Lets talk about the 42nd week of pregnancy - Mothering Forums
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#1 of 28 Old 10-15-2007, 02:40 PM - Thread Starter
 
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For some reason, doctors in our area of the country are delivering babies either by c-section or via augmented birth practices near the 38th or 39th week. I hear this comment all the time, "My doctor doesn't want me to go past 39 weeks".

What is really behind this, and why do mothers and fathers no longer "believe" that pregnancy is 42 weeks of gestation.

What happens in the the weeks 40 through 42, that a doctor feels can be missed?

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#2 of 28 Old 10-16-2007, 05:36 AM
 
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Originally Posted by Jyotsna View Post
What is really behind this, and why do mothers and fathers no longer "believe" that pregnancy is 42 weeks of gestation.
Our culture no longer thinks of a term pregnancy still being term (not past-due) at 42 weeks exactly because women are being induced at 37, 38 weeks. I think we put WAY too much stock in the due date (which is technically a Estimated Due Date.....the estimated part has been dropped by most people). The fact that women can have their baby at 40 weeks and 4 days and then tell people that they were 4 days late....y. :

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What happens in the the weeks 40 through 42, that a doctor feels can be missed?
Nothing. There is NO rise in fetal mortality until 42 completed weeks (and even then, it is only a small rise). Babies' weight gain slows way down at this point, averaging around 1/4 lb per week.

IMO, it all essentially boils down to providers wanting to manage birth. It is far more convenient to schedule an induction (or cesarean) for most or all of your clients than wait for labor to being in it's usual unpredictable time. The local hospital here does this as well, and their cesarean rate is horrid (close to 60%, I hear now) with a no VBAC policy. The fastest way to increase the cesarean rate is to increase the induction rate.

The whole thing makes me .

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#3 of 28 Old 10-16-2007, 04:45 PM - Thread Starter
 
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I would like to know how to combat this ingrained belief. I see this every time I talk to a mom that is being heavily managed by a doctor. One particular group of doctors in our city does this. I hate to see that mothers don't have the real info, and even if they do, they ignore it for medicalized information, which is often not correct. What happened to baby pushing itself out?

And BUMP...would love more convo on this.

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#4 of 28 Old 10-16-2007, 05:59 PM
 
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Interestingly, this guide for family docs recommends monitoring the baby but not inducing labour until the end of 42 weeks.
http://www.aafp.org/afp/20050515/1935.html

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#5 of 28 Old 10-16-2007, 06:06 PM
 
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The last thing to develop are the lungs so the risk to having the baby early have to deal with its breathing. The only thing that can happen post dates is the placenta can discentrigrate (sp?) but this usually doesn't come into play until at least 42 weeks.
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#6 of 28 Old 10-16-2007, 10:09 PM
 
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Yeah, its frustrating. Doula clients of mine feel by 39 weeks they have waited long enough and don't care that the baby could be three weeks premature. They're just tired of being pregnant. :

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#7 of 28 Old 10-17-2007, 08:14 PM
 
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That has to be frustrating! I had a client that chose to be induced at 41 weeks & 5 days. Her FP Dr was comfortable going at least a few more days. The induction worked & went well, but baby was only 7lbs 7oz & had a lot of vernix. Dr even commented about how baby was NOT almost 42 weeks. I told her: "Makes you glad you don't induce at 40 weeks." She said: "We don't do that."

Goes to show that inducing or having a c-section at 37, 38 weeks, you could have a preemie. Argh!

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#8 of 28 Old 10-17-2007, 08:29 PM
 
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I'm certainly no birth professional but I saw this in new posts...

I'm frustrated that people think 37 weeks is full term and nothing to worry about. I'm frustrated that when I try to voice that people look at me like I'm a nut who's overreacting/being a worrywart.


I'm just happy to see that there are still people who view pregnancy as lasting more than 37-39 weeks.

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#9 of 28 Old 10-17-2007, 08:32 PM
 
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Yeah he was an itty bitty baby. Smallest of fifteen clients. 6lbs 5oz. Caked in vernix. Also had a not-perfect apgar, and stayed blue longer than most babies I've seen.

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#10 of 28 Old 10-17-2007, 09:15 PM
 
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DD was born (on her own accord) at 37 weeks and was completely covered in vernix. We couldn't rub it all in like a lotion, instead we had to scrape it off of her. :

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#11 of 28 Old 10-17-2007, 09:23 PM
 
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One of the things that I found really interesting in my research was that the death rate for 38 week babies and 42 week babies was about the same.

It seems to me that a lot of care providers don't bat an eye at inducing at 37-38 weeks but get a major anxiety attack when babies go past 41 weeks. Doesn't make much sense.

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#12 of 28 Old 10-18-2007, 10:12 AM - Thread Starter
 
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And it is down right scary when babies come out like that, and they are not really as far along as thought.

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#13 of 28 Old 10-18-2007, 10:15 AM
 
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#14 of 28 Old 10-18-2007, 05:22 PM
 
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Originally Posted by Jyotsna View Post
And it is down right scary when babies come out like that, and they are not really as far along as thought.
Yeah, especially when I read research that says that babies born only two weeks or less early can have developmental problems in life.

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#15 of 28 Old 10-18-2007, 11:25 PM
 
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This totally strikes a nerve :

My nursing instructor yesterday probably scared the crap out of anyone who will have/has had a baby. She kept saying that at 41 you "need to get that baby OUT! The placenta is aged and disintigrating and that baby isn't getting enough oxygen!" I swear, she said it just like that. Being in nursing school makes me want to throw up some times!!!!

I think docs almost always quote the disintigrating placenta and it just really scares mom's to think 'what if'? I know I've thought it before, and then I remembered that research indicates otherwise!

The midwifes I work with even start to freak out when moms go past 41 weeks, what's up with that?

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#16 of 28 Old 10-20-2007, 01:08 AM
 
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The midwifes I work with even start to freak out when moms go past 41 weeks, what's up with that?
That is from OB's rubbing off on them.

All of these interventions are done on and ESTIMATION, which is a scientific guess. A GUESS. You are not postdates until after 42 weeks, at least by then you are at least close to full term if you are two weeks off. I have seen 37 weeker born by "choice" cesearean end up on a ventilator for crying out loud. What they are really trying to do is help make antibiotics useless because every woman "induced" and ends up with "chorioamnionitis" from all of the interventions and vag exams etc her baby will have to be treated with abx since we don't know if they are infected or not.
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#17 of 28 Old 10-20-2007, 02:19 AM
 
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here is my informed choice agreement on postdates, which is technically anytime after 42 completed weeks.

I think it's horrible that midwives get sucked into this fear, too.
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#18 of 28 Old 10-20-2007, 10:00 AM
 
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I hate the term 'due date'. I tell my ladies and any pregnant woman who will listen: You have a DUE MOON, not a due date. Sometime within about a full month period, your baby will be born at the perfect time! You and your baby together will know just when that should be, and it's not entirely safe to mess with that.

Yes, with all the inductions going on, even some homebirthers get kinda squinchy about 'going overdue' or they get simply impatient: hey, my friend got her induction at 39/40 weeks, why can't WE induce ME? Isn't it perfectly safe if the docs are all doing it?

with hating the term due date, I also hate having to explain things 'defensively', that is--in terms of what the OBs are doing now. Among hb fams, luckily I don't have to do a lot of it tho some fams really push the point--but still. We seem forced to communicate about birth in relation to the OBs/med practice, and that is just entirely BACKWARDS!
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#19 of 28 Old 10-20-2007, 10:54 AM
 
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Pamamidwife: thanks so much for posting your informed consent form! It has tons of information that I'm always trying to tell my students about, and I appreciate seeing some more evidence to back up what I've already been saying...

Homeschooling Mama to DD-20, M>F DD-18, DS-10 and DD-7
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#20 of 28 Old 10-20-2007, 11:55 AM
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here is my informed choice agreement on postdates, which is technically anytime after 42 completed weeks.

I think it's horrible that midwives get sucked into this fear, too.
Thanks for posting that. It is incredibly complete and unbiased.
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#21 of 28 Old 10-20-2007, 05:48 PM - Thread Starter
 
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The reason I posted this thread to begin with is because I am doing some postpartum care for a mom who chose to give birth via c-section in her 38th week. When I talked to them about their baby being premature, they said, NO, she is only 5 days early. She had heavy vernix, hair all over her entire body, and gosh, after three hours in the nursery, she latched on and nursed lazily, and a couple more times, but then hardly nursed at all. When I left the first day, I thought nursing was a go, even though it was taking a long time. The next morning, the mother told me that her doctor said the baby's billirubins were too high, and her weight was too low, so she told her NOT to breastfeed, but rather bottle feed. The doc also said that she should bottle feed every three hours. I feed my babies every 2 hours, and I am just shocked that the doc would say that. In fact, one of my babies nursed every 1 hours for the first few days I had her.
My clients baby is looking week, skin is loose, and I am so concerned, I had a dream in the middle of the night on Thursday night that the baby was in danger, and felt I must help the mom move to feeding more often. I am so tired right now that I am not saying all that is on my mind, so forgive me. But I really believe that the baby having been born at week 38, just can't breastfeed, and has had a very dangerous start. I am so angry I want to bite something. And this family is having such a difficult time caring for this little baby, under too much stress and I have never seen anything like this.

Finally, after getting more comfortable with the mom, I asked her why she didn't want a vaginal birth (she called me 1 week before the scheduled c-section) and she told me that she was afraid of having a painful vaginal birth. She made this face which looked as tho she would never forget this pain.

I can't work with clients like this in the future. I think I will draw up a natural vaginal birth contract with future clients, that I will only support a c-section in the event that the mom has an emergency.

About her being in the nursery, the baby was kept from her while she was being sewn up, cleaned up and recovered, and then later the nursing staff kept saying they were doing this or that with the baby, but actually it wouldn't take three damn hours to do these things, but lead my clients (who are from India) to believe they were working on the baby the entire time she was in their care.

Finally, I pushed the dad to go and get the baby, and finally they brought her out. I nearly cried at the sight of a baby who was born from her mothers body, but didn't SEE her mom for the first three hours after birth. I can't even type anymore, I am so upset.

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#22 of 28 Old 10-21-2007, 10:43 PM
 
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We had a client who we thought was 42 weeks... she went into labor and that baby came out looking 38 weeks, 39 weeks at the most. Definitely not a 42 weeker. Can you imagine if she'd been induced two weeks ago?
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#23 of 28 Old 10-21-2007, 10:46 PM
 
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I was due June 2 and gave birth on the 22nd-- I went into labour on the day I would have been induced. Everyone I said "forty two week" to looked at me like I was insane.
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#24 of 28 Old 10-23-2007, 08:48 AM
 
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Not to mention the fact that the Dr.'s change the due date throughout the pregnancy to match ultrasound readings. With my first, Noah, we started at a due date in the first week of July and ended at June 24st because of ultrasound readings. That was before I knew anything.

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#25 of 28 Old 10-23-2007, 01:38 PM
 
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Genetic play a big roll as well. Some women just carry to 42+ weeks. Like me. You think its just coincidence that I was born at 43 weeks and all 7 of my kids were born at 42+ weeks? I think not. Imagine if I had been induced that first time and continued to be for every pg. I would certianly think there was something wrong with me that I couldn't produce a child in the correct time frame. I know alot of women who have had more than 1 "late" pg feel this way. Of course blame the womans body, we all know it doesn't work right : .

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#26 of 28 Old 10-23-2007, 07:56 PM
 
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First off, I am not a birth professional. (but I would like to be one someday)

My comment here is that many of the older women I have talked to frequently tell stories about their children going 43+ weeks gestation. This was, ofcourse, years ago. They commonly refer to this as "3+ weeks late" and when I was pregnant with my DD I just thought that they were all nuts and they had incorrectly estimated their due dates. How could that be when my OB was talking about induction at 41.5 weeks?

I am sure many due dates are calculated inaccurately but that being the case wouldn't it be more prudent to wait rather than induce early?

I am so much smarter now. I couldn't wait to get induced with DD, luckily I went into labor on my own and she was big and healthy. After my DH and I saw some of the tiny ones born in the hospital while we were there we vowed that we would never entertain the thought of induction again.

Which brings me to question, actually. My midwife recommends using EPO at 37 weeks. This won't cause labor to begin earlier than my DS is ready, will it?

I am sure she wouldn't steer me wrong, but I gotta' ask anyway. What are the real benefits of EPO? (I'll make a new thread)...

-Iris, hoping for another big, healthy "past-due" baby!
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#27 of 28 Old 10-23-2007, 08:52 PM
 
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EPO is used to soften the cervix... before using it, I would personally check your own cervix if you are able. I've always been mushy and effacing by 37 weeks so there would have been no point in my shoving capsules up there.

If you are not effacing/dialating, your cervix will feel firm like the tip of your nose. If your cervix is softening (and it may be effacing/dialating too), it will feel soft like your lips.
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#28 of 28 Old 10-24-2007, 12:33 PM
 
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I am not a birth professional but found this thread not only interesting but it hits home to me.. My daughter was born 10 days "late" and everyone thought I was NUTS...She was almost 10 lbs (I am a pretty thin person) so everyone always gasps when I "didn't have a c-section!!" and that I had her at home with a midwife. I need to get better about saying that she wasn't 10 days late. I need to probably be saying something like, "10 days postdue, or maybe 10 days after EDD". Semantics matter.

Here's the thing. We've been to a lot of specialists in the last few months for her torticollis and for a slight weakness on her right side. The last place we went, a neurologist, said he believes she may have had a stroke while she was in-utero. He felt this might explain the weakness, and also why she is developementally a bit behind (which he said is rather unusual, since babies born past 40 weeks seem to be a little ahead developmentally on average). My thoughts are that THANK GOD I waited until SHE was ready to come out. What if she needed those extra 10 days to finish healing from that stroke??? What if I had stayed with one of the OB's I was with and they induced right after my EDD and she wasn't ready b/c of the stroke??

Size wise, I guess she would have been fine if she had been born earlier, she was a big girl, but IF she did have a stroke, I am glad she had the time she needed to get ready to be born, and I am glad my midwife trusts birth and the research enough to know that babe will come out when babe is ready. I feel like there's just so much we still don't know about what babies in the womb are doing to prepare to be born and if we start messing with that...no good.
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