Post-dates, expectant management and fetal distress (now Nichols' Rule too)

[Kess]

Just been talking to my SIL. They've been nagging about my due date and I've refused to be any more specific than "end of July" (I don't want to get nagged if I go over), citing as my reason (paraphrasing here): "Since only 5% of babies show up on their due date, MW says not to focus on a particular date and any time between this weekend and mid August would be no biggie", and attempted to soften it with saying I'd been having chats with Dinky re. not being late so we didn't miss a relative's wedding etc. SIL has replied that they will induce me at 10 days over since the placenta deteriorates.

Now I was intending to opt for expectant management, with monitoring for Dinky to keep an eye if he was distressed. But then a couple of thoughts occurred to me as I was trying to figure out how to phrase that as a reply to someone who would automatically go along with anything the Drs said: if they're monitoring to keep an eye on the placenta, how do they do that? Presumably it's a gradual deterioration, and we would only need to take action if Dinky started showing distress, indicating he wasn't getting enough oxygen. But what's the cut off point, if it's gradual? And what's the next step then, induction or straight to c-section since he's showing distress?

 

[Mervs Mum]

They monitor the placenta function with a Doppler scan which measures the flow across the cord. I had this with my last baby because they thought he'd stopped growing but it transpired the sonographer had got the measurements wrong so it was human error that had them talking induction at 37 weeks thankfully I didn't just go along with what they said or my boy would have been force out too soon for no good reason. I got an apology.
Depending on what they found they might suggest induction but they would only opt for a CS of there was an immediate need ie they felt it wasn't possible to wait for an induction. That would be quite unusual.

 

[Bournefree]

As you have rightly pointed out to your SIL the EDD is just that estimated.. so who is to say you are "over due"? It's not a science after all and your placenta won't start to suddenly go down hill when you hit 40+1 (it just might not be your time yet.
Also, your dates could be totally wrong.. and your cycle will not be like everyone else’s, your baby will not be like everyone else’s (it is a very individual thing). Babies do come when they are ready. They release a protein indicating lungs are ready and start the ripening process and gear up your hormones to start contractions.
10days past EDD and you will be offered both the expectant management and induction. But there is no need to go for an induction if you and baby are well - You just wouldn't have any treatment in any other aspect of your life without some evidence that you need it - so why in this instance, when it is so important to reduce risks to you and baby by avoiding the inherent risks of induction?

It some times gets lost in translation that over EDD isn't really "over-due" 37-42 is normal. You will only be "over-term" at 42+1... even then we all have to remember it is an estimate and it can be particularly unhelpful to have a day of expectation - when all most all of us will not ever have our babies on that day!

Good for you for keeping it vague on your dates.. you don't have to explain yourself to your SIL - I can only imagine if you let her know the EDD, she would be texting you on it to find out if you have had a baby yet!! Not very helpful! ;-)

My baby-party-line has been a strict “some time in July” policy! As I figured it was from yesterday to the 1st of August.. And that is about as accurate as I can get.

Xxx

 

[Kess]

Has anyone heard of Nichols' way of calculating EDD? It seems more accurate in some ways than Naegele's rule, but gives me a really different due date! You add 12 months, take two months and 14 days off for a first time mother (two months 18 days for a second or more time mother), then add or minus any days that your cycle is different from 28 days. But I'm slightly confused by it - are these calendar months or lunar months I'm adding and taking off? If calendar, won't the accuracy vary depending on whether you have, say February or a bunch of months with 31 days in that time period?

 

[Bournefree]

Oh sorry Kess, I dont know?!?

If your like me -you prob have enough EDD dates to contend with!
We have one by LMP 18th July
One by early ultra sound 15th July
One by conception 13th July

Then because just like you, I'm interested in tormenting myself, I worked out that DD gestations was 270 days - so have another date from that, of the 20th July!

They come when you and baby are ready - It is only a ball-park date, so you can be ready-ish!

I know a few ladies who have had previous so called "late babies" who have deliberately changed their LMP forward by 2 weeks so they don’t have the pressure of induction.. which is a sad indication of how hard the pressure can be to induce post EDD... but no-one should be doing that without good reason.
XxX

 

[Mervs Mum]

I know women who have change their LMP and declined a 12 wk scan so they cant be 'tarred' with a date with the induction issue in mind.

 

[Kess]

Oh it was more curiosity than any desire for a new EDD. I came across Nichols' when I was reading around on induction and found the idea that there was a more accurate way to calculate EDD interesting, and also interesting that no-one seems to have heard of it.

 

[NDH]

I know women who have change their LMP and declined a 12 wk scan so they cant be 'tarred' with a date with the induction issue in mind.

Ooh I like that idea - I might consider doing that next time.

 

[fides]

I know a few ladies who have had previous so called "late babies" who have deliberately changed their LMP forward by 2 weeks so they don’t have the pressure of induction.. which is a sad indication of how hard the pressure can be to induce post EDD... but no-one should be doing that without good reason.
XxX

I know women who have change their LMP and declined a 12 wk scan so they cant be 'tarred' with a date with the induction issue in mind.

in my opinion, it truly is a sad indication when women feel like they need to lie about their LMP just to avoid that kind of pressure. baby's going to come out when it's ready to, right?! my sister was pregnant while in the military, and it was standard practice to induce ON the due date (which was based on LMP alone) if the baby had not come by that point. i kid you not.

 

[Kess]

I know a few ladies who have had previous so called "late babies" who have deliberately changed their LMP forward by 2 weeks so they don’t have the pressure of induction.. which is a sad indication of how hard the pressure can be to induce post EDD... but no-one should be doing that without good reason.
XxX

I know women who have change their LMP and declined a 12 wk scan so they cant be 'tarred' with a date with the induction issue in mind.

in my opinion, it truly is a sad indication when women feel like they need to lie about their LMP just to avoid that kind of pressure. baby's going to come out when it's ready to, right?! my sister was pregnant while in the military, and it was standard practice to induce ON the due date (which was based on LMP alone) if the baby had not come by that point. i kid you not.

And that's why iatrogenic prematurity is on the rise, especially in the US.

 

[Bournefree]

Don' tknow if you would be surprised or not, but we actually have a similar thing here in the UK.

NICE Guidelines are not to induce before 10 to 14 days post EDD, if all is well....

BUT...

if you have a partner who is in the services, then you can be offered induction on your EDD so that leave for the partner can be arranged for the 2 weeks from EDD. (Pre and post 2 week EDD leave can't be arranged easily)

It is a situation that makes me feel alittle uneasy - I mean the "system" allows for a women to undergo an induction which has inherent risks, rather than grant adhoc leave to it's defence personnel.. boggles the mind?! Why can't paternity leave be better provided for in our services?
Xxx