Due dates are a funny thing. Most first time mothers and even those who have been through it before come to us eagerly with their due dates dutifully calculated by the friendly and efficient scan machine. Their ecographer assures them that theirs given dates are 99% correct and the mothers expectations that, all will happen according to plan and their babies will come on the day stated on their print out. As the weeks pass and due dates approach and pass I see the look of growing concern and even panic in on the mothers faces. We recalculate their dates on last menstrual periods to try and allow them time before they are ‘strongly encouraged’ to induce their labours for the ‘safety’ of their babies.
We are taught that after 42 weeks, the placenta begins to cease to function as well as it previously had in its previous weeks and the longer baby is in utero after this time increases the risk of possible infant mortality. The Cochran report, “Induction of Labour for Improving Birth Outcomes for Women at or Beyond Term” notes that, “Births after 42 weeks seem to carry a slightly increased risk for the baby”.
In its review of 19 study trials involving 4000 women given induction of labour at various times from 38 weeks to over 42 weeks’ gestation, it found that “A policy of labour induction after 41 completed weeks or later compared to awaiting spontaneous labour either indefinitely or at least one week is associated with fewer perinatal deaths. However,the absolute risk is extremely small. “
But where does this 42 week point originate from and why, if pregnancy and birth are a very individual experiences from woman to woman, does it apply to every woman on the planet? I don’t have the answer, but I do have more questions that I feel need to be put to the obstetric profession. In my personal experience I have carried two children over 42 weeks by scan dates and seen many other women do the same. What I have not seen is fetal demise caused by these over date births.
On the other hand I have witnessed more than my fair share of c- sections because of fetal distress due to inductions at 41 and over weeks of gestation. I have witnessed women being bullied and threatened in to induction and the depression or sense of loss felt by these mothers that followed from this. The feelings of having their births and bodies hijacked by a hospital protocol and lack of ability by their health care professional to treat them and their birth as an individual experience.
In my experience as a student midwife I have supported women during the birth of their still born child and these experiences have helped me to understand why we work so hard to aid the reduction of infant mortality but obstetrics must walk hand and hand with humanity and common sense. Pushing mothers and babies into labour with artificial hormones, when neither one is ready is proving to cause more harm than good. Yes we are delivering live healthy babies, but there is little evidence to suggest that these babies would not have delivered this way in their own time. There is also little to no study done on the trauma we are causing the mothers we push into inductions and possibly needless c- sections.
My experience as a mother and midwife (albeit newly qualified) has taught me that each and every birth is different and individual, birth does not fit nicely into obstetric boxes. Life changing decisions in maternity care are being made based on small unchallenged studies and women are more and more being stamped ‘at risk’ for their birth. Once this is done their personal choice and physiological abilities are being sidelined and birth is becoming less normal and I feel in a strange twist, less safe.
At times I feel so small in this huge medicalized obstetric machine. Yes I have gratitude for the great strides that have been made in maternal health, but I also see what is being lost and feel that maybe we have hit a tipping point and we are now actually creating risk in labour and birth.
A very wise woman said to me the other day (she is a doctor by the way) “medicine has become a business, and ‘risk’ is big business” How can it be that as medicine progresses women are more and more unable to simply birth normally? How can it be that gestating our babies is now a dangerous part of our pregnancy process?
I am a mama who cooks her babies well done, and with good antenatal care, by well trained midwives my bodies process works well. I am currently waiting with two mothers, for home birth, who are both due on the same day and both over 41 weeks now. The pressure being put on them by the hospitals is astounding. They are healthy and turn up daily for their baby trace. We are in constant contact and babies are moving well. Each woman is a second time mama who’s first babies delivered after 41 weeks. For them the personal work they are doing during this time around is deep and needed, I am confident when they go into labour and birth their babies it will be the right time for them, I just hope its not at the same time, for me.
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The Barcelona Midwife 