Category: Ultrasound

The Lie of the EDD: Why Your Due Date Isn’t when You Think

300_361878Associated Content, an online publisher and distributer of original content, published the below story on Setp 24, 2008, written by Misha Safranski.

I’ve posted several times about the inherent problems associated with basing due dates on a 28 day menstrual cycle or on ultrasound. The below article provides another way of estimating when your baby will be born.

But remember, it’s always an estimate and baby will be born when she is ready.

 

 

 

http://www.associatedcontent.com/article/1047180/the_lie
_of_the_edd_why_your_due_date.html

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 

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 (41weeks 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

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Ultrasound – What Every Mom Needs to Know

 

~ Conclusive scientific evidence that routine (and by routine I mean scanning to see baby’s position at every prenatal in the last weeks of pregnancy, or 3-D ultrasounds to “meet your baby” in the womb) use of ultrasounds are safe does not exist. Its use is very familiar to the use of X-rays. 50 years went by assuming that X-rays were safe for pregnant women before hard lessons were learned. A textbook on prenatal care published in 1937 has this to say about X-rays: ”It has been frequently asked whether there is any danger to the life of the child by the passage of X-rays through it; it can be said at once there is none if the examination is carried out by a competent radiologist or radiographer”.

 

In 1978 that same textbook, after seeing the dangers of X-raying babies, revised its stance: ”It is now known that the unrestricted use of X-rays through the fetus caused childhood cancer”.
This mimics the current textbook view on ultrasounds: ”One of the great virtues of diagnostic ultrasound has been its apparent safety. At present energy levels, diagnostic ultrasound appears to be without injurious effect … all the available evidence suggests that it is a very  safe modality”.

~ Lancet, A current British medical journal, has this to say about Ultrasounds: “There have been no randomized controlled trials of adequate size to assess whether there are adverse effects on growth and development of children exposed in utero to ultrasound. Indeed, the necessary studies to ascertain safety may never be done, because of lack of interest in such research”.

~ The output of ultrasound plays a huge part in the affects on baby, however there are no controls in place as to what is a safe amount even though low outputs have been shown to be just as effective as high outputs.

~The skill of the technician performing the ultrasounds matters tremendously, yet there is no licensing or certification process for operators of the machines.

~Training midwives and doctors in the skills of palpation – using their own hands to feel baby’s position is just as effective as a machine. Not only is this low-tech and inexpensive, it also helps care giver and mom physically connect.

As an aside: I had a friend tell me of someone she knows who has gone through 2 pregnancies and the first time a care giver ever even touched her belly was well into the 2 pregnancy! I haven’t heard anything sadder since then in awhile.

Ask Ask Ask your caregiver why they are requesting an ultrasound. Ask what are the risks of an ultrasound. Ask what research their answer is based on. And then ask what are the risks of not getting an ultrasound. You may be surprised at the answers.

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