Pregnancy Postdates Decision Making
Many normal pregnancies continue past a woman’s expected due date, often by several weeks. If a pregnancy continues to 42 weeks and beyond, balancing the safety of mom and baby as well as maintaining and preserving a normal, physiologic and birth becomes a challenge.
Current research supports either induction of labor or awaiting spontaneous labor after 41 weeks of pregnancy. By 42 weeks the risks increase 3-4 times. Most of the risks are due to the inevitable aging of the placenta, which provides oxygen and nutrition to the growing baby. These risks exist in otherwise low risk, healthy women with well-dated pregnancy. Predicting which mothers and babies will be affected by these risks is not possible. The community standard of care in this area and many others is to induce labor at 41 weeks of pregnancy and to strongly recommend that pregnancy not progress past 42 weeks.
Risks to the baby may include an increased risk for stillbirth and early neonatal death (2-3/1000 at 40 weeks, to 4-7/1000 at 42 weeks). The risk of meconium passage (baby’s first bowel movement) in utero is higher, as is the risk of Meconium Aspiration Syndrome (when meconium is inhaled into the baby’s lungs), but this risk is quite small. The risk of Fetal Dysmaturity Syndrome is higher and leads to low amniotic fluid, umbilical cord compression, meconium passage and short- term complications after birth such as low blood sugar, seizures, and respiratory difficulty. The risk of infant death during the first month is also slightly higher. Furthermore, some babies can grow quite large leading to higher risk of Shoulder Dystocia (stuck shoulders during birth) and subsequent lack of oxygen leading to brain damage, or nerve injury to the baby’s neck and arm.
Some of the risks to the mother may include abnormal labor progress and need for intervention including Pitocin augmentation and/or cesarean birth, infection in the uterus, and /or postpartum hemorrhage. Postdates babies are more likely to be larger, potentially leading to an increased need for assisted birth with vacuum or forceps, or cesarean birth. The risk of severe lacerations to the perineum is also slightly higher.
Given the current evidence from research outlined above, and the standards in the community where we practice, the midwives at Natural Beginnings Birth Center offer induction of labor at 41 weeks of pregnancy. However, the goal of our care and our patients is a Birth Center birth. At 41 weeks, in order to “induce” labor, we usually utilize midwifery interventions such as membrane sweeping, acupuncture, castor oil, or herbal/homeopathic remedies. The decision to utilize these interventions is discussed and made together between you and the midwives. A medical induction at the hospital is also a valid choice if you prefer. We also recommend monitoring placental function and fetal well-being with twice a week non-stress testing and ultrasounds once a week starting at 41 weeks. By 42 weeks of pregnancy we recommend induction of labor at the hospital usually with Pitocin or Foley bulb, if midwifery interventions have not been successful. Most women with a post-date pregnancy will respond well to induction since the body is generally ‘ready’ for labor. Research does not show an increase rate of Cesarean birth due to induction of labor after 41 weeks. When a Cesarean is necessary it is usually due to one of the complications listed above, and not a “failed induction”.
We feel strongly that women and families will make the best decisions when given accurate information. Your decision on how your post-dates pregnancy should proceed will be made collaboratively with you and your midwives.
Nicole is an outstanding midwife. She is knowledgeable, kind-hearted, understanding and easy to talk to. With her help and encouragement I was able to give birth naturally. My "birth" day was better than I imagined and I am grateful for such an awesome midwife. I will come back to Nicole EVERY time!
- Bobbie Garland, RN