can we talk about postmaturity?

[majormajor]

so, no one ever said that my DD was post-mature that i remember hearing (she was born at 41 weeks 2 days). however, i was reading about postmaturity (because i was curious about some things i thought were weird about DD when she was born), and from what i've read online, she had all the signs of postmaturity except for meconium staining.

i am certain about my dates. we began doing BPPs at just shy of 40 weeks when i noticed a decrease in movement, and continued them every other day until i was induced (fluid levels were dropping, but no other signs that DD was less than perfectly healthy).

she ended up delivered by emergency c/s. her heart rate was fluctuating the whole labor, and tanked at the end when she finally started to move into the birth canal. her cord was around her neck.

i was wondering what people's experience with postmaturity is, and how common it is to have a postmature baby at just a few days over 41 weeks? if it's very common, that'd make me feel better. but if it's not, i'm wondering what was going on with my body that DD didn't come out on her own, when staying in was clearly not the healthiest thing for her.

thanks for any thoughts on this.

[attachedmamaof3]

I'm not sure of your specific question??

I do know that post-maturity is PERFECTLY normal since our menstrual cycles are all individual. As in not every single woman has her period on the 28th day EXACTLY...therefore, your "due date" could have been off up to 2 wks in either direction.

Additionally, post-maturity is not something to be worried about. It's truly a non-issue as long as your placenta is functioning normally. Labor itself often causes heart rates to vary. This is normal. It is also normal to have a cord wrapped around the baby's neck or body. This in itself is not an emergency unless the cord was being pinched between baby and you which is extremely uncommon. Some drs like to make a big deal out of cords around babies necks. There are very simple ways to birth a baby who is wrapped in their cords. Even at home or in an unaccompanied birth.

So it actually sounds to me like your daughter was doing fine in utero....

[sg784]

DD was "post mature"

They tried to induce at 41 weeks with cervadil for 12 hours then pitocin for 12 hours. No dialation whatsoever, no effacement, nothing. not one contraction. Obviously she wasnt ready.

They tried again at 42 weeks my CNM insisted that it had to be done or her OB would intervene, and she was already under pressure to give up and schedule a c/s

42 weeks I got cytotek, for 4 hours then pitocin for 15 before i even had one contraction. 8 more hours on the pitocin and I finally was having regular contractions. it was another horrid 12 hours before she was born.

Aside from the dry skin and a bit of meconium staining (probably from the harsh induction) no other "signs" of post maturity.

[Robinna]

What ARE the signs of post maturity? Other than mec, which is the only one I'm really familiar with... (or an agitated doctor )?

[majormajor]

the signs of post-maturity are:
* dry, peeling skin

* overgrown nails

* abundant scalp hair

* visible creases on palms and soles of feet

* minimal fat deposits

* green/brown/yellow coloring of skin from meconium staining (the first stool passed during pregnancy into the amniotic fluid)

i should read more, but my cursory study says that the biggest problem of postmaturity is that the placenta begins to degrade and the baby is less able to tolerate labor, which obviously was the case with my DD. my biggest question is, how common is actual postmaturity at 41 weeks? and, why does it happen? why does a baby sometimes not get born even after the womb becomes a less than ideal place for them?

[Storm Bride]

My personal guess is that on the rare occasions when the womb becomes less than ideal, there's an existing problem that's delaying the labour, and "postmaturity" is simply a symptom. Mind you, from what I've read, the midwifery community and the medical community are a little divided about the significance of the placental "deterioration".

That said...I tend to pay very little attention to the postmaturity stuff. I was coerced into my second repeat section because ds2 was "late" and the OB threatened to drop me from care. He was all about the dangers of postmaturity. He told dh just what the baby would look like because it was so overdue (the peeling skin, overgrown nails, etc. etc.).

DS2 was taken at 41w, 5d, and the OB was careful to point out that he did, in fact, show the signs of postmaturity (although he didn't phrase it that way). He also overlooked that my son was 10lb. 8oz. - not even remotely lacking fat deposits!...and that he had apgars of 9 and 9 - no evidence of a deteriorating placenta and/or inability to tolerate labour (if they'd been willing to let me keep labouring at all)...no meconium. So, the OB freaked about my dates (the ultrasound had me a week further along than my LMP did) and my postmature baby, and the baby was healthy as a horse.

Baby-under-construction is 41w, 2d right now. I'm hoping he/she comes soon, because my mom has to go out of town, and I want her here for the labour...but aside from that, I'd happily wait another two weeks...

[Robinna]

Hmm... other than copious scalp hair and mec staining my babes both had all those traits too, though. ds was born at 40+2 and dd was 39+4. Is there a reason to believe these are signs of stress, or are these just traits common to slightly older babies?

[Storm Bride]

Originally Posted by Robinna

Hmm... other than copious scalp hair and mec staining my babes both had all those traits too, though.

Interestingly enough, ds1 (38w, 5d) and dd (39w, 2d) both had a ton of scalp hair. DS2, my "late" baby, didn't - he was almost bald.

[*Erin*]

my dd was supposedly almost 3 weeks past her edd, but i maintain they screwed up my date by about a week and a half, which would make her a week and a half postdate.
i tested positive for down's on the triple screen blood test, which frequently means the baby is younger than estimated. She was/is fine, no downs.

at birth there was meconium, but i also took lots of castor oil to try and induce, which may have caused her to pass it.

she was 8 lbs, 15 oz, minimal vernix, some hair, no dry skin or long nails, and was nice and round looking. she looked perfectly Done to me

[majormajor]

erin, yeah, definitely doesn't sound like your DD was postmature either. my DD's fingernails were adhered to and grown over the tops of her fingers when she was born. it took a few weeks for them to peel up so that they looked like normal fingernails. she also had very little fat, no dimples on her knuckles, no vernix, and her hands and feet were so creased and wrinkled, they looked like old people's. pretty much the whole top layer of skin on her hands and feet peeled off... not her whole body though.

i'm just finding it strange. i'm SO certain of my dates--i charted and had two early ultrasounds that absolutely confirmed due date. she wasn't more than 41 weeks 2 days. i totally agree that "postmature" is a description of condition at birth and not a "condition" in and of itself. what i'm trying to figure out is why my daughter would have these characteristics earlier than other babies, and what that means. does it mean that there was something preventing labor from happening when it was "supposed" to? could DD's bad positioning be an explanation?

i know there are no definite answers to these kinds of questions. but there must be other people who's babies looked postmature at birth? what are your thoughts/experiences?

[savithny]

My DS was born at *exactly* 40 weeks (I was charting, I *know*), and showed almost all the signs of "postmaturity," including a bit of mec staining. He was bald as an egg and had fat deposits, though.

DD was born 2 hours after 40 weeks exactly, and didn't look as postmature as DS did, but she had no vernix whatsoever on her, either.

[HerthElde]

I wonder if you would have given birth earlier if she had been able to get into a better position? Perhaps the cord around the neck prevented her from moving to where she wanted to be - maybe going past 40 weeks isn't the norm for your body . . . then again, maybe it is! My girls were both born 9 days "early" and both had long fingernails and a full head of hair.

[Storm Bride]

Originally Posted by majormajor

erin, yeah, definitely doesn't sound like your DD was postmature either. my DD's fingernails were adhered to and grown over the tops of her fingers when she was born. it took a few weeks for them to peel up so that they looked like normal fingernails. she also had very little fat, no dimples on her knuckles, no vernix, and her hands and feet were so creased and wrinkled, they looked like old people's. pretty much the whole top layer of skin on her hands and feet peeled off... not her whole body though.

i'm just finding it strange. i'm SO certain of my dates--i charted and had two early ultrasounds that absolutely confirmed due date. she wasn't more than 41 weeks 2 days.

FWIW, ds2 had the seriously cracked, peeling skin, creases and wrinkles and overgrown nails...and he was taken at 41w, 5d...only a few days later than your dd. He did have major fat deposits, though. Mind you, he may have started out big enough that starting to lose weight in utero (if he was) wouldn't have meant a lack of fat deposits...

[wifeandmom]

Originally Posted by attachedmamaof3

I do know that post-maturity is PERFECTLY normal since our menstrual cycles are all individual. As in not every single woman has her period on the 28th day EXACTLY...therefore, your "due date" could have been off up to 2 wks in either direction.

There's a big difference between a baby being born 'post dates' when the only implication behind that term is the fact that baby was born 'after' the estimated due date and a baby actually being diagnosed with 'post maturity syndrome'. The two are very different. The first, just being 'late' or 'post dates' is not a big deal in and of itself. The latter, 'post maturity syndrome', however IS a bigger issue.

Additionally, post-maturity is not something to be worried about.

This is absolutely NOT true all of the time. There ARE babies that simply do NOT come 'when they're ready', unless of course you consider stillborn to be 'ready'.

It's truly a non-issue as long as your placenta is functioning normally.

Post maturity syndrome, whether or not the placenta appears to be functioning properly or not, IS an issue that should at least be considered. To what extent calcification of the placenta plays in potential harm to the fetus is not completely known or widely accepted, however it IS documented fact that babies over a certain gestation are more likely to be stillborn than their younger gestation counterparts.

Good placenta, bad placenta, so-so placenta, doesn't really matter what you personally believe about the placenta's function in all this. Once a baby is truly over 42 weeks, the stillbirth rate starts increasing at a much higher rate than the weeks 38-42 of pregnancy.

Labor itself often causes heart rates to vary. This is normal.

Surely you aren't suggesting that ALL heart rate fluctuations are normal during labor? Sure, *some* fluctuation is normal. *Some* decels are normal. But *certain patterns* are indicative of severe fetal distress. The OP states her baby's heart rate 'bottomed out' during pushing. *That* is most assuredly NOT normal. Babies are not designed to be born with no heart rate whatsoever. Or at least I've certainly never heard that this was a healthy thing.

It is also normal to have a cord wrapped around the baby's neck or body. This in itself is not an emergency unless the cord was being pinched between baby and you which is extremely uncommon. Some drs like to make a big deal out of cords around babies necks. There are very simple ways to birth a baby who is wrapped in their cords. Even at home or in an unaccompanied birth.

This I agree with. I've seen stats that say up to 1/3 of babies have some degree of nucal cord. Obviously 1/3 of all babies aren't in dire distress at birth, so the cord being wrapped around them in some fashion is not in and of itself an emergency.

So it actually sounds to me like your daughter was doing fine in utero....

A heart rate that 'bottoms out' during pushing doesn't sound like a baby doing just fine to me. Considering it's perfectly normal to push for several hours, what condition would you expect a baby to be born in that has had a heart rate in the toilet for that long?

[wifeandmom]

FWIW, I was one of the babies that almost died from post-maturity syndrome. Of course, this was back in the very non-interventionist 1970's when the prevailing thought was 'babies will come when they're ready'.

For whatever reason, I just didn't.

By the time my mother was finally sectioned, she was having eclamptic convulsions, and my heart rate was zero. I spent days in the NICU, with my mother in the ICU. Neither of us *should* be here medically speaking.

So, yes, post-maturity CAN be a problem if not addressed.

Now, I'll have to say that with the induction happy society we now have, I'd be incredibly surprised to see very many cases of it at all. In our case, my mother was WAY over 42 weeks, so it wasn't a case of just a few days 'late' that caused our issues.

[Storm Bride]

Originally Posted by wifeandmom

Post maturity syndrome, whether or not the placenta appears to be functioning properly or not, IS an issue that should at least be considered. To what extent calcification of the placenta plays in potential harm to the fetus is not completely known or widely accepted, however it IS documented fact that babies over a certain gestation are more likely to be stillborn than their younger gestation counterparts.

Good placenta, bad placenta, so-so placenta, doesn't really matter what you personally believe about the placenta's function in all this. Once a baby is truly over 42 weeks, the stillbirth rate starts increasing at a much higher rate than the weeks 38-42 of pregnancy.

This does appear to be true. However, the way this fact is addressed by the medical (and possibly midwifery) community as a whole needs to be changed. The bare fact of increased stillbirth after 42 weeks gestation totally overlooks two key things, imo:

1. Family history. A friend of my mom's went 44 weeks with all four of her children - they were all healthy. DH and his brothers were all the product of 43+ week gestation (44 weeks in dh's case). They were all healthy (and close to 10 pounds - no lack of fat deposits). This strongly suggests to me that macrosomia and long gestation are normal for babies in dh's family. The fact that my babies with him have all gestated longer than my baby with my ex also tends to lead me in that direction. As far as I can tell, there has been little or no research done on the risks of going post-dates when long gestation is part of the family birth history. (Sadly, as more and more women are having their babies taken early, by scheduled section and/or induction, this research will be harder to do at all. When women aren't "allowed" to go post-dates, it's hard to get good numbers.)

2. Cause and effect. There are a higher percentage of stillbirths in post 42-week pregnancies (I haven't looked at the numbers for a while, but I remember them still being very small.) So, we immediately jump to the conclusion that the long gestation is causing the stillbirths...not that it might be the other way around. Going overdue becomes the bogeyman, and there's never any thought given to the idea that maybe there was a problem with that particular baby, which prevented labour from occurring...that maybe the baby went "overdue" because it simply wasn't going to ever come out. While that's not going to help a given mother deal with losing her baby before/at birth, it's an entirely different scenario than assuming that our uteri become "hostile" after a given time period.


I am interested in the OP's question, as the statistical link between 42+ weeks gestation and postmaturity syndrome wouldn't seem to have any bearing on her situation. Her baby was still 5 days shy of 42 weeks. It would certainly appear that "postmaturity syndrome" is really about something other than length of gestation...but I doubt we'll ever know what causes it, or what it's really about - because nobody seems to be very interested in finding out...

[Storm Bride]

Originally Posted by wifeandmom

So, yes, post-maturity CAN be a problem if not addressed.

I'm not trying to be harsh, as I realize you're talking about your own life here, but...do you, your mother, or your mother's doctor have any indications that the length of her pregnancy was the problem? It sounds as though there was something going wrong, that prevented her from going into labour. I really feel the way this is looked at is very backwards.

Now, I'll have to say that with the induction happy society we now have, I'd be incredibly surprised to see very many cases of it at all.

No - now we just have a climbing rate of premature birth, which honestly doesn't strike me as a big improvement.

[4C-mom]

post dates and post maturity are different things.

some ppl just naturally go "longer" than the EDD, of which the E means "estimated!"as in not an exact science.

#1 was 41w2d, #2 was 41w0d, #3 was 40w2d. at this point, i thought teh pg's were getting shorter. nope. #4 was 41w2d. (none induced)


#1 and #4 had meconium. #4 was 10lb 7 oz, shoulder dystocia, broken clavicle, 1min apgar of 2. (he's fine now). no other issues. was never pressured into induction, either. with #4, ob offered pitocin when i was 40w6d, i said no, he said okay.

the average first pg (and the op makes it sound like that was her first) is 41w1d, from what i hear.

[4C-mom]

i also do believe that, mostly, "babies come when ready" but do recognize that there are problems that can happen, therefore i would induce at 42 weeks, but not sooner.

[attachedmamaof3]

Originally Posted by majormajor

erin, yeah, definitely doesn't sound like your DD was postmature either. my DD's fingernails were adhered to and grown over the tops of her fingers when she was born. it took a few weeks for them to peel up so that they looked like normal fingernails. she also had very little fat, no dimples on her knuckles, no vernix, and her hands and feet were so creased and wrinkled, they looked like old people's. pretty much the whole top layer of skin on her hands and feet peeled off... not her whole body though.

i'm just finding it strange. i'm SO certain of my dates--i charted and had two early ultrasounds that absolutely confirmed due date. she wasn't more than 41 weeks 2 days. i totally agree that "postmature" is a description of condition at birth and not a "condition" in and of itself. what i'm trying to figure out is why my daughter would have these characteristics earlier than other babies, and what that means. does it mean that there was something preventing labor from happening when it was "supposed" to? could DD's bad positioning be an explanation?

i know there are no definite answers to these kinds of questions. but there must be other people who's babies looked postmature at birth? what are your thoughts/experiences?

Oh, I get it now!! (sorry, soooo confuzzled!!)

I really don't know! It is interesting for SURE that your DD was showing all of these signs at birth and was barely "postdate". Bad positioning IMO could definately be a factor. Stress/worry about labor could also play a part from what I've read.

Sorry, I don't have any more than that for ya....