The "dangers" of a postdue baby - Page 2

[Xenopus]

We, as biological organisms, eperience variation in every aspect of our existence - metabolic rate, eyesight, height, need for x number of hours of sleep at night, appetite, sex drive - so how would we not experience variation in a physiological process as complicated as labor and childbirth?

Due dates are based on a 40 week gestational period, from Henci Goer via Lamaze.org:

"A major conceptual problem with routine induction at 41 weeks is that the median length of pregnancy in healthy first-time mothers is 41 weeks 1 day. The conventional 40 weeks is just that: a convention. It is based on nothing more than a German obstetrician's fiat two centuries ago that since women cycle according to the moon, pregnancy lasts 10 moon months, that is, 10 months of 4 weeks each. Practitioners may argue over how great a deviation from normal warrants intervention, but in the case of routine induction at 41 weeks, they are arguing for intervening when there is no deviation from normal. The same study that reported a 41 week 1 day median pregnancy length in primiparous women found a 40 week 3 day average pregnancy length in women who had had babies before. First-time mothers are notoriously more likely to have problem labors and cesarean sections than multiparous women. This means that the increasing complication rates and cesarean rates seen with advancing gestational length may well be nothing more than an artifact created by having a higher and higher proportion of primiparous women in the mix as the days roll by after 40 weeks.

Practice philosophy aside, a policy of routine induction at 41 weeks produces more than a conceptual problem. Primiparous women have roughly double the risk of having an induced labor end in a c-section. A policy of routine induction at 41 weeks exposes large numbers of a vulnerable population to a greatly heightened risk of surgical delivery with all of the attendant problems of a major operation as well as all the future reproductive consequences of having a uterine scar. In addition, crowding the labor ward with women undergoing an unnecessary intervention means there may be no room for a woman who really needs care. In their paper criticizing routine 41-week induction, Menticoglou and Hall (2002) cite a case where admission was delayed for a pregnant woman requiring IV antihypertensive drugs for severe hypertension because no beds were available. Several were filled with women undergoing routine 41-week inductions. The woman died of a stroke before she could be admitted. To quote Menticoglou and Hall's conclusion: “Routine induction at 41 weeks is ritual induction at term, unsupported by rational evidence of benefit. It is unacceptable, illogical and unsupportable interference with a normal physiologic situation.”

With DD, my OB suggested inducing me at 39 weeks - with no jusitifcation/reason provided. So, I stopped answering the phone and ignored my appointments. Labor started spontaneously and DD was born 41w3d with no problems.

I'm just sayin'.
-Xen

[EBeth0000]

Originally Posted by sapphire_chan

Some definite "dangers" of an overdue baby, as determined from numerous anecdotes:
Being told that something will go wrong.
Having to refuse inductions.
Getting treated like you're putting your baby's life at risk.
Calls from relatives asking where the baby is.
Having to defend your decision not to induce.

These risks begin at 40 weeks 1 day and increase in severity every day after that with sharp increases at 41 and 42 weeks.

laughup

I went 42 weeks, 5 days. I totally agree with all of these! My placenta, fluid and baby on the other hand, were perfect in every way!

[sapphire_chan]

Originally Posted by mommyofmany

The PP was right that being overdue doesn't START until 42 weeks, and I thought was right on the money that at 42 weeks from LMP, baby is only 40 weeks developed, which is right around when most are born.

No, the arbitrary 40 week date is from LMP. Where 42 weeks becomes a factor to consider is that statistically 90% of babies will spontaneously arrive within 2 weeks of the 40 week date--before or after. I daresay there's also some unscientific attempts at symmetry going on with the whole 38 weeks being full term thing. (If 38 weeks is "safe" then 42 weeks must be the other side of "safe". Utter BS, but you can see where people would think that.)

[sapphire_chan]

Originally Posted by Xenopus

We, as biological organisms, eperience variation in every aspect of our existence - metabolic rate, eyesight, height, need for x number of hours of sleep at night, appetite, sex drive - so how would we not experience variation in a physiological process as complicated as labor and childbirth?

Due dates are based on a 40 week gestational period, from Henci Goer via Lamaze.org:

....

I'm just sayin'.
-Xen

:

[firespiritmelody]

In regards to post-date babies leading to longer labors, my MW has said that in her practice (she's in her 70's) nearly all of the post-date babies have had shorter easier labors because they've had more time to get positioned correctly. In her experience, 37/38 weekers are often not positioned well and therefore take longer.

Now, obviously this is just her perosnal experience, but it makes sence to me. Just thought I'd share so that anyone who is post-date isn't setting themselves up with the fear that they *will* have a harder labor, because that just isn't neccessarily going to be the case

[akaisha]

Originally Posted by veronicalynne

Where did you read that about the risk of ur in 1st time mothers as compared to vbac mothers? I am just curious as I am going for my 2nd vbac and would love to read the article....give me some courage :

i hope this isn't a UAV but, i read it on another forum. a poster was saying that her midwife told her that, although i have no way to know if it's actually the case. from what i can gather myself it looks like a syntocinin induction for a first time mother carries about the same risk of uterine rupture as a VBAC. so, that should give you some reassurance anyway: it really puts the risk of VBAC rupture in perspective, it's pretty darn small. women are induced in ridiculously high numbers and are not told that this is a risk of rupture. but for women who want a VBAC, this is suddenly enough of a risk that it is used as a scare tactic to talk them out of it, or as grounds to flatly refuse them a vaginal birth at all. anyway, congrats on your VBAC!

[Lily Eve]

Originally Posted by tireesix

Yeah, the Doctors seem to forget that the due date is ESTIMATED.

I always go by my dates anyway because I know the day I ovulate and I refuse to have some bloody idiot claim that some machine knows better than I do as to when it happened.

Also, as others have said, a normal pregnancy ranges from 37-42 weeks so it seems adness to want to induce between 10 and 14 days.

Yep, exactly.

I was 11 days late and while looking forward to giving birth so I could finally meet my baby and do things like roll over at night without having to sit up just to turn my huge stomach over, lol, I wasn't terribly worried about being late. Labor was fast and my DS came out in 3 or 4 pushes. He was obviously in no hurry to get out though as the amniotic sac was still around him when he emerged.

[Turquesa]

Originally Posted by sapphire_chan

Some definite "dangers" of an overdue baby, as determined from numerous anecdotes:
Being told that something will go wrong.
Having to refuse inductions.
Getting treated like you're putting your baby's life at risk.
Calls from relatives asking where the baby is.
Having to defend your decision not to induce.

These risks begin at 40 weeks 1 day and increase in severity every day after that with sharp increases at 41 and 42 weeks.

May I continue?

* Unsolicited advice from strangers and family members who have somehow developed the delusion that they are your OB.

* Ongoing paranoia that your doctor or midwife will "accidentally" strip your membranes during a "routine" vaginal exam.

* Fear and anxiety that you will not sound convincing when you lie to your family: "So it looks like my due date's been pushed back a little . . ."

* A two-week + extension of the usual rude comments from strangers: "Wow, honey, you look like you're gonna pop!"

* And finally, an itching sense of self-doubt in your decision to try to ignore it all.

[PEace4hippychick]

I wish I had some stats or something for you but I don't. I just wanted to share with you that my little boy was a 44 week uvbac. Nice strong relatively short labor and he and the placenta and amniotic fluid were absolutely fine!!

Want to wish you the best of luck and lots of courage and strength!

[Julz6871]

The 38-42 weeks being "term" wasn't made up. I think the 40 weeks is from the cycle, but an ultrasound is considered the best predictor of due date and its margin of error is +/- 2 weeks.

Learned that the other day

[soso-lynn]

Originally Posted by Julz6871

The 38-42 weeks being "term" wasn't made up. I think the 40 weeks is from the cycle, but an ultrasound is considered the best predictor of due date and its margin of error is +/- 2 weeks.

Learned that the other day

Yeah that means it is an approximate due month, not a due date. And being outside of that margin does not mean there is a problem.

[soulshine]

i can speak only to the subject of stillbirth.
my baby was born stillborn at 41wk5d. unexplained, but her placenta was calcified which i was told was a possibiity as to why she died. i am not saying that is why she died, because we had no autopsy, but it is a possibility. but who knows, i have read on another recent thread that a calcified placenta is due to too many tums during pregnancy, not the placenta possibly losing its supportive function...

i know 2 other women who had their babies die at or well past 42weeks. in the grand scheme of things, it is a very small percentage. but, it is worth mentioning at least in this thread that it does happen sometimes. most of the time things go well, but sometimes they don't.

losing a baby has made me very aware of the reality of small risks. i was a huge defender of no induction until at least 42wks, but for me, my next birth will be a 39wk c-section- for some medical reasons, but also for the simple fact that a living baby is way more important to me than a shi**y birth experience. i realize this is probably very unpopular, but for me, i wouldn't go near 42wks again. that's just me, coming from the experience of an acute loss.

not *everyone* goes to and past 42 weeks with a great outcome. but, what a way to live your life is that? its much better to focus on the 'most of the time it goes great'...

its too bad the discussion has to be so black or white. ob's want to induce, women don't, but what are the real facts? how can you make an educated decision when one side is saying 'you and your baby are in danger' and the other side is saying 'nah, you'll both be fine, for sure'?

i didn't mean to stir anything up here, and to the op, i would say...
if you are nearing post dates, i think if you are comfortable getting an nst, it could be worthwhile to check on the baby and give you confidence and reassurance, and if you don't want an nst, you can at least be very aware of kick counts.

[MKury]

One piece of research I've found states that only 3% of babies who go past 43 weeks experience negative side effects. Compared to all the ills that can happen to a baby if he/she is prematurely induced, I'd take the risk (as long as both mother and baby are healthy and low risk) and allow my bun to continue baking, no matter how much past the EDD we were.

[tireesix]

I don't think one side is saying 'nah you will be fine'.

In my experience, I have ad Obs etc telling me my baby 'will die' if I go past 42 weeks and then there is stuff I have researched that states that around 10% of womengo over 42 wweeks, alot of these have in fact had EDDs wrongly calculated, and around 10% of the women who go past 42 weeks will have babies showing signs of post maturity.

I don't know, I see one side using scare tactics and the other side using facts and figures that make me feel like I can make a more informed decision.

[EBeth0000]

Soulshine, I am so sorry for your loss. I cannot imagine what you must have been through, and I respect the change that this experience gave you in looking at birth.

I, too, did not mean to sound as though I was saying there was no risks. My mom, a L&D nurse who is very naturally-minded and had 2 natural births herself, put it to me this way. With anything medical, there's a risk of doing something, and a risk of doing nothing. It's not like the intervention is always risky and doing nothing is always safe, or vice versa--both have risks and benefits.

The point any woman should consider a medical intervention is when the risks of that intervention becomes outweighed by the potential risks of doing nothing.

I'm sorry if my post came across as though I do not have a healthy respect for the risk. I hope you have a wonderful birth!

[soulshine]

and maybe i should add that i think inducing a large population of pregnant women 'just because' they are over 40wks is indeed questionable and of course ends up having all kinds of undesirable results, ranging from disappointment in not getting the birth you hoped for, to serious complications for mom and baby.

but i just felt the need to say that there ARE babies that die from being post due, even though a tiny percentage, it does happen, and when it happens to happen to YOU, it doesn't feel like 1%, or 3% of the 10%, it feels like 100%. subjective experiences, including mine, don't really speak to whether or not it is 'safe' to go post dates or not... that is always going to be unique to each individual circumstance.

i'll tell you, there was a woman under the care of my cnm who had her baby 4 days after i had my baby that died. i met up with her a few months later, and she was actually mad at me, at the situation, for making the cnm nervous about allowing her to go past 42wks, she was induced at 42 and a day, and had a 'really shi**y birth'. my cnm is as laid back as they come, even told me at my 41wk nst 'nah, you'll be fine'. she never threatened a dead baby, but she did say after 42 weeks she felt 'less comfortable'. but when the care provider goes through a loss like that, it affects them, too, i suppose. not having a definative cause for our baby's death, i think she felt that it really could have been the placenta giving up. how much calcification is too much for an individual baby? maybe if you have seen enough loss, it makes you more conservative in the care you give? who knows.

i wasn't taking offense at anyone's opinions or experiences, but i felt that in this kind of discussion, there is another, albeit small, side of the story, so i said it.

[sapphire_chan]

Originally Posted by soulshine

i wasn't taking offense at anyone's opinions or experiences, but i felt that in this kind of discussion, there is another, albeit small, side of the story, so i said it.

Obviously, inducing at 42 weeks wouldn't have helped your baby. Is there some kind of testing that could have been done that should maybe be the standard protocol instead of "Oh, X weeks! Time to induce!"? (Please don't answer if it's too painful.)

[sapphire_chan]

Originally Posted by EBeth0000

The point any woman should consider a medical intervention is when the risks of that intervention becomes outweighed by the potential risks of doing nothing.

Yep.

Which is why it's soo annoying that doctors seem to minimize the risks of what they want to do while emphasizing the risks of what they don't want to do. How is anyone supposed to make an educated decision with biased information?

[MegBoz]

Originally Posted by sapphire_chan

Which is why it's soo annoying that doctors seem to minimize the risks of what they want to do while emphasizing the risks of what they don't want to do.

:

Which is why I'm so glad Henci Goer wrote "The Thinking Woman's Guide to a Better Birth" and we have the NIH website on which to peruse TONS of studies published in MW & OB/gyn journals from around the world. So we can arm ourselves with lots of facts.

When one MW told me some women beg her to induce at 40W, I couldn't help myself but saying, "I can't imagine why anyone would opt for induction with pitcon if they really knew the risks...." (Presuming there was NO medical indication... just mere impatience!)

[clavicula]

It is so funny! Yeah, I agree, we are not robots, we are human unique beings with different "levels" in our bodies. Nobody has the same cholesterol or haematocrite level. Somebody gestates for 37 weeks, someone for 43. This is how things go. Period.