Pressure! Going past your due date can bring lots of pressure from family, friends and even complete strangers.  No one would place a bet on something when the odds of winning are only 5% but that doesn't seem to apply to due dates.  It amazes me just how much focus we put on a date that we know has a 95% chance of being wrong! (Click here to read my post on due dates.)

What should you do? Provided you and baby are doing well, I don't feel there is a need to "do" anything besides wait.

There are ways to check on how baby is doing in utero just to be sure waiting is a good option. I like using a biophysical profile to assess.  A biophysical profile is an ultrasound witih additional factors measured.  It measures five criteria: amniotic fluid levels, fetal movement, breathing movements, fetal heart rate, and fetal muscle tone.  Each criteria is worth a maximum of 2 points.  If the score is 8 or higher, that indicates baby is doing well and it is ok for the pregnancy to continue without any interventions for up to a week.  I like to listen longer during prenatals to hear how baby's heart rate changes during the stimulation of palpation and how long it takes to come back down to baby's normal or resting heart rate. This helps me assess how well baby is doing.  I ask clients to track baby's movements starting at 28 weeks gestation so it is easy to spot any changes that might need further evaluation.  I also rely on mother's intuition since they are the ones who know baby best.

There are risks to be aware of if pregnancy goes past 42 weeks.  The risk of stillbirth doubles from 1 out of 1,000 babies to 2 out of 1,000.  Your baby should continue to grow so it will be larger than if you gave birth earlier.  There is an increased risk of cesearean section if a hospital induction fails, meconium aspiration syndrome and baby being in the NICU.  

My clients and I will have a discussion about the risks of pregnancy going beyond 42 weeks.  We will also discuss the options of going to the hospital for an induction, waiting for labor to start on its own as well as gentle things that can be done at home to encourage labor to start like chiropractic or accupressure.  If I do not see anything that concerns me or tells me that baby needs to come soon, and my client's intuition isn't telling her baby needs to be born, then I will support the option of waiting if that is what the client decides to do.  





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Do you strip membranes?  Can you rupture my amniotic sac?  When should I start this tea, herbal rememdy, preparation to get my body ready for labor? What do I need to do to get labor started? 

What do all these questions have in common?  The idea or belief that the body needs some form of help or assistance to get labor started, that the body will not or can't start labor without help.

Please stop!!  Your body isn't broken!  Your body doesn't need help!  Your body knows what to do!  You can trust your body!

Due dates are based on Naegel's rule.  Franz Karl Naegel was an obstretrician born in Germany in 1778, who became the director of what we would consider a maternity hospital.  Naegel's rule assumes every woman has a 28 day cycle, and that ovulation is on the 14th day of the cycle and that pregnancy lasts 280 days from the first day of the last period. We can use modern tools such as ultrasound to try to estimate a more precise date,  but we are still using an estimated date.

The evidence shows that only 5% of women actually give birth on the due date.  Even if the date of conception is known there is still a wide variation in how long gestation is.  Up to 41% of pregnant women are induced for reasons including being close to or past the due date.  We have very little data on women who carry past 42 weeks gestation in part due to inductions. It appears that 1% of women will go past 42 weeks. I personally know mothers who had in-vitro fertilization and went over a week past the due date even though the date of conception and implantation was known.

Just as we grow at different rates after birth, babies grow at different rates inside the uterus.  Some babies are ready to be born before the estimated due date and some babies wait 2 or more weeks after the estimated due date.  This is to be expected and perfectly normal.  Having to wait for labor to start does not mean that your body won't go into labor, or that something is wrong.  It simply means that you need to continue to wait.  

Labor works best when it starts on its own without "outside" help.  When it starts on its own, your body is primed for labor and your baby is primed for birth.  Being primed means labor may be more effecient, and your baby will be ready for life outside the uterus.  When introducing something external such as rupturing the amniotic sac to get labor started, there can be interference with the hormonal cascade of labor which may lead to a longer labor, or baby not tolerating labor well.

If I have a client who goes well past her estimated due date (more than a week), we will discuss what all the options are including continuing to wait.  We will have a discussion about the risks and benefits of the options and I will trust her to make the choice that is best for her and her baby.  I do not consider going past the due date an emergency or requiring the need for interventions.  Babies come on thier own schedule and that is ok. Your body doesn't need help just because you are past your due date.  You can trust your body to go into labor without help when the time is right.