WWYD at 42+ weeks? X-posted in pregnancy - LONG

[COgirl19]

I know a mama who is 42 weeks plus 2 days. (charting so very sure of dates) No signs of labor happening. She has tried all the natural methods to induce including castor oil and EPO with no effect. She has her heart set on a homebirth but I don't know how much longer she will be able to wait this out. To be honest I am a little worried for a couple of reasons:

1. I am all for homebirth and have considered it myself, but after this point, I am not sure how much longer she can be under her midwife's care and I know she doesn't want to go unassissted (this is her first baby).

2. Her midwife honestly concerns me. This mama is GBS+ and she doesn't seem concerned. I know that the risk of passing onto baby is very small and antibiotics aren't always necessary but I would at least want a hibeclens or something done to minimize the risk.

3. The midwife has made a number of very unprofessional comments. She basically told this mama's mother to her face that it was her fault that my friend wasn't in labor yet. Completely untrue, my friend WANTS her mom there. I can understand how some women don't / can't go into labor with lots of visitors and interruptions, but I also have met mothers who NEED their own mothers there too.

4. The midwife has made my friend terrified of hospitals. I know not everyone wants a hospital birth and some hospitals are truly awful. However our local hospital is wonderful, natural minded and supportive of the natural birth process. She was so surprised that I was able to do my labor naturally, walk around, use a birthball, wear my own clothes, do skin to skin, have DH cut the cord, ect. She was convinced that she was going to be strapped down and c-sectioned if she set foot in the hospital. I just think that it was really unprofessional (and NOT helpful) to give her so much misinformation about the hospital to the point of making her afraid to go near it even in the event she really had too.

Anyway, I really feel for her. I also want her to have her homebirth but I think she really needs to be open to other options at this point. Any advice for her? How much longer do you think she can safely wait? She has not had any kind of ultrasounds done so I don't know much else as far as fluid levels or anything like that.

[Mama2Kayla]

I tried everything to induce labor with my son. Had no BH until the night before he was born. He finally came at 42 weeks and 6 days.

Some babies just take a little longer. If her midwife isn't concerned, baby's moving and her fluid levels are ok, I think waiting is fine.

The GBS thing is her call.

[MegBoz]

Yikes, I see some red flags there too.
Despite the length of her gestation, being terrified of the hospital is a bad idea! for one thing, if the MW really thinks the hospital is that evil - I would think she'd be very reluctant to recommend transfer & that's a very bad idea!
But for another thing, your friend must be equally reluctant to transfer.

Probably not much you can do at this stage though to help. I have to say I'm surprised she just took the MW's word for it & didn't look into it herself a bit.

I personally don't worry much about GBS either, although ideally her MW would have had a nice protocol to help her test negative in the first place (Mine does & said it's been very, very successful.) If I were still +, I'd go with the hibiclens. I think IV ABTs are absurd - like taking a sledgehammer to kill an ant. You will kill the bug you intend to kill, but you'll do a heck of a lot of damage at the same time & it's a lot smarter to use other tools that would be more appropriate!

[AutumnAir]

Yeah, I think the only thing I would be concerned about there is the potential for the MW to avoid recommending transfer in a necessary situation and/or for the mama to be so scared of the hospital in the event of needing a transfer that she either refused to go or had an awful experience simply from being so terrified.

If baby's moving normally and there aren't any other indications of a problem I really don't think it's that big a deal to wait past 42 weeks. Consider that with what's considered to be the average pregnancy of 40 weeks, most providers are more than happy with births from 37 weeks (some even from 36) but most start to get antsy at around 41 weeks, and very few will be happy going past 42 weeks. But what a double standard!! Why can you go 3-4 weeks before the mean, but only 1-2 weeks after? Then, take into account the fact that your average first-time white mom's pregnancy actually lasts 41+1 weeks and see how ridiculous it is to get all het-up about 'post-dates' pregnancies.

BTW - I had my DD at 43+1 weeks, and am now at 42+1 weeks with this little one, who doesn't seem in a huge hurry to come out either. It's hard to be patient, but I'm confident that baby is doing well - keeping an eye on movements, occasionally checking heartrate myself, drinking plenty of water etc. Natural induction methods (and medical ones too!) will only really work if baby's ready to come out anyway - her baby sounds like it just needs a bit more baking!

But I would have a gentle chat with your friend about the possibility of transferring into the hospital. It sounds like you have had your own positive experience(s) there, so you can temper some of the fear she may feel about it - possibly even help her come up with a transfer plan, just in case, so that she can feel a bit more optimistic and in control about it. Is there some kind of legal issue with homebirths/midwives in the area where the midwife would not be welcome transferring a client, or where she fears retribution against her clients for attempting a homebirth? That wouldn't be unheard of.

[COgirl19]

thanks for your replies mama's. It's good to hear stories of successful natural births at over 42 weeks. I guess now my only concern is the fear that her midwife has put in her. I know most homebirths go well but in the event she had to transfer I wish the midwife didn't scare her so much. I guess it is a personal preference with the monitoring. I would really not be comfortable going this long without at least a quick check of fluid levels but if the baby is still moving around normally she should be ok right?
I really hope she gets her homebirth, she has her heart set on it.

[honeybee]

Well, to be honest I think you may not be interpreting things accurately. It may not be her midwife scaring her about the hospital. Just doing your own research is enough to make hospitals scary. Your friend may also have a fear of hospitals in general. And if your mw did mention some things to her about that hospital, it could be she has a more accurate picture than you do. Just because your birth was all rosy does not mean that is what happens for a majority of women, even in that same hospital. A lot depends on circumstances and the particular caregivers at the time.

You seem to be blaming the midwife for every thought your friend has expressed. Give her some credit for independent thought and feelings. Most women who are choosing homebirth are acknowledging their own responsibility and decision-making in the process. Honestly, I would be a little offended if you were my friend and assuming that I was being brainwashed by my midwife.

I am not advocating that anyone should be afraid of the hospital. Fear doesn't help anything. Your friend may want to do some Birthing from Within exercises or talk through her fears about the hospital. Sometimes a hospital transfer is necessary, and she should try to work out some of her fears of a possible transfer. Fears can inhibit labor, and sometimes things just need to be acknowledged and expressed before labor happens.

Honestly, there is nothing you've mentioned that worries me. I do not even test for GBS, myself. Other countries have much different protocols than the US. I would trust that your friend has done her research and made her decision. I would also not worry about going past 42 weeks. Your friend can do kick counts, and be monitored with the doppler periodically. I am sure at this point she is seeing her mw every day or two. Just because she is not getting an u/s does not mean she is not being monitored. The research on going past 42 weeks is NOT conclusive, in terms of inducing/c-sections improving outcomes.

As far as the mother issue goes, I don't think it's up to either you or the midwife to decide whether it is a true "issue" for her. I do think it would be unprofessional for the mw to say something to the mother, although it might be appropriate to mention the possibility of it being a factor to your friend.

[phathui5]

At the first birth I attended as a doula, the mama was 42w 5d along. I wouldn't worry about your friend because of her being 42+ weeks. Some babies need more time to grow.

On monitoring fluid levels: Many women choose not to have any ultrasounds at all. I have four children. I had the usual 20 week ultrasound with my oldest and chose not to have any ultrasounds with my other three children. Even if she did have an ultrasound to measure fluid, there's no guarantee that the results would be accurate. I've sat in on ultrasounds where they measured a baby's weight and seen that baby born hours later at a different size.

[MegBoz]

Originally Posted by phathui5

Even if she did have an ultrasound to measure fluid, there's no guarantee that the results would be accurate. I've sat in on ultrasounds where they measured a baby's weight and seen that baby born hours later at a different size.

True - and even if the results WERE accurate, the evidence that low fluid levels are associated with poor outcomes & therefore induction can improve things is weak anyway.

[mommato5]

At least someone is worried!

The longer you go, the higher the risk of stillbirth! The more or less fluid you have impacts the child's lung development! Too much fluid can indicate problems. GBS can cause a very sick or dead baby. This situation is a recipe for disaster!

[MegBoz]

Originally Posted by mommato5

The longer you go, the higher the risk of stillbirth!

True, but induction has it's own risks - especially for a first time mama. AND while the risk of stillbirth increases starting beyond 41W, it is still very low.

Originally Posted by mommato5

The more or less fluid you have impacts the child's lung development! Too much fluid can indicate problems.

Some snippets from this article, page 3:

The AFI has low specificity and positive predictive value for oligohydramnios, and there is scant evidence that isolated term oligohydramnios causes adverse fetal outcomes…

A primiparous woman with an unfavorable cervix who strongly desires a spontaneous, vaginal birth could be told that, although there may be a small risk for her baby, no study has demonstrated any increased long-term morbidity or mortality associated with low fluid in her situation and that labor induction may double her chance of cesarean delivery.

emphasis added.
The article basically recommends more testing as opposed to moving directly to induction for low AFI alone. While I personally would feel better with twice weekly NSTs at 42W+, I also wanted to share this data that low AFI alone is not a dreadfully risky thing.

Originally Posted by mommato5

GBS can cause a very sick or dead baby. This situation is a recipe for disaster!

Also true, but it's a very rare thing. Only about 30% of women are GBS+. And of those who are, only about .5% (1 in 200) of their babies will get a GBS infection. Of THOSE babies, only a very small percentage will die (I forget that #, but Mothering has an article.)

Whereas if you get IV antibiotics (the standard hospital protocol here in the US) you have a 10% risk of side-effects including deadly antibiotic resistant infections such as e.coli as well as thrush, which can kill breastfeeding.

By way of comparison, they don't even test for GBS regularly in the UK.

My point is this:
Yes, there are risks with "expectant management" (i.e. not testing for/treating unless a problem is observed, not inducing despite being post-dates)
But there are also risks with "active management" (IV Antibiotics in labor, induction.)

You have to analyze the data & pick which set or risks you think is best for you & your family. Nobody is 'guaranteed' a perfect birth & perfect baby. Birth is as safe as life gets.

[COgirl19]

Megboz - thanks for all the info. It is really helpful to have some articles to shed some light on things. I hope it will put this mama's mind at ease. I do know she is doing more monitoring now but hopefully she won't be induced or anything like that and can still go for a homebirth. I am just not sure the laws in our state regarding midwives attending a homebirth after 42 weeks.