Going Past 42 Weeks

[alli437]

Hi. I'm a childbirth educator (Bradley) and I just started teaching. One of my first couples went past 42 weeks (her due date was accurate), and they ended up getting induced. My question: How dangerous is it to go past 42 weeks? Does anybody have any statistics? And how can I help teach couples that it is okay to follow their bodies to term, when they are faced with hospitals automatically scheduling them for inductions when they go past their due dates? Thanks.

[nashvillemidwife]

Incidence of still birth and complications does rise after 42 weeks. However, what's important is baby's (and mom's) health, not a number on a calendar. I would tell them to insist on having the care provider monitor the baby with ultrasound and nonstress tests and agree to induction only if there is an indication that it's necessary.

[sapphire_chan]

Originally Posted by nashvillemidwife

Incidence of still birth and complications does rise after 42 weeks.

Have there been studies done that look at 43 weeks babies by themselves? I swear I read somewhere that the studies that showed more problems after 42 weeks grouped people at between 42 and 43 weeks in with people who went to like 45 weeks.

[Wittyone]

Sapphire Chan~
I just did a bunch of research for a paper on prolonged pregnancy. The literature seems to indicate that there is a higher relative risk after 42 weeks, and actually even after 41 weeks, independent of most other factors, but the absolute risk is still pretty small. In Canada the rate of stillbirth is 1-2 per 1000 births, and in the US it's 2-3 per 1000. ACOG's management bulletin states "The rate of stillbirth at 42 weeks gestation is twice the rate at 40 weeks, and increases 6-fold by 43 weeks" though there are other studies that disagree. As nashvillemidwife pointed out, careful monitoring is important...no one can MAKE you be induced against your wishes!! (though they can pull all sorts of scare tactics and bully you into it )

[IrelandsMama]

I've looked up many studies about this myself and I agree that that studies show a higher rate. That being said I don't think weeks of pregnancy are good indicators of health. And we have to remember that unless a couple had IVF than dates are only so close. I don't think couples need to be fearful. I think the best thing you could do is encourage them to do research and then share with them both the pros and the cons you find.

You may want to share something like my story with them. I was talked into a c-section at 43 and a half weeks (LMP and early ultrasound were pretty good indicators of how far along but never sure right.) Stress most likely sent my blood pressure up and scared my providers. My decision haunts me. My son was born screaming and vigorous and my health was great as well (except for the wounds that the surgery left me both physically and emotionally.) I don't think we should ever make a decision based on fears. We have to remember that there are chances to everything in life, and when something seems to be too high of a risk we should avoid it yes, but making babies creates some risk and we still choose to do that.

I commend you for going the extra mile for you couple, birth is so complicated and none of us have all the answers.

Sav

[time4another]

I will tell my students the following:

If you are in the US check out the birth stats on the CDC website. The infant mortality rate in 2004 (the page I have bookmarked) for babies born at GA=

37-39 Weeks=2.61 (per 1000)
40-41 Weeks =2.00
42 weeks + = 2.87

So yes there is a slight increase in mortality rate past 42 weeks but then you have to look at the mortality rate for babies born between 34-36 weeks which is 7.32 per 1000 and think about what the risk actually is.

There will always be risk in birth and in life.

[jengacnm]

In our practice we recommend that women start evening primrose oil at 37 weeks. At 40 weeks we recommend chiropractic and/or acupuncture; at 41 weeks we recommend homeopathics in addition.

Our general policy is induction at 42 weeks, but if a mom is very against it, we recommend every other day biophysical profiles and that she deliver in the hospital. Our practice is about half home and half hospital. We made our decision on this based on a 1998 study in Obstetrics and Gynecology. This is an excerpt of the abstract:

"Overall fetal and neonatal mortality for those beginning labor at home was 2.5/1000. Fetal and neonatal mortality for those actually delivering at home was 1.8/1000. The authors note that intrapartal mortality during intended homebirth is concentrated in postdates pregnancies with evidence of meconium passage."

FWIW, in 3 and 1/2 years and about 150 clients, we've never had to induce JUST for being 42 weeks. Two women were in early labor AT 42 weeks; no one has gone beyond that. In other words, the "every other day biophysical and recommend hospital birth" is something that hasn't been tested yet because we haven't had to.