Ten Month Mamas campaign for 'overdue' to be at 43 weeks instead of 42.

[Spidermama]

My friend is a week and a half 'overdue'. Feels fine. Looks great. She went for a scan today and they told her she's low on amniotic fluid so they're going to induce in a couple of days. She really didn't want this.
Then my midwife friend posted this article on Facebook.

I've googled and found, on the one hand, people saying 'Low fluid can have implications for the babies lungs, can mean the placenta's not functioning so well ... etc etc.

Then on the other side women saying 'WHEN will they stop inducing women unnecessarily for this' and talking of how teeny and over exaggerated the risks are.

So what are your experiences and perhaps more importantly how can I best support my friend. My natural inclination (and experience) is that medics overstate risks.

[ThreeWheelsGood]

Is your "natural inclination" based on any medical training or study?

[Alibabaandthe40nappies]

Spidermama - perhaps as part of your research you should talk to people who have delivered a stillborn child at 42+ weeks, to get a balanced picture.

[Trazzletoes]

? Surely your friend can say no to induction if she wants? Why increase overdue to 43 weeks though and take the possibility of induction away from those mums who would rather not take the risk of lung problems etc? In your friend's position, I'd have taken the induction to be on the safe side as I accept that trained medical professionals know more about this than me, but then I don't really understand those who actively avoid medical intervention. Each to their own I suppose.

[Rosebud05]

Some women do naturally go to well over 40 weeks with a pregnancy, and they and the baby are fine.

Some babies are stillborn at 41+ weeks, and they would likely be alive if they had been delivered earlier.

The problem is that there is no way of knowing which category you will fit into in advance.

For every woman like the one in the article who says that 'they knew what they were doing' going overdue there others saying 'I had no ideas of the risks'.

I don't know what's best for your friend - only she and her medical folk can know that - but I would take any concerns about my pregnancy seriously.

[Lovingbeingpregnant]

Did you know that the statistics are actually higher to have a stillborn baby at 37 weeks than to have one at 42

[Rosebud05]

Really? None that I've ever seen - do you have a reference for that information?

[Spidermama]

I gather from the article its an outdated view lovingbeingparent.

I just sighed when my friend called me all distressed today because she'd been happy and well up until the point she went for her 'you're overdue' appointment. I see this so often. Women are encouraged - through fear - to have procedures that they really don't need. It's way out of proportion to the risks. I was just after some views from real women who have gone over or had the 'too little fluid' issue raised.

I just want my friend to have the best birth possible and all too often I see women frankly robbed of that by over zealous medics and their worst case scenarios.

Don't get me wrong I know they can save lives and have amazing skills etc -- but birth is a natural process and those skills are used too often when they really needn't be.

[Spidermama]

Sorry lovingbeingparent I misread your post and thought you were saying still births are more likely after 42 weeks which, according to the article, is dated.

[Karoleann]

I naturally go into labour at 42 weeks, but my placenta only lasts 41. Without being induced at 41 weeks with dc2&3 I would have had the same problems I had with dc1 (placental abruption, assisted labour, and a baby in special care).
Even if the risks are tiny - why risk it?

[Badgerina]

I'm all for going into labour spontaneously, and all being well I'll be declining induction, but I have to say that if I was scanned and told my waters were low, I really wouldn't risk it. Everyone has to make their own decisions, but medical intervention does have its place (and this is coming from a VERY pro natural birth Mama, who is planning a home birth)

[elliejjtiny]

There are risks when you go overdue. There are risks with induction as well. I had to make that decision with all 3 of mine and I felt stuck between a rock and a hard place.

[WidowWadman]

Why would you want to support a campaign for something which puts babies at an increased risk of stillbirth?

[WidowWadman]

As for weighing up risks, you shouldn't only look at likelihoods, but also impact of what the risk actually is.

[Rosebud05]

spider, of course birth is a natural process, but equally as natural is that it's a very imperfect process and, left to its own devices, it can go catastrophically wrong.

Unnecessary interventions can also have catastrophic consequences, of course.

I'd suggest that the best way you can support your friend is to help her work in partnership with the midwifery team. Honestly, no-one is trying to rob her of a good birth experience, just trying to ensure the best possible outcome. Of course she should ask questions, do her own research and make up her own mind, although seeing the medical profession as some sort of enemy isn't helpful in this process.

[meditrina]

IIRC more babies in terms of numbers only are stillborn at earlier gestations. This is not however a reflection of the risks. Far more women whose pregnancies are over 24 weeks gestation are still pregnant at 37 weeks than at 42 weeks. The rate of stillbirth per pregnancy is higher once over 40 and certainly 42 weeks.

Guidelines should be set where they protect the majority population. The death of a baby is so devastating that staff, who may have seen that happen several times or even been through it themselves, are of course deeply concerned to spare other families from that.

As other posters pointed out, you can't predict who can go longer safely. When tests start to show something astray, it's time to go in. Low amniotic fluid certainly can be associated with some grim outcomes.

[shinyblackgrape]

If this is just based on "natural instinct", why not go for 44 weeks? Or 45 even?

I'm shocked at this. I'm expecting DC1 and DH and I have been GUI g to hypnobirthing and for us are probably quite woo re the whole birth thing. However, one thing we have absolutely agreed in is that we will agree to induction if I am overdue (40+10) at my local hospital once we have discussed with the doctors. This is despite my sister having a hideous birth post induction.

I do agree that it does appear that there is a medical " timeline" for giving birth and that sometimes that us more for the benefit of the hospital. It is right that parents can question that. DH's aunt and uncle are both doctors and readily admit to that. However, they have both attended births where the mother had insisted on waiting. One with an awful outcome (dead baby, placental failure) and one where the placenta was totally knackered and the mother was very, very lucky to have got away with waiting. Mother one also had a "natural instinct" that all would be ok - not so.

My sister had a terrible birth and had some counselling after. One RBI g that made her feel a lot better was the counsellor pointing out that there is so much more to being a parent than the birth. to me, it is les material to have a lovely "natural" birth than having a baby born alive. The first is all about me and what I want. An induction (if genuinely medically necessary) is all about the baby. How I give birth will only be a tiny part of being a parent.

[shinyblackgrape]

Ps - you say your friend looks and feels great. As I understand it, placental failure dies not present itself by way of how the mother feels or looks. Wonder how the baby's doing?!

[DawnOfTheDee]

The article quite rightly points out the lack of data, which is obviously hard to come by as you can't make women go way past their due date just to get some info. However, I have always found it interesting that in france the due date is set at 41 weeks.

I'm very interested in this topic as my mum went 2 weeks over with my and DSis before being induced. I had my first DC this year and went 15 days over. Also I'm pretty certain my 'due date' was wrong (as my cycle isn't 28 days, I know exactly when we conceived) and I was 3 weeks overdue.

More research is the key - i wonder if any studies are in the pipeline as much of the data/research being used does seem to be getting out of date.

[Shagmundfreud]

I think the key to this issue and the route to the best outcomes is treating women as individuals, and also good communication - making it clear to women that they can make a choice.

It irks me, for example, that it's known that Asian women tend to have shorter gestations than Caucasian women and yet for the purposes of induction the same protocols are applied. It also bothers me that it's not made more explicit to first time mums that starting an induction with a very low Bishops score results in a high likelihood of failed induction and emcs. And the reason they don't make it clear is because if they did women would ask for a planned c/s instead or expectant management.

I could go on - but point being, too many women are being induced for post-dates, and many women aren't being given enough information to make an informed choice.

[Lougle]

"It also bothers me that it's not made more explicit to first time mums that starting an induction with a very low Bishops score results in a high likelihood of failed induction and emcs."

But that, too is so variable. I was in my first pregnancy, induced due to suspected IUGR, and the midwife told me that my Bishops Score was 2 "and I'm being generous!"

One pessary later I was contracting. 4 hour labour, which was so 'efficient' that I was fully dilated before they realised that I was actually in labour.

The trouble with labour/childbirth is that it is completely individual, and for a woman like me, having a CS because of the 'likelihood' of failed induction would have been a massive intervention.

There was a woman on One Born Every Minute who had a 7 day induction attempt. Poor woman. I think I would have asked for the C-Section on day 3.

[Rosebud05]

Me too, Lougle. I chose to be induced with my dc for various reasons and went from 'your cervix is fairly soft but completely closed, this could take a while' to a panic about the midwife getting her gloves on in time to catch the baby within 3 hours with dc3.

[carrielou2007]

If anyone had told me I would not be induced u til 43 weeks I would have say on them and squashed them flat!!

For everyone who us saying this is my body and my choice I do not want to be induced I was begging for it. I wanted my babies out safely in my arms I did not give two hoots about waiti g as my body will do it I was happy that my body could do with a nudge to have s healthy live baby.

It is all about choice but the thought of 43 weeks before any intervention makes my blood cold with fear - just my own personal opinion and would be over my dead body!

One of my many readings when overdue was that father has a factor in it, ex p four children with his first wife were all overdue as were my two and this one bound to be too.

I just know that for md 4; weeks would be totally out of the question.

[DawnOfTheDee]

See I'm the opposite of you carrie! What made me 'fearful' was my LO being born before she was ready. I said yes to induction at 2 weeks over (but personally i think she was nearer 3 weeks) and it failed and I ended up with an EMCS.

I hadn't heard about the father having a factor in it but actually in my experience that does make sense. As I've said the women in my family all have 'longer' pregnancies. My DH was born just after his due date but he was a twin so that could probably be counted as a longer pregnancy too.

[Badgerina]

OP says this: She went for a scan today and they told her she's low on amniotic fluid so they're going to induce in a couple of days

Like I've already said, I will be opting for "Expectant Management" if I go over 42 weeks. The idea being that if all is well i.e. if scans show that placental functioning and amniotic fluid levels indicate baby's well-being, I can wait to go into labour spontaneously. This is something that the SoM and consultants agree to. If there is any indication that induction needs to take place, I will go for it.

OP - If the scan has shown that the amniotic fluid is low, then induction really, really, REALLY must be the safest option for mother and baby, no? Surely the point of the "wait and see" approach, is to use the medical knowledge and techniques of your consultant and SoM to your advantage, to gain the best possible, individualised care.

I can completely see why you would like to support your friend to avoid unnecessary induction, but if the scans indicate otherwise, surely...

[WidowWadman]

Isn't there also an increased risk of meconium in the waters with overdue babies? Meconium aspiration can be lethal for babies.