I’m excited by this article! I’ve placed it in my Resource Notebook and plan to give to Doula clients whose doctors are talking induction. Gail Hart is one of my favorite midwife authors and I love reading anything by her. This article really gave me more foundation for what I have already been telling moms about induction. In addition, she provides ways women can help themselves prevent pre-term labor by cultivating a healthy vaginal floriculture. I think everyone should read this article:
Under most situations, if you are giving birth in a hospital, you are likely to be offered an induction after 41 or 42 weeks, with significant pressure to accept. This option may be provided based on the schedule of the caregiver, concern’s for baby’s size, timing of ruptured membranes, or other health concerns. (Buckley 2009)
A serious concern with induction is that often other interventions are needed to cope with the induction, which increases the risk of a cesarean birth. The first important step to preventing an induction is understanding your estimated due date.
Estimated Dates
Gestation
Induction Benefits
Induction Risks
Alternatives
Waiting for your baby: Surpassing 40 weeks gestation in your pregnancy
Expected gestational age of an infant is approximately 40 weeks. This is the basis upon which an estimated due date is calculated. Due date is 40 weeks after the last menstrual period and based on an average cycle of 28 days. While in calculating averages and quantifying biologically processes this is fairly accurate, it is not necessarily always the case. Menstrual cycles are not all 28 days long, and not all babies take exactly 40 weeks to mature. Rather than considering the estimated due date a helpful tool to help us understand when to expect a baby, we have begun to consider it a rule for when the baby must come. It is this misuse of the 40 week marker that presents unnecessary challenges for birthing families.
Consider that in the United Kingdom gestation is considered complete after 42 weeks. Are our babies biologically different than babies in the United Kingdom? No, rather our interpretations of what gestational age means are. Consider also that this is a country where homebirth is a widely accepted norm.
Gestational age is a helpful guideline. Much like two pieces of fruit do not ripen at precisely the same time, women are unique and diverse and the way that their bodies function, while remarkably similar, are different and we should allow those differences to exist, appreciate and embrace them.
Once a 40 week due date is surpassed most women will be asked to have regular ultrasounds and non-stress tests to ensure the health of their baby. If these tests show a healthy baby there should be absolutely no reason to suggest intervention at that time. A myth that babies will grow to be too large for us to birth is often perpetrated by birth practitioners and frightens many women into unnecessary inductions. This is widely believed misinformation. Our bodies are wise and we must trust that we are not going to grow babies too large for us to pass. Our species is extremely efficient and functional, and believing in that is the key to a healthy birth.
There are more natural and more medically interventive means of inducing childbirth, but unless there is a medical indication to do so, both should be avoided. Women can safely go many weeks over 40 weeks gestation as long as their health is monitored by supportive birth practitioners. Women have the right to refuse any intervention. I encourage you to do your own research regarding the risks of induction versus post-dates pregnancies. You can then make a decision that suits you.
While, after 40 weeks, pregnancy can be uncomfortable and the anticipation of meeting your newborn can be a great motivator for induction, it is important to allow nature to take its course and not to attempt to artificially hasten the process. In doing that we are sending our bodies a strong message about their efficacy and setting ourselves up for a potential cascade of unnecessary interventions following the first.
All of that being said, when medically indicated, induction can be a lifesaving procedure. When it is necessary it often works efficiently and provides necessary results. It is essential for you to be aware of what presents a real medical indication for induction and what does not. Do not be afraid to ask for a second opinion. Your birth is in your hands, and you are the one who needs to decide what is best based on information from professionals, good science and intuition.
Tips for anxious parents awaiting a post-dates child:
-Speak to your health care provider in advance about their protocols regarding post-dates pregnancies
-Ensure your due date is accurate by calculating it yourself based on the length of your cycle, or ideally your date of conception
-Abandon your attachment to a specific due date. Think more in terms of “due week”, or “due month”
-Trust your body. It is wise and knows just what to do. Your baby will come when they are ready
-Keep yourself occupied. Pregnant women often do not schedule activities beyond their due date because they expect to have their babies. When the babe has not arrived they find themselves idly waiting for their upcoming birth. Scheduling self care appointments such as massages and pedicures can be a nice treat and something to look forward to post-due date. Appointments can be cancelled. Projects such as crafting, making things for the baby, and cooking and freezing foods for the postpartum period are pleasant and useful distractions for the post dates period
-Get exercise. Lots of exercise helps prepare for the physical act of childbirth, gets the baby in an optimal position for birth, and can hasten the onset of labour. Long walks, yoga, and swimming are enjoyable and gentle exercises for late pregnancy
-Enjoy some alone
time. If this is your first child you are about to enter into a period of your life where you will have very little time to yourself compared to what you may be used to. Take the last weeks of your pregnancy to enjoy some quiet solitude
-Indulge. Spoil yourself with some of your favourite self-centered activities such as eating lots of chocolate or going shopping. Obviously activities should not be harmful to your health or that of the baby.
-Communicate with your baby. If you are getting uncomfortable in late pregnancy and want the baby to come, explain to the child that you are excited to meet them, that you have a warm and safe place outside for him or her, and that the passage out will be safe and peaceful.
-Process any emotions or fears you have about birth or mothering. Occasionally fear about birth or uncertainty about parenting can prevent the onset of labor. Welcoming birth and motherhood can help. Discussion and emotional work with your partner, Doula, midwife or therapist will benefit you in your transition into parenthood
Congratulations on the upcoming birth of your child. Trust yourself. Women’s bodies are infinitely wise.
-By Stephanie Elliott
Portland Birth Collective
