When I got my first ultrasound, my doctor measured the peanut-shaped embryo growing inside of me and managed to gift me with the sweet, sweet sound of my baby's heartbeat. I was five weeks along, maybe six, she said. After I told her the first day of my last period, she confirmed that I was in fact six weeks pregnant. I told her my menstrual cycles were much longer than the 28-day average and wondered if that fact changed anything. But her mind was set: my baby was to be born on October 29, 2014.
My pregnancy, as a nurse later told me, was "boring" -- I was a healthy 29-year old woman; I didn't have gestational diabetes; and my blood pressure remained steadily normal throughout the pregnancy. There was no reason to believe that I would need to fight for a chance to give birth naturally.
Yet a week before the big day, my doctor informed me that my cervix was not thinning. I was apparently nowhere close to going into labor, and I should schedule an induction to deliver on my due date. Why the rush, I asked? My son’s predicted birth day seemed to be more of an educated guess, and a pregnancy is usually considered late at the 41-week mark. In fact, many doctors are willing to wait until the 42nd week to perform an induction. My OBGYN, on the other hand, regurgitated all the scary science she knew on stillbirths, C-sections and late labors. According to her, I was not an at-risk patient, but I could become one by holding on to the idea of a natural birth. That day (and again on my due date), I did not schedule an induction, and my son was born on November 1, 2014 — three days ‘late.'
As it turned out, my son’s tardiness wasn’t the exception, but the rule. Only 5 percent of women deliver on their actual due date, and doctors do recognize that due dates are anything but predictable. So why was I being forced into labor a week before the big day? What did my son and I really risk by waiting it out? And if due dates offer no guarantee, what do they really stand for? To help prepare for your baby’s big debut, we’ve asked the pros to give us their views on due dates. Here’s what they said:
Lauren Abrams, CNM, MSN — Clinical Director of Midwifery at Mount Sinai Hospital
"One of the most important things the midwife or doctor does at the first prenatal visit is to establish the due date. Having an accurate due date is crucial, because it allows us to offer prenatal tests at the appropriate time in pregnancy, and it tells us the safest time for the woman to give birth. Many of the tests we do during pregnancy need to be done during a specific time frame, so if the due date is not correct, the results of these tests may not be accurate.
In terms of labor, we know that a pregnancy is considered full term any time between 37 and 42 weeks after the first day of the last menstrual period, so this is the safest time period in which to give birth. For women who are having uncomplicated pregnancies, it’s always best to wait for labor to start on its own. Sometimes women ask us to induce the labor before the due date, because they are tired and uncomfortable, or wish to give birth on a certain date; however, for women who are having uncomplicated pregnancies, waiting for labor to start on its own is best, because it gives the woman the best chance of having an uncomplicated vaginal birth and a healthy baby. If labor has not started by 42 weeks, though, we will recommend induction, as we know that babies born after 42 weeks have a higher rate of complications."
Lindsey Bliss — Carriage House Birth Director & Birth Doula
"Due dates are only based on an averages. I wish we could all call it the due month instead. Two weeks before or after the due date is still considered term. I don't know about you but I am not average, nor have I ever fallen within an average range for anything in my life. I'm on my sixth baby & not one of them came on their due date. There is this extreme pressure from our society for women to have delivered before or on their due date. This is such an unrealistic expectation. I can't tell you how many unnecessary inductions are performed just because women are considered "LATE" when they go past 40 weeks. In a healthy pregnancy, I truly believe that labor will start when the baby is ready. I believe in our bodies innate wisdom to give birth."
Cara Dolin, MD — OB/GYN, Maternal-Fetal Medicine Fellow at NYU Langone Medical Center
“The due date is very important. It tells me how far along my patient is, what developmental milestones I expect to see on the ultrasound, what tests to perform and how to counsel patients. Many management decisions about the pregnancy are made based on the due date, this becomes especially important as a woman's due date comes and goes with no sign of labor. There are risks to letting a pregnancy continue beyond the 40th week, including having a very large baby, needing forceps, a vacuum or cesarean delivery and even stillbirth. Because of these risks to both mother and baby, it is recommended that labor be induced before 43 weeks. Many providers will induce labor at 41 weeks. Ultimately, the decision to be induced is made between a woman and her physician or midwife based on the specific circumstances of her pregnancy.”
The Labor Nurse
"The medical community has quit putting so much emphasis on delivering by the due date. That's because too many inductions fail to lead to vaginal births and too many women end up with c-sections. Too many babies thought to be due or near due, are being delivered just a wee bit too early and ending up in the NICU with breathing problems. We know there's a lot of finish work to be completed before a baby is ready to leave the womb and live life independently from its mother. We shouldn't shortchange babies by unnecessarily delivering them early. Even the American Congress of Obstetricians and Gynecologists agrees that mothers and babies know best (most of the time, anyway) about when baby should be born. Their most recent guidelines discourage doctors and mothers from scheduling inductions solely for due-date related reasons. If a healthy woman with a normal pregnancy is pressured by her doctor or midwife to have an induction or scheduled c-section, she should ask for more information. She needs to understand why her pregnancy or health falls under ACOG's guidelines for appropriate induction. If she's fine and her baby's fine, then it's probably also fine for labor to start on its own."
Aimee Raupp — Wellness & fertility expert, acupuncturist
"To me, due dates are approximations. They are calculated based on the first day of the last menstrual period, which is roughly two weeks before a woman ovulates and can even get pregnant. Plus, it can take from 2 to 9 days for the fertilized embryo to implant in the uterine wall. So I encourage my patients to think of their due date as a guesstimate. I remind them that babies come when they are ready: they can come early on their own, and they can come later than expected, which is often the case for first time pregnancies. If babies aren’t budging, there could be a reason that requires our patience and/or further medical intervention.
Acupuncture can really get the labor process going, and many women who are nearing or past their due date often come to me (or are referred to me by their doctors). From my experience, acupuncture usually works within one or two visits. When it doesn’t, I believe it means that baby just isn’t ready to come out.
Let’s not forget, too, that the very definition of a ‘full-term’ pregnancy varies from one country to the next. Here, ‘full term’ is technically 40 weeks and 6 days; in some European countries, ‘full term’ is now 41 weeks and 6 days. But I think that as long as there are no medical reasons — like high blood pressure, swelling, fever, low amniotic fluid, etc — and the woman is still comfortable, it is ok to go past the ‘full term’ mark. When and if the time comes, I rely on signs of early labor, like the baby’s low positioning and contractions, to do some treatment and encourage the progression of labor — but only once the woman hits 40 weeks, not before."
Mona Amin, DO — pediatrician at Tribeca Pediatrics
"A due date does give us a lot of information about what to expect with a baby, especially if he or she is premature (born prior to 37 weeks). We always like to know if the baby ended up needing any support at delivery (i.e. oxygen support, antibiotics, or a stay in the NICU). And when seeing a family for their baby’s initial visit, knowing gestational age, along with any complications during pregnancy, gives us, pediatricians, an idea of the baby’s transition into the world and of the health outcomes to closely follow.
For those born post-term (after 40+ weeks), health outcomes are standard to those born term. Some findings with post-term babies include large babies (which can make vaginal deliveries more difficult and require close monitoring of sugar levels), as well as dry flaky skin from being in a water-like environment in mom for so long. The most important thing for these children is to have regular OB exams and fetal monitoring — to make sure that they continue to receive adequate nutrition and perfusion from the placenta.
Premature babies (especially those born before 32 weeks) can have many of their vital organs affected, as they are not fully developed. So they do require much more visits to their pediatrician and coordination with specialists. They are closely monitored for their breathing, nutrition and heat regulation. We understand that if you have a premature child, you will have many questions and concerns — and rest assure your NICU doctors and pediatrician are ready and willing to walk you through what to expect."
Image of calendar courtesy of For the Love of Stationery.