoulder distocia.