Overdue Pregnancy

Myths & Half-Truths About Pregnancy & Due Date

You may have even heard scary statistics about stillbirth and concluded continuing with a pregnancy past your due date is a risky proposition. However, respected doctors and natural birth advocates like Dr. Bradley and Dr. Sears advocate a watch and wait approach to the end of pregnancy.

According to Dr. Robert Bradley in his classic Husband-Coached Childbirth,

Read on for some questions and answers about overdue pregnancy and due date that should help clear up any confusion and help you make an informed decision should you find your pregnancy goes past your due date:

What is the definition of an overdue pregnancy?
Technically, a pregnancy that goes two weeks past your EDD (estimated due date) is termed "post-date" or "overdue." But many care providers begin calling you overdue and treating you as such as soon as you go beyond your due date.

Why might this be problematic?
First, due dates are notoriously inaccurate- only 5% of babies are born on them! And it's impossible to predict a single date on the calendar because of the number of unknown variables that come into play:

• variations in the menstrual cycle
• variation in rate of fetal growth (some babies need to "cook" longer, some shorter),
• inaccurate recall of dates, etc.

We also know the average length of gestation for a first pregnancy is not 40 weeks like all the due date calculators use, but 41 weeks and 1 day. (This is according to research from the 1990's. The 40-week measure came from data collected in the 1800's and continues to be used in spite of this new finding.)

So what is normal for length of pregnancy and gestation?
Well, we know average is 41 1/7 weeks. We also know that in nature, the normal curve describes the range of normally observed behavior. For pregnancy, the normal range is about 37-43 weeks.

Dr. Bradley likens it to the way apples ripen at different rates on a tree. He warns us not to pick an apple (or baby!) before it's ripe. In fact, many experts are concerned about the large number of mistimed labor inductions in recent years. As a result, more preterm infants are being born, causing increased complications and need for time in the NICU or special care nursery.

So what is my provider worried about with overdue pregnancy and what's all this about the risk of stillbirth?
Unfortunately, many providers may be acting more in the interest of convenience and/or defensive medicine than in the name of hard science.

According to Midwifery Today in the article "A Timely Birth":

And while the fear-inducing stillbirth risk seems to get thrown at pregnant women a lot, very little is mentioned about the significant risks of the proposed "solution" for overdue pregnancy: labor induction

What are my options when it comes to overdue pregnancy?
Dr. William Sears describes three options in The Birth Book:

• Simply wait: He writes, "Have patience and trust that nothing will go wrong. Statistics are on your side...Only about 4 percent of babies are truly postterm, and the majority of these are variants of normal and go on to a good outcome regardless of management."
• Induce your labor: Though Dr. Sears states, "But because you may not really be overdue and in most instances your baby is perfectly safe staying inside for a while longer, this aggressive intervention may not be the best choice. Induction can lead to a less satisfying birth experience with more complications than would have occurred if nature had been allowed to take its course."
• Wait and watch: Dr. Sears calls this "the most prudent course for most women who are overdue." This involves monitoring the baby in various low- and higher-tech ways as you wait for labor to begin on its own.

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