Pregnancy over 42 weeks - what are the risks? - Mothering Forums
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#1 of 32 Old 01-21-2009, 05:18 PM - Thread Starter
 
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Does anyone know the specific problems that develop when gestation goes over 42 weeks? I know 1 is placenta aging - how does that affect the baby? Is that the only issue that crops up and then has different ways of affecting the baby? Or are there other problems that increase in frequency after the 42nd week?

Has anyone gone over 42 weeks and had healthy babies here? My dr wants to induce and I still want my homebirth. Baby and I are both completely healthy.
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#2 of 32 Old 01-21-2009, 05:57 PM
 
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Sometimes the reason babies aren't born in the typical timeframe is that they have problems already, and it's not that going late caused a problem. Then in labor they go into distress of some form, or pass away. That's the main cause of the poor statistics on postdates babies I'm almost certain. Yes sometimes placentas start to calcify or not work as well also. Babes are more likely to pass meconium before birth if they are "late", that's not much of an issue though. Usually going late is just because individual kids just take longer to finish up in the womb. It's more of a CYA issue for health care providers than an issue of saving anybody from anything.
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#3 of 32 Old 01-21-2009, 07:11 PM
 
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My first was finally induced at 42+4 days. She was a perfect baby in every way, other than there was a little meconium when my water broke. My midwife currently has a policy of letting women go until 43 weeks if everything else looks good.

Things that can happen postdates - placenta aging, so the baby isn't getting enough nutrients and oxygen, decreased fluid - which if severe enough can cause cord compression.

Have you had a biophysical profile and NST? Those were my OB (with my first baby) and my midwife currently recommendations after 40 or 41 weeks. With reassurance from those, your OB might feel a little bit better about waiting to induce.

Good luck!
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#4 of 32 Old 01-21-2009, 07:11 PM
 
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I totally understand that you really want your homebirth but honestly there are risks with postdate babies. Some significant.

As an example one of the moms on this board recently got irate enough with her OB who wanted to induce at 42 weeks (becuase she didnt' want it) that she fired her OB. Found a homebirth midwife - her NST's had all been fine as well as her BPP's too. Well long story short - she got to the point in herr homebirth that she wanted to transfer for pain meds, lost fetal heart tones in transit and had a stillbirth.

I wouldnt' wish tha ton anyone - homebirth is wonderful but when it comes to postdates I'd much rather be safe than sorry. Just because you cant' detect it does not mean that there isnt' a problem lingering somewhere you cant' see it.
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#5 of 32 Old 01-21-2009, 08:00 PM
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The three things that pop into my head are:

1)deteriorating placenta
2)unsafe drop in amniotic fluid levels = traumatic birth & potential cord compression
3)extremely large baby = increased risk of shoulder dystocia & c-section

All of these have pretty ugly consequences.
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#6 of 32 Old 01-21-2009, 08:09 PM
 
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I totally understand that you really want your homebirth but honestly there are risks with postdate babies. Some significant.

As an example one of the moms on this board recently got irate enough with her OB who wanted to induce at 42 weeks (becuase she didnt' want it) that she fired her OB. Found a homebirth midwife - her NST's had all been fine as well as her BPP's too. Well long story short - she got to the point in herr homebirth that she wanted to transfer for pain meds, lost fetal heart tones in transit and had a stillbirth.

I wouldnt' wish tha ton anyone - homebirth is wonderful but when it comes to postdates I'd much rather be safe than sorry. Just because you cant' detect it does not mean that there isnt' a problem lingering somewhere you cant' see it.
The rate of stillbirth goes up dramatically at 42 weeks. I would not personally feel comfortable continuing a pregnancy beyond 42 weeks and 1 day, which is when my 3rd son was born. He was fine, but I sure as heck couldn't live with myself if one of my babies was not fine. I was actually planning on going to the hospital for an induction that night, but he was born early that morning.
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#7 of 32 Old 01-21-2009, 08:29 PM
 
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I UCed a baby at 43 weeks. 8.5 pounds very healthy.

There's an "overdue" thread here: http://www.mothering.com/discussions...7#post13028337

Mommy to DD March 2008, DS July 2010
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#8 of 32 Old 01-21-2009, 08:49 PM
 
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how sure of your dates are you? sometimes 42 wks is actually 41. I had a 41w1 day baby with kind of a lot of vernix and even some languno

DD1 7/13/05 DD2 9/20/10
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#9 of 32 Old 01-21-2009, 08:56 PM
 
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All mine were 42 weeks and beyond. All but 1 was a hb. All were perfectly healthy. There is tons of good info around here, check over on the birth and beyond forum I know there has been lots of threads about this.

I do not believe that the risk of still birth increases dramatically. From the reading I have done typical stillbirth rate at 40 weeks is 2-3 where in post dates its 4-7 in 1000. But stillbirth increases starting at 38 weeks. 42 weeks is not the magic time at which still birth begins to increase. Stillbirth at 40 weeks is higher than 39 and 39 higher than at 38.

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#10 of 32 Old 01-21-2009, 08:58 PM
 
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Baby's come when baby's are GOOD and READY. I would go with your gut and know that you and baby are healthy and let baby pick his birthday. Any kind of induction is an intervention that can lead to the next and it just dog piles, and there are many risks that come with that path.. Trust your body, trust your baby to come when he is ready. I'm not sure what the percentages are with post dates and still birth but I remember it being extremely low. You wont be pregnant forever and you may want to head over to the UC forum for some support on this.

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#11 of 32 Old 01-22-2009, 10:48 AM - Thread Starter
 
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Thank you ladies!! I was hoping to get some positive feedback and I did! : I'm heading over to read about all those "over due" babies on the other thread.
Going to the dr today for a NST to stay on top of things. I also think my due date may be off by a as much as 4 - 5 days. I always had 28 day cycles and the cycle before I became pregnant was 32 days. My EDD was based on a 28 day cycle.
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#12 of 32 Old 01-22-2009, 11:13 AM
 
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PLEASE read this thread Can my OB fire me?

This is the thread the mom I mentioned started back in October.
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#13 of 32 Old 01-22-2009, 11:22 AM
 
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There is very little research on pregnancy over 42 weeks and what there is probably can't be trusted because of small sample size. Get monitored frequently, trust your body and you should be fine.
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#14 of 32 Old 01-22-2009, 03:35 PM
 
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Personally I'm one of the people not comfortable going past 42 weeks. It feels too risky for me. With that being said, I chart so I know my exact due date - if I were not positive I may think differently. I'd start to get nervous around 41 weeks and start natural induction methods (EPO, sex, nip stim, castor oil) and likely even move on to less natural methods closer to 42 weeks (cohoshes, stripping membranes, and possibly even pitocin if my bishop score was favorable). Just my opinion thought and I respect women who feel otherwise. The risks of distress, placenta breakdown, dystocia, and cord compression feel too risky to me.

Unfortunately I've seen post-date loss happen to a few people close to me, one of those people being my own mother.

Zen doula-mama to my spirited DS1 (2/03), my CHD (TAPVR) warrior DS2 (6/07) & a gentle baby girl (8/09)
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#15 of 32 Old 01-22-2009, 04:28 PM
 
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i went 42 weeks and a day.......but i had to be induced anyway which did indeed lead to a lot of crap like water breaking by the doc, leading to fever (iv antibiotics), pitocin leading to crazy pain and unwanted epidural and not being allowed to move, eat or shower. on the plus side i had a fairly quick vag. birth and a super healthy kid. 9 pounds. placenta looked good. he had low blood sugar and needed some formula at first (and tons of blood tests argh) which felt like the end of the world but made no difference in the end, either, he went on to a stellar nursing career that continues to this day

looking back i think i made way too big of a deal about (not wanting to be) induced, including fights with my OB. lots of worry and drama. now i think its better to err on the side of caution.

this time i would go a bit under 42 weeks for my own sanity/peace of mind.

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#16 of 32 Old 01-22-2009, 04:47 PM
 
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I agreed to an induction with my first at 10 days "postdate" . There was some calcification of my placenta but more troublesome was my extremely low amniotic fluid level (so low that there was not a pocket large enough to measure). Thankfully it ended up a quick, uneventful, and otherwise unmedicated birth. It was worrisome at the time.

Be, happy momma to Liberty (12-31-02), Henry (3-17-07) and Prudence (7-02-09)
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#17 of 32 Old 01-22-2009, 04:53 PM
 
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Originally Posted by tak View Post
The three things that pop into my head are:

1)deteriorating placenta
2)unsafe drop in amniotic fluid levels = traumatic birth & potential cord compression
3)extremely large baby = increased risk of shoulder dystocia & c-section

All of these have pretty ugly consequences.
Whats an extremely large baby? Mommy's grow babys the right size. Shoulder Dystocia is rarely a complication that NEEDS a C section. In the hospital, Dr's may feel it is undignified to have a butt in their face, but turning over on all fours almost always solves shoulder dystocia.

Where have you seen "pretty ugly consequences" with shoudler dystocia? Most likely hospital births. Physicians are so busy inducing that a baby over 7 lbs is HUGE and you need a C section. That's sad.
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#18 of 32 Old 01-22-2009, 04:56 PM
 
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My mom carried me to 45 weeks and my bro to 44. We came out at 7 lbs with no signs of being late. Imagine is they induced her?


I'm a big believer in baby's come when ready. That said, I am not sure how comfortable I would personally be going much over 42 weeks. I would be getting screened and I may agree to an induction at that point anyway. It all goes to what you are comfy with really.
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#19 of 32 Old 01-22-2009, 04:57 PM
 
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I had to be induced at 42 weeks due to extremely low levels of amniotic fluid. If it had just been at the cusp of it I would have gone longer, but my levels were super, super low so I had the induction. Really, all they did was break my water and labor started immediately.
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#20 of 32 Old 01-22-2009, 05:25 PM
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Whats an extremely large baby? Mommy's grow babys the right size. Shoulder Dystocia is rarely a complication that NEEDS a C section. In the hospital, Dr's may feel it is undignified to have a butt in their face, but turning over on all fours almost always solves shoulder dystocia.

Where have you seen "pretty ugly consequences" with shoudler dystocia? Most likely hospital births. Physicians are so busy inducing that a baby over 7 lbs is HUGE and you need a C section. That's sad.
My sister's baby was over 10 pounds, his head got stuck after over 3 hours of pushing, he went into distress and pooped in utero, ended up in ICU for a week and my sister hemmorhaged for 4 hours after the c-section. It was not an ideal birth situation.

Shoulder dystocia -- friend's stepmom had a baby die during birth. It wasn't a hospital birth.

My doctor, and most doctors I know in Canada, would NEVER say a baby over 7 pounds is large. That's actually on the small side of average. And not all moms grow babies the perfect size to deliver vaginally. There are always exceptions.
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#21 of 32 Old 01-22-2009, 05:30 PM
 
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PLEASE read this thread Can my OB fire me?

This is the thread the mom I mentioned started back in October.
If she had gotten induced, would that have effected the cord being wrapped around the baby's neck? I'm not being snippy, I'm really wondering. I bawled my eyes out at the end of that thread...

Single mama to S ~ 6/09

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#22 of 32 Old 01-22-2009, 05:36 PM
 
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well said, TAK.

Unfortunately, not every situation is ideal, and you just have to do what you think is best. Have the test run and that should give you some direction on what is safe, and what will work best for you and your baby.

Best of luck, and keep us posted!

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#23 of 32 Old 01-22-2009, 07:14 PM
 
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If she had gotten induced, would that have effected the cord being wrapped around the baby's neck? I'm not being snippy, I'm really wondering. I bawled my eyes out at the end of that thread...
No. Cord around the neck is very common. About 1 in 4 babies has the cord around the neck at least once. Usually it happens earlier on in the pg when the baby can flip and move more freely. It has nothing to do with being post dates.

Drs have tried to manage shoulder dystocia for years. Nothing they have done has had any positive outcomes. Inducing to prevent a macrosomic baby that might have sd does not work. http://www.shoulderdystociainfo.com/ has some great info about that.

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#24 of 32 Old 01-22-2009, 07:20 PM
 
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If she had gotten induced, would that have effected the cord being wrapped around the baby's neck? I'm not being snippy, I'm really wondering. I bawled my eyes out at the end of that thread...
There is just no way to know. It may not have been the cord that caused the cessation of heart tones. All of mine have had their cords wrapped twice with no consequence at all.

For me - I wouldn't feel safe going beyond 40 weeks - yes I did say 40 weeks. But that is because I tend to "cook" them fast it seems.

DS was born at 35 weeks and was 9.3lbs - no GD either his lungs wer enot fully mature at the time and his apgars reflected his gestational age.

DD#1 was born at 39 weeks and was 8.14 pounds, DD#2 born at 37 weeks and 8.9 pounds. This baby was 6 pounds - per palpation and ultrasound at 33 weeks and will likely be induced at 37 weeks becuase to be candid I've been on bedrest since 12 weeks and can hardly walk becuase she is already fully engaged and at 0 station. I'm on narcotic painkillers just to be able to get up and walk to the bathroom. No I will not argue with induction early given my current state. I know I can birth big babies, I also knwo I cook them "on high" as someone put it. So I wont' feel comfortable at all going past 40 weeks.
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#25 of 32 Old 01-22-2009, 08:22 PM
 
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I keep thinking about this issue. I don't really know anything about it, but I'm wondering....what are the risks of being induced at 42 weeks, compared to the risks of not being induced? I mean if you're induced at 42 weeks, you know the baby isn't going to be premature right? Aren't you pretty likely to have a healthy baby? Sure you might not get a natural childbirth, but if the choice is between pit and an epi, or even a c-section.....or waiting too long and having a stillbirth....is there really any choice? I'm sorry if this sounds completely ignorant, I'm genuinely curious as to how the risks and benefits compare.

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#26 of 32 Old 01-22-2009, 08:26 PM
 
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There is very little research on pregnancy over 42 weeks and what there is probably can't be trusted because of small sample size. Get monitored frequently, trust your body and you should be fine.
I had some good discussions with my MW about this recently when deciding whether or not to get induced. She worked on a study at Northwestern U in the 80s about post-dates. Mostly the outcomes were fine with meconium being the main problem. I believe the study someone cited on this thread about stillbirth rates came out in 1987 and that is when more and more practitioners stopped "allowing" moms to go past 42 weeks. My MW said they could no longer do studies about post-dates because there just are not enough people going past 42 weeks to constitute a reasonable sample. (I had to sign a waiver to go past 42 weeks with their practice. They have only had 3 people ever sign that waiver in maybe 10 years? The doctors who practice at the same hospital have apparently never had anyone go past 42 weeks? Hard to believe but that is what my MW said)

That said, I think you can only decide for yourself what is best for you. After I signed that waiver I still got induced at 42w2d. Also remember not all inductions are equal, although it is true that all involve intervention. Yes, some practitioners will just hook you up to Pitocin and hope for the best but there are other options to try. I was lucky enough that just Cervadil worked for me (did not need Pitocin) and was able to give birth quickly, easily w/o pain meds.
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#27 of 32 Old 01-22-2009, 09:23 PM - Thread Starter
 
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Well, we had quite a day today. I don't think the NST machine was working properly at my doctor's office - fetal beats per minute were on the 120s and dr wanted to see more spikes - there were also a lot of blank spots (when baby moved) on the paper. So dr said she didn't like what she saw, that after 40 weeks most babies pass miconium, that my baby may be under distress, the placenta ages, babies no longer get the nourishment they need, fetal death has an extremely sharp rise, etc. My DH panicked. I listened to her wanting to say a lot of things but just nodding on the outside. So she told us to go to the hospital for a NST and a biophysical profile. On the way I told my husband to trust me, that baby was ok. I've had her in me for over 9 months now and could just tell she's perfectly fine. Not to let the dr scare him.

We went out for breakfast and we went to L & D at the hospital. Her NST looked awesome, lots of peaks. My placenta has no calcifications or any signs of aging whatsoever - the ultrasound tech was genuinely surprised to see how healthy it looked, fluid looks perfect, baby's movements were wonderful, and they even measured her diaphragm movements (they were adamant about having her "practice her breathing" or they would take points off). She got a 10/10!!!! : With that info at hand Dr still asked if I wanted an induction (this is the same dr who told me months ago that baby could die in utero if I didn't get a flu vaccine she was pushing at her office, which I declined). I said I'd rather wait and now we're finally home. DH is relieved --- and of course I had to say "I told you so!!" With everything looking so good & healthy I'm really wondering about the accuracy of my due date and also wondering about how many women get induced without really needing to just because they passed the 40 week mark. My Mom is flying back to Spain tomorrow without having met her 1st granddaughter but I am relieved that she is perfectly healthy and that we can give her more of the time that she needs/wants.


Mommas for your support!!
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#28 of 32 Old 01-22-2009, 10:34 PM
 
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DD#1 was born at 39 weeks and was 8.14 pounds, DD#2 born at 37 weeks and 8.9 pounds. This baby was 6 pounds - per palpation and ultrasound at 33 weeks and will likely be induced at 37 weeks becuase to be candid I've been on bedrest since 12 weeks and can hardly walk becuase she is already fully engaged and at 0 station. I'm on narcotic painkillers just to be able to get up and walk to the bathroom. No I will not argue with induction early given my current state. I know I can birth big babies, I also knwo I cook them "on high" as someone put it. So I wont' feel comfortable at all going past 40 weeks.
Wow. I hope that you are feeling better soon, and best of luck to you.

Married to my best friend, expecting #1 6/09. Little angel came early- 4/10/09, 2lbs 5oz. Lilah Grace:
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#29 of 32 Old 01-22-2009, 10:59 PM
 
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after 40 weeks most babies pass miconium

(this is the same dr who told me months ago that baby could die in utero if I didn't get a flu vaccine she was pushing at her office, which I declined).

uh.....are you sure this is the person you want delivering your baby???? I switched from an OB to a CNM at 36 weeks, it's never too late!!

congrats on the great NST and being so calm and collected in the face of fearmongering.

DD1 7/13/05 DD2 9/20/10
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#30 of 32 Old 01-22-2009, 11:22 PM
 
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Wow. I hope that you are feeling better soon, and best of luck to you.

Thanks!
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