Now that theRoyal Baby is among us, I've been pondering all the frenzy that surrounded the birth of Britain’s future heir to the throne. Like many others, I found myself lured into the “Royal Baby Watch,” otherwise known as a large group of stalker-journalists waiting outside a hospital where the Duchess of Cambridge, Kate Middleton, was likely to give birth at some point. The reporting turned especially dramatic as discussions focused at great length on the fact that Kate Middleton’s due date had passed. HOLD THE PRESS!!
There is so much confusion around how long pregnancy is meant to last, and, even worse, the sense of impending doom that arises as soon as that much anticipated day slips into another. But why? With only 5% of women giving birth on their actual due dates, why are we as a culture so freaked out when babies come “late?”
According to the Mayo Clinic, a woman might go past her due date if:
• The exact date of the start of your last menstrual period isn't known
• This is your first pregnancy
• You've had prior overdue pregnancies
• Overdue pregnancy runs in your family
• Your baby is a boy
• You're obese
So pretty much everyone, unless you’re a skinny second-time mom (who gave birth by 40 weeks the first time), having a girl. Ummmm…..
The Bookends of Pregnancy
A big part of my job is in supporting and mentoring women all the way through their pregnancies. The early days can be pretty intense, as you desperately try to maintain your normal life in the face of nausea, unrelenting fatigue, unrivaled breast soreness and the stress and worry over the health of your tiny growing little bun in the oven (or Bao, if you will). During these first 12-16 weeks, women need a lot of support, both physical and emotional.
Once those weeks pass by, pregnancy usually becomes a time of great joy, excitement and anticipation. Sure, the last few weeks can be a bit cumbersome, but for the most part, it’s a really cool experience… until…
The due date comes.
At that point, pregnancy can become a grueling, stress-filled, agonizing wait for that pot to boil. It brings up a veritable cornucopia of emotions, from fear, to anxiety, to whatifsomethingiswrongwithmeandmyIneverhavethisbaby?!
To name a few.
Let’s break this due date thing down a little, shall we?
First of all, the mere notion of a “due date” is pretty absurd. There is no legitimate research in the entire canon of obstetric medicine that definitively (or accurately) pinpoints exactly how long a pregnancy is meant to last. The most common way to calculate a due date is to add 280 days to your last menstrual period (LMP), which adds up to 40 weeks. This method was published by one Dr. Naegele, in 1806. Dr. Naegle did not arrive at his conclusion via any of the scientific methods we would deem reasonable today. Really, he just published his observations and everyone adopted them as gospel. (source)
Now, that’s not to say that Dr. Naegle was out in left field or anything. I mean, clearly, we all gestate for approximately 40 weeks. Please note that the key word in the previous sentence is approximately, because every legitimate study on the duration of pregnancy gives us a standard deviation of about 9 days (8-10, depending on how the due date was calculated). 9 days! This may not sound like a lot of time, unless you’ve ever been pregnant and watched your due date come and go. In that case, I’m sure you’ll agree that 8 days is nothing short of an eternity. E.T.E.R.N.I.T.Y. (source)
Even the term “due date” is fraught with all kinds of stress-inducing secret code. Starting as early as elementary school, we are indoctrinated into an educational system that gives us assignments, and tells us when they are due. Turning projects in late can get us in some serious trouble, even result in a big fat F on our ever- important report card. When we grow up, failing to finish things on time can result in extra fees, lost opportunities, even the loss of our jobs.
Is it any wonder that passing a “due date” gives women a sense of impending doom?
In addition to the connotations of the term, some (read: NOT ALL) OB/GYN’s play their part in helping women feel like their bodies won’t go into labor on time. Many physicians begin scheduling inductions and even c-sections as soon as a day or two past the “due date.” Women are commonly informed that the risk of fetal death goes up significantly past 41 weeks, even when nothing about the pregnancy indicates any sign of distress or decline. The reality is that things do get a little riskier around 42 weeks, but really not any sooner. Of course, I’m talking about a typical pregnancy here. If you are having serious medical issues, or if your baby is in distress, you should always listen to your doctor. Still, remember that doctors frequently practice defensively, and are happy to have your baby born sooner than later. It’s ok to ask for second opinions or medical position papers that substantiate their recommendations.
According to the CDC report from the center of vital statisics, “[fetal morality rates] declined sharply to a low of .89 for 40 weeks of gestation and then increased to 1.45 [at] 42 weeks of gestation or more. Gestational age data is primarily based on the interval between the first day of the mother’s last normal menstrual period (LMP) and the date of birth, and is subject to error due to imperfect maternal recall or misidentification of the LMP.” (source)
I’m not recommending that anyone avoid non-stress tests, or ignore their doctors advice. What I am suggesting that you ask questions. Lots of them. Ask for data to support any recommendations (like study abstracts). Ask what percentage of patients go into labor spontaneously, how often they induce and for what, what percentage of c-sections do they perform?
In an ideal world, these questions are best asked in the early stages of pregnancy, and choices in care providers made based on the answers given. Unfortunately, the majority of women don’t ask. Many women tell me that they “knew” that their doctor was not an ideal fit for them, but they stayed the course anyway, leaving them with little recourse as their pregnancy days wind down.
What’s the big deal with inducing labor?
While this topic is an entire post in and of itself (coming soon!), I’d like to take a moment to discuss the issue of chemical labor inductions. This type of procedure involves checking into the hospital before you are in labor (or in some cases if you water has broken and you haven’t had contractions for several hours), and having your labor artificially started by a drug called pitocin aka synthetic oxytocin. While labor induction is a reasonable thing to do if you have a medical condition that warrants it, it should be avoided for reasons of convenience, scheduling (yours or your doctors), or being “tired” of pregnancy. Labor induction is not risk free, it increases c-section rates, can cause fetal distress from strong contractions, and increases the risk of infection, bleeding and uterine rupture to the mother. (source)
What you can do
Just because the clock is ticking and your Dr.’s foot is tapping doesn’t mean you can’t work yourself towards a natural start to labor. It’s ideal to start most of these things by 36 weeks at the latest. That will give your hormones and emotions enough time to get balanced so the big day isn’t delayed (too much).
Fudge your due date
We all love the support of family and friends, but post-due-date “support” has driven many a woman around the bend. Endless phone calls, text messages and not- so-well thought out comments (ie. “have you dropped that kid yet? He must weigh 10 pounds by now!”), often contribute to a woman’s sense of impending doom. There’s an easy fix for this problem: lie.
From as early on in your pregnancy as you can, tell everyone you know that your due date is 10 days later than it really is. Tell it so often that you actually come to believe it, too. Doing this will help to keep the crazy questions at bay until your birth is not more than a few days away, possibly allowing you to avoid them all together.
This minor amendment to the truth does more than allow you to dodge the endless queries of loving onlookers- it also contributes to your efforts to maintain inner calm, your ticket to going into labor ASAP, since all those pokes won’t be stressing you out!
Trust me on this one’s, it’s worth its weight in gold!
There is a Yogic expression which states that a “A woman who walks five miles a day has a baby that falls right out.” Wait- 5 miles?! Whaaaaaat?? That’s right. You heard it right. 5 miles. Now, Please, if you haven’t been exercising much (or at all) since becoming pregnant, please don’t go outside and walk five miles right now. Start slowly, adjusted to your fitness level, and work your way up as far as you can comfortably go. You don’t have to do it all at once, either. Lots of ladies break their walk time into two or three shorter sessions per day.
Ever wonder why you hear about women going into labor in the middle of the night? It’s because we can’t stress out as much while we are sleeping! High levels of stress tell your brain that it’s not safe to go into labor, because your body’s first priority is to keep you alive. The part of your brain (the animal instinct part) that is responsible for letting labor happen is also in charge of your survival, and it can’t tell the difference between perceived stress (like needing to go into labor before your mother-in-law’s plane lands) and real stress (like a herd of lions is coming over the mountain to eat you).
A few ways to coax your primal brain into thinking that the coast is clear to let the baby out might include:
• Getting plenty of rest, including at least on daily nap.
• Laughter! Being silly and irreverent increases your serotonin levels, and sends warm and fuzzy signals to your nervous system that all is well in your world. Curl up with a funny book or movie….
• Cuddling and Kissing: Being warm and fuzzy with the one you love releases Ocytocin, the magical hormone thatcauses labor contractions, stimulates milk let down, and makes you bond with your baby
• Sex: It might sound like the worst idea ever right now, but sex can stimulate contractions, and sperm contains prostaglandins that help soften the cervix
• Acupuncture: Acupuncture does a great job at calming the nervous system down, sending signals to the brain that labor is a good idea. Some acupuncture points can also stimulate contractions… be sure to see someone licensed and experienced in acupuncture for pregnancy.
In the End
We can never lose sight of the true means to this end. The birth of a child is one of the most magical moments of a lifetime, and it should be regarded with reverence and consideration of what is best for the baby. I believe, whenever possible, that babies do best when they are able to follow natures course, influenced only by the hormones and signals from their mother without outside intervention. In our current climate of maternal care, this is increasingly difficult to accomplish and requires a great deal of conviction on the part of the birthing mama.
Choosing a care provider that supports these choices, and making sure you have enough support in your corner at the time of your birth is the best way to minimize your risk of unnecessary interventions. However things go in the end, there’s not much that can’t be healed by that baby in your arms.
PS. As of the final writing o