The Waiting Game

The Waiting Game: Why Baby Knows Best

October 22, 2010 By Cara Terreri 6 Comments

By Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE

Patience is truly a virtue after 9 long months, especially when you’re a few weeks or days from your due date. The swollen feet, extra pounds and late-night bathroom trips can take their toll. Wouldn’t it be easier to just schedule your baby’s birth and get the show on the road?

Elective induction offers the satisfaction of knowing your baby’s birth date in advance, but it might not go as planned. Sometimes women scheduled for induction are bumped from the hospital agenda because the staff is busy. Plus, induction doubles your risk of cesarean birth. The major risk of elective induction is that your baby may not be ready to be born. Experts agree that a normal pregnancy lasts between 38 and 42 weeks, and research indicates that the baby actually initiates the labor process. Once his lungs are fully mature, he releases a protein that tells his mother’s body that it’s time. A baby born even a few weeks early is at an increased risk for breathing problems, admission to special-care nurseries and breastfeeding difficulties.

Inductions & Interventions

An induction usually requires more interventions than a naturally starting birth. You will need IV fluids and continuous electronic fetal monitoring, making you less mobile. Also, artificial contractions may peak sooner and be more intense than natural ones. You are therefore more likely to request an epidural, which increases your chances of needing forceps or vacuum assistance, developing a fever and/or requiring a cesarean section. Plus, the most common medication used for induction (Pitocin) interferes with the release of hormones that promote birth happening normally and breastfeeding.  

Because of these risks, some hospitals do not offer or limit elective inductions. “It seems that, if we are too cavalier about inducing labor for the convenience of either the mother or the provider, we are ignoring the baby’s essential contribution and asking him to participate even when he is not ready,” says Biddy Fein, CNM, who attends births at Brigham and Women’s Hospital in Boston. “We accept this as necessary when the risks of continuing pregnancy outweigh the benefits. But in all other circumstances, we should be respectful of nature’s plan for the initiation of labor and the exquisite interplay between mother and baby.”

Baby Makes the Date

If there are valid medical reasons for labor induction, your health-care provider will weigh the benefits of immediate delivery versus continuing the pregnancy for the health of your baby. But if you are like the majority of women who have a healthy pregnancy, the safest option for you and your baby is to wait for labor to begin on its own. Your baby may decide to come on his due date (although less than 10 percent of babies do), but you may want to plan for a later date in case your pregnancy does extend to 42 weeks.  

If your pregnancy lasts longer than expected, try not to worry. Continue normal activities and remember that you are giving your baby the best start by allowing him to decide when he is ready to make his grand entrance into the world.

This article was reprinted with permission from Lamaze International and is available on the Lamaze parent resource Web site along with many more helpful tips and advice for pregnancy, birth and parenting.

Why your due date isn't what you think it is...

by: Misha Sanfranski
associatedcontent.com


We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The "due date" we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation.


 When we are still pregnant after that magical date, we call ourselves "overdue" and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because "that's the way it's always been done". 

The folly of Naegele's Rule

The 40 week due date is based upon Naegele's Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks. 

Variants in cycle length

Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman's EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth. 

The inaccuracy of ultrasound
First trimester: 7 days

14 - 20 weeks: 10 days 

21 - 30 weeks: 14 days 

31 - 42 weeks: 21 days 
Calculating an accurate EDD

Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first
time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose (refer to links in resources section). Complete classes on tracking your cycle are also available through the Couple to Couple League


ACOG and postdates

One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG's official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery. Remember, babies can't read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready. 
Sources: 

Mittendorf, R. et al., "The length of uncomplicated human gestation," OB/GYN, Vol. 75, No., 6 June, 1990, pp. 907-932. 
ACOG Practice Bulletin #55: Clinical Management of Post-term Pregnancy