Close friends and family know that this is close to the top of my list of ‘bloody irritating questions’, along with a) ‘Is he/she a good baby?’, b)’How is he/she sleeping?’ and c)’When are you going back to work?’ (Answers: a) What the chuff is a ‘bad’ baby?! b) Like a baby and c) If/when I want to/have to.)
I shouldn’t get so riled, I know – I mean, think of the cortisol, for God’s sake – but WHAT is this obsession with a singular date in what is actually a five week window, between 37-42 weeks? At best, it’s a lucky dip of one number out of a possible 35. At worst, it makes women and their partners obsess over one date and, once that date arrives, along come ‘those’ messages from friends and family. Well intended, of course, but there’s only so many times you can open a message to see, ‘Any twinges?’ before you want to throw your phone at the wall. I particularly like this website, which you may also find useful. You’re welcome.
Don’t get me started on the ‘helpful’ suggestions for ‘natural’ induction of labour. Suddenly, everyone’s an expert. Spicy food? Castor oil? Oh, yes, I’d LOVE to irritate my bowel in order to irritate my womb into starting contractions. Pineapple? Love it, but not the rock hard middle section of at least 8 of them in one sitting, which is the minimum you’d actually need to eat to get enough bromelain to mimic prostaglandin. Sex? Aside from the fact I’m knackered, I once heard that you’d need to have sex roughly 30 times – THIRTY TIMES! – in order get the right amount of prostaglandin (found in semen) to ripen the cervix and induce labour. Enough said. Of COURSE there will always be folk online who claim that they did X, Y or Z and along came the baby but, really? They were due anyway, so maybe it was just their time to arrive.
Then there are the health professionals who also pin everything on your EDD, despite that fact that only 5% of babies actually arrive on their predicted date. Before I’d even reached the 40-week mark with Primrose, I was being asked if I’d ‘like’ a ‘Stretch and Sweep’ when the ‘day’ arrives. Errr, that’ll be a no. And when I hit 40+1 this week, my midwife mentioned she’d offer one at 41 weeks. Again, I’m good, thank you.
Why are such interventions being offered as standard and immediate practice, rather than the suggestion of ‘expectant management’, where a women is regularly monitored to check the condition of her placenta, amniotic fluid levels, blood pressure, urine and baby’s heart rate?
Why did my friend arrive at her midwife appointment at 41 weeks of healthy pregnancy to hear, “So you’re here for a stretch and sweep.” (Note the lack of question mark here – she felt like she was being forced into something without consent.)
Why was another friend, who recently turned 40 midway through her pregnancy, told that she ‘had’ to be induced at 40 weeks due to being a ‘geriatric mother’, despite an otherwise healthy pregnancy? When faced with statistics relating to stillbirth in babies born to 40+ mothers over 40 weeks gestation, she asked for information relating to the mothers in the study – were they smokers? High BMI? Were their pregnancies otherwise healthy? First/second/third+ time mothers? Previous history of late miscarriage or stillbirth? Any additional information at all. ‘No’, came the reply. Any statistics regarding the number of inductions performed by the trust that related to increased use of pain relief? Further interventions in labour? Emergency C-sections? No information offered. She later read back through her notes to discover that the consultant had put ‘IOL 40/40’ – Induction of Labour at 40 weeks. Again, this was without her consent or knowledge.
Bearing in mind the information she was given was printed off the internet (albeit from a study by The Royal College of Obstetricians and Gynaecologists), gave no information about the scale or scope of the study, and ended with ‘Further research is required to more clearly define the effect of induction in labour in women of advanced maternal age’, the consultant gave an inordinate amount of weight to its claims. In fact, not giving a full and accurate picture of all benefits, risks and alternatives of induction, taking into account (maternal) intuition and the implications of doing nothing (BRAIN), could leave medical professionals at risk of accusations of negligence: ‘The failure to provide appropriate information may also leave the healthcare professional open to a successful claim of negligence if you suffer harm as a result of the treatment… [they] must give full, honest and objective answers.’ This is taken from a brilliant factsheet on ‘Consenting to Treatment‘ on the Birthrights website; an absolutely invaluable resource. So many women feel bullied into procedures and interventions that they do not want or need, due to a lack of quality information being passed on or effectively communicated. Birthrights seeks to educate and empower women in understanding their right to choice, dignity and autonomy in pregnancy, labour and birth. Similarly, the NICE guidelines state that ‘Treatment should take into account women’s individual needs and preferences… Good communication between healthcare professionals and women is essential.’ Certainly not the experience of so many friends – the examples mentioned above are just two of SO many who have experienced the antithesis of ‘good communication’.
I absolutely appreciate that medical professionals need an idea of dates, especially if a pregnant woman or her unborn child are in any way poorly or deemed to be ‘at risk’. But, in otherwise healthy pregnancies, this obsession with dates leads to an inordinate number of interventions when, simply put, baby may just not be quite ready yet. Interestingly, this way of predicting due dates is based on a couple of things, both of which epitomise ‘outdated’. Firstly, Aristotle decided that 10 lunar months (10 x 28 days) was the correct length of human gestation. From a fixed point somewhere in space(!) Almost 2500 years ago(!!) Secondly, a Dutch Professor (Herman Boerhaave) used a random sample of just 100 women, back in 1744 – yes, you read that correctly. 1744. Almost 300 years ago – to deduce that, by adding 7 days to the date of your last period, then adding 9 months, you’d have your EDD. Except he never specified whether that should be 7 days from the beginning, or the end, of that last period. Read more about this here – further studies cited within the article suggest that your due date PLUS five days (40+5) is a more accurate estimate.
What if, like the French, we had a 43 week pregnancy? This is something legendary midwife and natural birth advocate Ina May Gaskin has long campaigned for. What if we were simply told ‘your baby is due between 18th July and 22nd August’, without the specific date being mentioned? Psychologically speaking, surely we’d be happier to continue being pregnant if given a window of time to work within? Surely we’d feel a little more inclined to trust the way our bodies feel? As it stands, when our EDD comes and goes without event, every day feels like a week, sleep is harder to come by and every ache seems magnified tenfold. Is it any wonder that so many women give in to the pressure placed on them to have membrane sweeps or inductions? Of course, it goes without saying that some women will want a sweep or induction, and that is, without question, their right and choice, but no women should feel pressurised into doing something that does not feel right for her or her baby.
We started this pregnancy telling people that our baby is due ‘in August’ but 90% of people just couldn’t seem to cope without a set date; it’s so ingrained within our culture. Now I’ve hit (and passed) my due date, I’m inclined to tell people that he’s due ‘any time in the next few weeks’. This time around, in fact, I started getting ‘those’ messages before my EDD, ‘because second babies come sooner’.
Never mind the fact that I believe my EDD is actually a week later than my scan dates suggest.
Never mind that it is an ESTIMATE.
Never mind the fact that I only had one period before getting pregnant again, so there was no clear idea of how long my cycle was.
Never mind that I have absolutely no intention of having a stretch and sweep or an induction, unless there is a suggestion that I, or baby, may be at risk. When the risks associated with induction outweigh the risks of remaining pregnant, it seems like a no-brainer to remain pregnant.
Gosh, what started out as a tongue in cheek moan about people asking annoying questions seems to have segued into something more serious! The crucial thing is that women understand their rights and choices in pregnancy, labour and when they’re giving birth. Regardless of the choices you make about what to do if you go overdue, you should never feel bullied or like you’ve had choices made for you. In an ideal world, no woman would ever start a sentence with, “They told me I had to…” or, “I didn’t want to, but…” With an astonishing number of women suffering from birth trauma, being treated for PTSD and referring to their experience as birth ‘rape’ (warning: graphic birth trauma described in this article), the work of groups like Birthrights, Evidence Based Birth, Fear Free Childbirth and The Positive Birth Movement have never been more important.
These articles contain some useful information to help you make informed choices:
The pros and cons of membrane sweeps from Evidence Based Birth
‘Dear OB, It’s not your vagina’ – US article on choice. See ‘Scenario 2’ for a specific example relating to membrane sweeps without proper consent.
‘Hands off my baby’ – Positive Birth Movement article on the freedom of choice to go to 42+ weeks.
The Guardian article on ’10 month mamas’ – women who choose to allow their baby to arrive when it is ready, without intervention.
BBC articles on how pregnancies can vary in length by five weeks, and the stillbirth risk for ladies over 40.
A brilliant, brilliant article by Sara Wickham, written for AIMS: Ten things I wish women knew about induction.
Cathy at Chilled Mama’s fascinating post: Taller women have longer pregnancies (and other factors that may affect your gestation).
I’d also recommend (again) The Positive Birth Book, by Milli Hill – a default read for any choices you need to make throughout pregnancy, about your labour and birth choices.
And I’ve mentioned her above but Sara Wickham has a plethora of superb articles about pregnancy, labour and birth choices. She also offers the option of signing up to her ‘Stay on top of the evidence’ service, where she collates all recent news and information into one handy email. Finally, her Facebook Page is here.
How did you deal with going ‘overdue’? Did you want to let nature take its course? Were you under pressure to ‘move things along’? Were you told in pregnancy that you ‘had to be’ induced at 40 weeks? Tell us all about it.
Jo, The Mother Side x
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