The "dangers" of a postdue baby - Mothering Forums

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Old 06-30-2008, 09:16 PM - Thread Starter
 
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Can someone point me to some real evidence that going "overdue" is actually going to lead to the following:
- Longer labor
- Traumatic birth for mom and baby
- Doubling of stillbirth by week 43
- Failure of the placenta
etc etc...

All the "mainstream" sites I visit tell this horrible tale of NEEDING to be induced by week 42, and my own doc wants to "talk about induction" by July 5th, a mere 5 days past my EDD. I want to go see her armed with some solid evidence/statistics.

TIA!
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Old 07-01-2008, 01:43 AM
 
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subbing!

Had my first visit with the new OB today, and since I don't know the date of my LMP and don't want a u/s, they're confused as to my dates.. Even though I know the date of conception, none of the geniuses can figure my due date out? Ummm... ok? So he proceeded to tell me that the placenta will fail by 41.5 weeks, and not knowing my dates could put the baby at risk, blah blah blah.
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Old 07-01-2008, 02:06 AM
 
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I really love pamamidwife's Postdates Informed Choice Agreement (it's a link to a PDF on that page).
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Old 07-01-2008, 02:17 AM
 
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Originally Posted by Halfasianmomma View Post
Can someone point me to some real evidence that going "overdue" is actually going to lead to the following:
- Longer labor
- Traumatic birth for mom and baby
- Doubling of stillbirth by week 43
- Failure of the placenta
etc etc...

All the "mainstream" sites I visit tell this horrible tale of NEEDING to be induced by week 42, and my own doc wants to "talk about induction" by July 5th, a mere 5 days past my EDD. I want to go see her armed with some solid evidence/statistics.

TIA!
psh...5 days past your EDD? post dates starts after 42 weeks, not at the beginning of week 42, so all this BY week 42 stuff is a whole bunch of bologna. i dunno, i would say "i will not consider an induction before the end of 42 weeks. after 42 weeks i will only consider an induction if my baby is proved to be showing measurable signs of distress." doctor will complain, you repeat ad nauseum. not to mention the fact that 42 weeks pregnant is probably only around 40 weeks gestational age...

longer and/or traumatic labour (as long as the trauma isn't escalating to the point of serious injury or death to mom or baby, obviously) is IMO not a valid medical reason to induce. what constitutes long or hard is up to the person giving birth, and that varies greatly.

increased risk of stillbirth and placental failure is another story. i've never been pregnant myself, i've done a lot of research, but i might be wrong but wouldn't reassuring weekly (or daily? every two days?) NSTs put that concern to rest? as long as baby is moving at the regular rate, has a good HR, and as your fluid is good it's kind of a moot point, isn't it? i did a quick search but came up empty, hopefully one of the experienced moms will chime in. i would cross-post this in the UC forum, those women know a lot about stuff like this.

personally, i would have greater concerns about fetal distress during an induction than the risk of going post dates, assuming that both mom and baby are healthy. would you consider natural induction methods or AROM to get you going after you've past 42 weeks? maybe that's the way to go for you... since you're a first time mom, and i assume delivering in the hospital if you have an OB, i would be really worried about induction since you don't have a "proven pelvis". induced labours are often long, and they might try to get you for unproven pelvis and failure to progress. also, i've read that the risk of uterine rupture in first time mothers who are induced is actually higher than the risk of uterine rupture to those going for a VBAC. not that many VBAC moms rupture, but if they can throw stats in your face to scare you, they probably will, and you don't want to walk out of there with an incision unless you absolutely have to.

and the obvious and probably annoying question: are you absolutely sure on your dates?

good luck mama!

oh, i might have just found something. try this link, i didn't read it all, but it looks promising.
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Old 07-01-2008, 09:07 AM
 
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i dunno, i would say "i will not consider an induction before the end of 42 weeks. after 42 weeks i will only consider an induction if my baby is proved to be showing measurable signs of distress."
I agree with this.

I know personal experience is not fact, but clearly the "dangers" of going past 42 weeks (or past 41 weeks, depending on who you ask) are not across the board.

My last two babies were each a few days past 42 weeks. There was *no* placental deterioration, they were covered in hair and vernix, no meconium evacuation before birth, and both of those labors were 4 hours long, almost to the minute. The only "complication" from post-dates was that they were big (9 lb 15 oz and 10 lb 8 oz).
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Old 07-01-2008, 10:29 AM
 
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I would read Henci Goer's books. She goes over the "evidence" about postdates in detail, and also explains why she does not believe the research supports such a practice.

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Old 07-01-2008, 10:55 AM
 
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There is no reason a healthy woman's placenta is going to start to deteriorate because of a date. Placentas don't watch calendars. I don't know why on earth a long pregnancy would have anything to do with a long labor or a traumatic labor. That makes no sense at all. Mine were 11 and 6 days late. My 1st labor was maybe 12 hours of active labor (15 or so of early labor). My 2nd labor was less than 4 hours from start to finish. Both were painful & hard (hello, it's labor) but not traumatic.

I don't know the still birth stats-I remember in my old Bradley materials that the risk at 43 weeks is equal to the risk at 37 weeks. Yet they're happy to induce at 37-go figure. However, the risk of stillbirth at full term is REALLY low. Even if it's doubled at 43 weeks, it's still tiny. It's like the "you're 5 times more likely to die from cesarean than vaginal birth" stat. Yeah, it's true-but the risk of death from either is very low. The difference, though, is that a cesarean is a manmade intervention, while a long pregnancy is just nature doing its thing. I would not personally induce without some reason, beyond dates.

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Old 07-02-2008, 01:30 AM
 
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I’m impressed at your resolve to do this. A lot of PPs have provided some great resources. You can also do a search on the Cochrane Library database, which is the storehouse for obstetrical research.

That being said, the burden of proof is your doctor’s to justify the intervention, not yours to decline it. Have no qualms about asking, “Can you point me to any studies indicating that an induction in my case is medically necessary?” If she comes back at you with anecdotes, (“A lot of my patients . . . ,” “I’ve seen a lot of cases of . . . “), politely insist on actual research.

If you do say no, you do not owe any explanations.

Good luck!

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Old 07-02-2008, 02:10 AM
 
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I would probably delay the visit for a while, but that's just me. I also said that if I got pressured into scheduling an induction, I would not show up for it.

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Old 07-02-2008, 02:13 AM
 
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I butted heads with an OB over this. DS was nine days overdue. The OB wanted to induce me based on statistics, policy, procedure blah, blah, blah. I flat out refused, knowing that she'd do an ultrasound to check the placenta if she had no other choice... and they checked, and the placenta was great. I went into labour on my own that day.

If the placenta had shown signs of aging I'd have been willing to talk induction, but I wasn't about to be induced based on population statistics, not when she could easily check what she claimed to be worried about.

I do think that there is merit to some of this research, but the research only points to things that a provider and mother may wish to consider. You still need to consider the specifics of individual patients, and what is applicable to their particular situation.

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Old 07-02-2008, 08:35 AM
 
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they are placed there for the amusement of those who like to point them out.
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Old 07-02-2008, 01:08 PM
 
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dd1 born 37w 7#1 - still don't understand why she was born "early"
dd2 born 42w5d 8#13 - I was climbing the walls, but I wasn't terribly worried

I think it's all a mythical guessing game anyway, regarding the "dates"! How on earth can it be an exact science? My period Usually comes 24-26 days, and I Usually ovulate about day 6-9. But, even that isn't EXACT. So, my dates have been predicted as anywhere between Dec 14-27. How do you know when it will be 2 weeks overdue?

Mama to 3 girls 12,8,3
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Old 07-02-2008, 01:25 PM
 
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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.
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Old 07-02-2008, 01:29 PM
 
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Originally Posted by SublimeBirthGirl View Post
There is no reason a healthy woman's placenta is going to start to deteriorate because of a date. Placentas don't watch calendars.
It's like the old "your breastmilk turns to water after X time" argument for weaning at X time.

Quote:
Originally Posted by SublimeBirthGirl View Post
I don't know why on earth a long pregnancy would have anything to do with a long labor or a traumatic labor.
Cause they're induced.

Hey, there's a thought, Halfasianmomma, "OB, how many of those longer labors you saw started spontaneously with no augmentation?"
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Old 07-02-2008, 01:52 PM
 
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I am not sure about that but I do know I was 7 days "overdue" with my 1st, and 9 days "overdue" with my 2nd....and everything was fine. It sounds like a scare tactic to me.....I have a friend who went 43 weeks and everything was fine fine fine.

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i've read that the risk of uterine rupture in first time mothers who are induced is actually higher than the risk of uterine rupture to those going for a VBAC. not that many VBAC moms rupture, but if they can throw stats in your face to scare you, they probably will, and you don't want to walk out of there with an incision unless you absolutely have to.
.

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:
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Old 07-02-2008, 02:37 PM
 
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Wow, only 5 days past the due date? I was 10 days past with my first and 12 with my third. Out of my three children, the longest was 12 hours, but that was an induction 2 weeks early (and wasn't my first baby, either).
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Old 07-02-2008, 02:54 PM
 
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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.

All of my pregnancies have been "overdue", probably because I normally have long menstrual cycles. The longest one was 17 days past the EDD (baby #3). All of my labors have been from 3 hours (shortest, natural homebirth) to 9 (longest, induced, figures, huh?).

Good for you for standing up for you & your baby!!

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Old 07-02-2008, 03:35 PM
 
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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.
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Old 07-02-2008, 04:05 PM
 
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I am really curious about where the idea that longer pregnancies result in more difficult labours comes from. As someone else said, induction must play a role. I was also wondering if babies who were not positioned properly might have something to do with it. If the baby is not in optimal position, there is less pressure on the cervix so it may take longer for labour to begin and those labours are usually longer and more painful. I have not even found any source to back up the initial assumption that post date pregnancies lead to longer labours, but I would be very wary of their conclusions of I did find them. From my purely anecdotal experience with what I have heard from people I know, it seems that babies who come between 41 and 42 weeks are usually easy labours. I do not see why that would suddenly change after that. Maybe it also has to do with OB's fear of bigger babies and their 'OMG! This baby will be almost 9 pounds, we have to do a c-section!' attitude.


OP, you should feel free to refuse any NST and such until at least 42 weeks if you feel everything is fine or just skip your appointment altogether. At this point, especially after refusing induction, you should absolutely refuse any internal exam to avoid the 'accidental' sweeping or breaking of membranes.

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Old 07-02-2008, 04:15 PM
 
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Ds1 was born at exactly 42 weeks, based on a calculation from my LMP, which I knew was off, as I always have long cycles. I usually ovulate on day 20+. A due date based on my LMP would automatically be a week or two early, since I NEVER ovulate on day 14. But, with my first I didn't realize it was a big deal, so just accepted the date I was given. When my doc started talking induction, I brought in my calendar, and said that based on my mean and median cycle lengths from the last year (I didn't know how to chart at that time), I most likely ovulated between certain dates... which would push my due date back a couple of weeks. So, at the time they were talking induction, I really was not even at a properly calculated EDD. Ds1 was born spontaneously, without any augmentation, with maybe 4 hours of active labor, right about when I estimated his due date to be. He had a bit of wrinkling on his wrists and ankles, but certainly was not a "postdates" baby.

Ds2's due date was calculated from ovulation, based on charting, not LMP. He still didn't arrive until 41 w, 5 days. He was covered in vernix and the newborn exam showed him to be term, not late. So, even with KNOWING my dates and the exact day I conceived, it still took a bit longer for him to cook. Oh, and that birth was 2 hours long from start to finish.

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Old 07-02-2008, 04:51 PM
 
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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

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Old 07-02-2008, 05:06 PM
 
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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!
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Old 07-02-2008, 08:53 PM
 
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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.)
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Old 07-02-2008, 08:54 PM
 
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Originally Posted by Xenopus View Post
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
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Old 07-03-2008, 11:55 PM
 
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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

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Old 07-04-2008, 04:29 AM
 
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Originally Posted by veronicalynne View Post
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!
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Old 07-04-2008, 07:43 AM
 
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Originally Posted by tireesix View Post
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.
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Old 07-04-2008, 04:20 PM
 
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Originally Posted by sapphire_chan View Post
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.

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Old 07-08-2008, 06:55 PM
 
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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!
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Old 07-08-2008, 07:07 PM
 
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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
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