Lets talk about the 42nd week of pregnancy

[Jyotsna]

For some reason, doctors in our area of the country are delivering babies either by c-section or via augmented birth practices near the 38th or 39th week. I hear this comment all the time, "My doctor doesn't want me to go past 39 weeks".

What is really behind this, and why do mothers and fathers no longer "believe" that pregnancy is 42 weeks of gestation.

What happens in the the weeks 40 through 42, that a doctor feels can be missed?

[Reha]

Originally Posted by Jyotsna

What is really behind this, and why do mothers and fathers no longer "believe" that pregnancy is 42 weeks of gestation.

Our culture no longer thinks of a term pregnancy still being term (not past-due) at 42 weeks exactly because women are being induced at 37, 38 weeks. I think we put WAY too much stock in the due date (which is technically a Estimated Due Date.....the estimated part has been dropped by most people). The fact that women can have their baby at 40 weeks and 4 days and then tell people that they were 4 days late....y. :

Originally Posted by Jyotsna

What happens in the the weeks 40 through 42, that a doctor feels can be missed?

Nothing. There is NO rise in fetal mortality until 42 completed weeks (and even then, it is only a small rise). Babies' weight gain slows way down at this point, averaging around 1/4 lb per week.

IMO, it all essentially boils down to providers wanting to manage birth. It is far more convenient to schedule an induction (or cesarean) for most or all of your clients than wait for labor to being in it's usual unpredictable time. The local hospital here does this as well, and their cesarean rate is horrid (close to 60%, I hear now) with a no VBAC policy. The fastest way to increase the cesarean rate is to increase the induction rate.

The whole thing makes me .

[Jyotsna]

I would like to know how to combat this ingrained belief. I see this every time I talk to a mom that is being heavily managed by a doctor. One particular group of doctors in our city does this. I hate to see that mothers don't have the real info, and even if they do, they ignore it for medicalized information, which is often not correct. What happened to baby pushing itself out?

And BUMP...would love more convo on this.

[Megan73]

Interestingly, this guide for family docs recommends monitoring the baby but not inducing labour until the end of 42 weeks.
http://www.aafp.org/afp/20050515/1935.html

[ZoeyZoo]

The last thing to develop are the lungs so the risk to having the baby early have to deal with its breathing. The only thing that can happen post dates is the placenta can discentrigrate (sp?) but this usually doesn't come into play until at least 42 weeks.

[Sileree]

Yeah, its frustrating. Doula clients of mine feel by 39 weeks they have waited long enough and don't care that the baby could be three weeks premature. They're just tired of being pregnant. :

[loudmama]

That has to be frustrating! I had a client that chose to be induced at 41 weeks & 5 days. Her FP Dr was comfortable going at least a few more days. The induction worked & went well, but baby was only 7lbs 7oz & had a lot of vernix. Dr even commented about how baby was NOT almost 42 weeks. I told her: "Makes you glad you don't induce at 40 weeks." She said: "We don't do that."

Goes to show that inducing or having a c-section at 37, 38 weeks, you could have a preemie. Argh!

L

[Ambrose]

I'm certainly no birth professional but I saw this in new posts...

I'm frustrated that people think 37 weeks is full term and nothing to worry about. I'm frustrated that when I try to voice that people look at me like I'm a nut who's overreacting/being a worrywart.


I'm just happy to see that there are still people who view pregnancy as lasting more than 37-39 weeks.

[Sileree]

Yeah he was an itty bitty baby. Smallest of fifteen clients. 6lbs 5oz. Caked in vernix. Also had a not-perfect apgar, and stayed blue longer than most babies I've seen.

[Ambrose]

DD was born (on her own accord) at 37 weeks and was completely covered in vernix. We couldn't rub it all in like a lotion, instead we had to scrape it off of her. :

[Defenestrator]

One of the things that I found really interesting in my research was that the death rate for 38 week babies and 42 week babies was about the same.

It seems to me that a lot of care providers don't bat an eye at inducing at 37-38 weeks but get a major anxiety attack when babies go past 41 weeks. Doesn't make much sense.

[Jyotsna]

And it is down right scary when babies come out like that, and they are not really as far along as thought.

[ananas]

Subbing

[Sileree]

Originally Posted by Jyotsna

And it is down right scary when babies come out like that, and they are not really as far along as thought.

Yeah, especially when I read research that says that babies born only two weeks or less early can have developmental problems in life.

[Funny Face]

This totally strikes a nerve :

My nursing instructor yesterday probably scared the crap out of anyone who will have/has had a baby. She kept saying that at 41 you "need to get that baby OUT! The placenta is aged and disintigrating and that baby isn't getting enough oxygen!" I swear, she said it just like that. Being in nursing school makes me want to throw up some times!!!!

I think docs almost always quote the disintigrating placenta and it just really scares mom's to think 'what if'? I know I've thought it before, and then I remembered that research indicates otherwise!

The midwifes I work with even start to freak out when moms go past 41 weeks, what's up with that?

[GatorNNP]

The midwifes I work with even start to freak out when moms go past 41 weeks, what's up with that?

That is from OB's rubbing off on them.

All of these interventions are done on and ESTIMATION, which is a scientific guess. A GUESS. You are not postdates until after 42 weeks, at least by then you are at least close to full term if you are two weeks off. I have seen 37 weeker born by "choice" cesearean end up on a ventilator for crying out loud. What they are really trying to do is help make antibiotics useless because every woman "induced" and ends up with "chorioamnionitis" from all of the interventions and vag exams etc her baby will have to be treated with abx since we don't know if they are infected or not.

[pamamidwife]

here is my informed choice agreement on postdates, which is technically anytime after 42 completed weeks.

I think it's horrible that midwives get sucked into this fear, too.

[MsBlack]

I hate the term 'due date'. I tell my ladies and any pregnant woman who will listen: You have a DUE MOON, not a due date. Sometime within about a full month period, your baby will be born at the perfect time! You and your baby together will know just when that should be, and it's not entirely safe to mess with that.

Yes, with all the inductions going on, even some homebirthers get kinda squinchy about 'going overdue' or they get simply impatient: hey, my friend got her induction at 39/40 weeks, why can't WE induce ME? Isn't it perfectly safe if the docs are all doing it?

with hating the term due date, I also hate having to explain things 'defensively', that is--in terms of what the OBs are doing now. Among hb fams, luckily I don't have to do a lot of it tho some fams really push the point--but still. We seem forced to communicate about birth in relation to the OBs/med practice, and that is just entirely BACKWARDS!

[jeffsdear]

Pamamidwife: thanks so much for posting your informed consent form! It has tons of information that I'm always trying to tell my students about, and I appreciate seeing some more evidence to back up what I've already been saying...

[CEG]

Originally Posted by pamamidwife

here is my informed choice agreement on postdates, which is technically anytime after 42 completed weeks.

I think it's horrible that midwives get sucked into this fear, too.

Thanks for posting that. It is incredibly complete and unbiased.