So when is a baby actually ready to be born? Even modern medicine generally can’t tell us that. Many providers will offer women cervical checks late in pregnancy. While many Moms-to-be rely on this information to assure them their bodies are doing what they’re supposed to, dilating and effacement of the cervix actually have no bearing on how soon or far away labor is. An Oxford Journal study notes:
- Half of all first time mothers delivered by 40 weeks 5 days
- 75 percent of first-time moms delivered by 41 weeks 2 days
- Half of women who had given birth previously delivered by 40 weeks 3 days
- 75 percent of mothers delivering for a second time did so by 41 weeks
This study implies that the due dates estimated for women by medical professionals are actually five days too short on average.
How This Works
The start of labor is actually put into motion by the baby. When the child’s lungs are fully matured, they release copious amounts of a substance called surfactant. From there, the surfactant activates macrophages, which are immune cells. Those cells then travel to the uterus and instigate an inflammatory response that causes the uterus to start contracting. Oxytocin takes over, contractions aid in dilating and softening the cervix, and the rest follows suit.
What is Overdue?
So, based on the 42 weeks that a woman is permitted to be pregnant by her care provider, anything beyond that is overdue. Thus, doctors tend to start recommending interventions at this point in time. But given the evidence noted above, there is logical reason to believe that some women need to stay pregnant longer than that, even into the 43rd week. Midwifery Today states less than 10 percent of babies born during the 43rd week show any signs of post-maturity.
There is continual conflict over this practice. Doctors and hospital-based midwives often argue that the benefits of induction outweigh the risks of staying pregnant past the 42nd week while lay-midwives and natural birth activists and mothers advocate for letting the baby decide when it’s time to be born.
Cultural Influence
There has been a growing amount of pressure placed onto the birthing hips of mothers-to-be in America that they must deliver by no later than two weeks after their due date. In fact, some doctors are beginning to enforce recommendations for induction at 41 weeks. Likewise, many doctors will induce early even — at 37 or 38 weeks, something medical research strongly advises against. The University at Buffalo notes research studies show babies born during these weeks have a significantly increased risk of hypoglycemia, infection and the need for intubation, IV fluids and respiratory support than babies born between 39 and 41 weeks.
The more commonplace any practice becomes, the more it is accepted by society — as a general rule. Cesarean sections have proven this to us, as has induction. If American women are accepting early inductions and cesareans are necessary when they aren’t, can we rationally assume that they are sometimes accepting such under the guidance of the same medical professionals who urge them to forego delaying delivery until their baby is ready? The research surely supports such.
Allowing a Pregnancy to Progress
The best methodology to use when judging the safety of an overdue pregnancy is to assess the actual risks as they pertain to the individual pregnancy rather than across all pregnancies as a whole. For example, if a woman is nearing 42 weeks with normal vital signs and an otherwise healthy pregnancy, then no intervention aside from non-stress tests and ultrasound if required should be needed.
These tests allow doctors and midwives to assess the functionality of the placenta and rule out significant calcification. The Journal of Ultrasound in Obstetrics and Gynecology notes that after 40 weeks of pregnancy, only 20 percent of pregnancies have any amount of calcification, much of which is normal. They also permit care providers to keep an eye on the baby’s estimated size — which can be off by as much as two pounds in either direction on ultrasound — and ensure they aren’t at risk of intrauterine growth restriction. Around 10 percent of babies born in the United States each year have IUGR, per Pregnancy Corner. Barring complications like these, there is no foreseeable harm in allowing a woman’s pregnancy to progress until labor begins naturally.
The Risks of Giving Up Control
While there are certainly good medical reasons to induce a pregnancy, such diagnoses must be used judiciously. Without the proper prenatal screening for placental function, growth restriction and the like pointing toward an evident problem in a pregnancy, there is no reason to assume that a mother needs to be induced.
Induction raises the risk of uterine rupture, fetal distress, post-delivery bleeding complications and more. Pregnancies that are induced are also more likely to result in the need for a C-section. Fit Pregnancy reports first-time mothers who are induced have higher rates of cesareans than those who aren’t induced citing a study in which 12 percent of mothers who went into labor on their own needed a C-section while 23.4 percent of those who are medically induced did and 23.8 percent of those who chose elective induction did.
Mothers who aim to have healthy pregnancies will usually have them. Mothers who aim to have healthy, uncomplicated births will usually have them, too. That isn’t to say unforeseen circumstances and emergencies don’t arise, but interventions should be reserved for those occasions. Mandatory induction of overdue pregnancies is an outdated concept with little evidence to support it.
Mothers have more rights than they are usually aware of when it comes to birth and should keep in mind that being pressured by their doctor or midwife to proceed with induction when they don’t want to and don’t medically need to may be a warning sign to switch providers — which many women do even in the final days of pregnancy for just such reasons. Should a woman find herself faced with this pressure, she should remind herself that the doctor works for her — not the other way around.
