Questions about due date, and going past 42 weeks?

[grey_pony]

When I use a due date calculator using my LMP of Dec 19 2010, and put a cycle length of 28 days in, my due date comes up as Sept 25th, however, my Dr's office has been using Sept 23 as my due date all along - they put your LMP into this little "wheel" and base your due date off that. So if I go over 42 weeks, based on my Sept 23 due date and they try to induce me, how long can I hold out and refuse induction?

If I do a NST, if they measure my amniotic fluid, and determine that my placenta is still healthy, and baby is fine, is there any reason I should not refuse induction? What if they try to tell me baby is too big... is that EVER a real reason to induce? Thanks for your advice, I am trying to come up with possible responses if they try to pressure me into being induced.

 

[Samantha675]

I think if you are comfortable refusing induction, you should. You should also make your OB stick to facts, and not use scare tactics against you to induce before you are ready. Saying the baby is too big, is a scare tactic. Fetal measurements at that stage are notorious for being off, and who is to say how your pelvis is going to open.

I have seen posts on myobsayswhat.com a lot about being over due, and comments made by OBs. Maybe head over there, and read some of the discussions. You can do a search of the sight for over due or what not, and see what other women have been told, and have handled the same situation.

 

[Trying4ababy]

I went 17 days overdue with Madison. I kept refusing induction and just had to go in and have monitoring twice a week to make sure baby was okay.

 

[irish_cob]

At least you've only got a couple of days in it hun, my LMP makes my due date the 21st of September but at my dating scan they put me forward a whole week and told me my due date is 13th September. Erm what? That means they're telling me I conceived on day 7 of my cycel. Not biologically possible! I know my cycles and I know my dates. It's irrelevant as far as I'm concerned because as long as I'm fine and well and baby is fine and well, I'm just going to continue on until I go into labour naturally.

I don't know how it works in the USA though, is it different because you're paying for care? Are there likely to be problems with the insurance company (do you have one?) if you "go against" medical advice? I'm not sure how it works. In the UK because it's the National Health service we don't have to worry about things like that. I'm certain that it's still absolutely your right to choose to be induced or not and to choose what you will and won't accept being done to you, I'm sure any unwarranted procedures are assault.

I can't believe some Drs though, I was watching some trashy birth program on Sky the other day, and there was one woman who'd got to 39 weeks and basically had enough and so the Dr induced her! No specific medical reason that I could tell, yes she was tired and a bit sore, but aren't we all? No chronic SPD which had her stuck in a wheelchair or on crutches when I'd have a bit more sympathy. I was just gobsmacked that the Dr thought it was a good idea! (Edited to add this was an American program, can't remember which state or hospital it was in though).

 

[madasa]

Really liking this article

 

[1stTimeMum33]

Sorry I can't offer any advice but I'd be interested to know what replies you get. I'm desperate to avoid induction.

At least you've only got a couple of days in it hun, my LMP makes my due date the 21st of September but at my dating scan they put me forward a whole week and told me my due date is 13th September. Erm what? That means they're telling me I conceived on day 7 of my cycel. Not biologically possible! I know my cycles and I know my dates. It's irrelevant as far as I'm concerned because as long as I'm fine and well and baby is fine and well, I'm just going to continue on until I go into labour naturally.

That's exactly what happened to me! It's not physically possible for me to have gotten pregnant then as we'd not had sex yet that cycle! I'm refusing induction for as long as possible.

 

[BetsyRN]

Those wheels are actually a little off; if you look midway through sometimes the "you're this many weeks today" line hits between two lines. The calculators you're using are probably based on Nagel's rule (LMP + 1 year - 3 months + 7 days), which is actually more accurate. ACOG actually says that LGA is NOT an indication for induction. If you were a gestational diabetic, then you wouldn't want to go past your due date as size can cause complications such as a shoulder dystocia. However, if you don't have any medical conditions, the only concern would be your placenta aging as you went past your due date. This can easily be assessed by NSTs and US BPPs to ascertain the baby's and placenta's status. I think it's fine to refuse indcution up to 42 weeks (most people will go into labor before this) but I personally wouldn't go past 42 weeks. I think you would be fine to continue past that date if you're comfortable with that but you MUST have frequent NSTs. BTW, you're only 35 weeks -- start having lots of sex and you should go into labor naturally!

 

[Leahmasie]

I've thought about this a lot, because I was induced at 42w6d. I actually wasn't worried about my placenta failing, I'm very healthy and my mom was 3 weeks over with me. I was more worried about the small chance it meant something was wrong with my baby. Babies with congenital defects are more likely to be born both pre- and post-term. In the end that was not the case. I just gestate longer.

The reason the mortality risk rises sharply at 44 weeks is because small-for-gestational age babies die more often, and the proportion of those increases with increasing gestational age. If you look at 3500-3999g birth weights, the risk is very minorly higher past 43 weeks. I mean really small. Look at the WHO database. Even without adjusting for birthweight the mortality rate is something like 2 in 1000 at 40 weeks rising up to 3.5 in 1000 at 47 weeks. That's right, an extra 1.5 in 1000 over 7 weeks. After seeing that, if I have another baby I am waiting for baby to arrive. As long as everything looks fine. I would get amniotic fluid monitoring every few days after 43 weeks.

That said, I'd be shocked if any doctor actually looked at recent data like I did. So everyone you interact with will think you're crazy for not inducing at 41 weeks. It can be mentally very hard to go against medical advice, you start to doubt yourself, at least I think most women do, especially for a first baby. So, if I did it again, I would lie about my LMP. Otherwise it's impossible to get objective advice. If you're past 42 weeks, you're bound to "fail" one of their "tests".

 

[Leahmasie]

I found this just now, take a look at the first color-coded risk grid. Why doctors are still relying on outdated, circa 1960's research is unfathomable.

https://www.vs.gov.bc.ca/stats/pdf/Appendix2andreferences.pdf

 

[irish_cob]

I think it's fine to refuse indcution up to 42 weeks (most people will go into labor before this) but I personally wouldn't go past 42 weeks. I think you would be fine to continue past that date if you're comfortable with that but you MUST have frequent NSTs.

But the question is whose 42 weeks? By my dates, which are accurate because I was tracking my cycles and I know when my last period was, I will be 40 weeks on 20th September. By scan date I will be 40 weeks on 13th September - which is biologically impossible, I can't have ovulated and conceived on day 7 of my cycle when we hadn't even had sex at that point! So by their dates I will reach 42 weeks on 27th September but by my dates I will only be 41 weeks by then. So whose dates do you go by? By my dates if I refuse induction until 42 weeks, I will be 43 weeks according to the EDD from my scan, and no doubt the Drs will be getting twitchy even though their dates aren't even biologically possible. Hopefully I won't get that far but you never know...

And as Leahmasie points out, the increased risks are really really tiny, I'm sure the risks of induction are higher than that. I'd rather wait and go into labour naturally.

 

[Leahmasie]

So I think your best bet is to continually disagree with their date. Your date is more reasonable. They will probably continue to put their date in their records, but everyone that you interact with should understand your point of view, and not treat you badly. So at every appointment I would disagree with them, don't let them think that putting you a week earlier is okay with you.

 

[StranjeGirl]

I don't know much about this, but my friend and I have the same doctor and she was recently induced about a week after her due date. He is an excellent doctor (best dr I have ever had) and completely supports natural childbirth etc. If someone wanted to wait he would leave it up to them, but his reason for wanting to induce is because after 40 weeks the placenta slows down, and the baby continues to grow. My friend ended up having to have a c-section because the baby was not able to fit through her pelvis. My other friend waited for natural birth, was 2 weeks late and had a horrible labor and broke her tailbone during pushing. If the baby was a couple pounds smaller maybe this would not have happened. I'm all for natural birth and I hope I can have one, but sometimes our bodies don't do what is right. If my body were to go into labor right now at 22 weeks I would want medication to stop it, and if time is passing and it doesn't get the hint that it is time to go into labor by 40 weeks, then I am not opposed to medication. And to me any risk of miscarriage is bad...no matter how tiny, I wouldn't want to risk it. Obviously everyone has to make their own decision as to what is best for themselves and I am in no way saying my way, or my doctor's views, are right, just that it is what sits well with me.

 

[Deimos]

Statistics are based on all women, including those induced, so it looks like almost no-one gives birth after 42 weeks. The most important thing to track is that your placenta is not starting to "die". It should need daily monitoring for that, since if it does, that is when the real risk occurs. That is much more time-consuming for hospitals than just induction, so their preference is to induce everyone at 42 weeks. If you go beyond that, make sure you are monitored daily...

 

[patch2006uk]

I was due on 25/12 by LMP dates and 28/12 by scan date. I wasn't offered induction until 15 days over the scan date, so 18 days over the LMP date. They'd given me 3 sweeps by then and we'd done everything we could to try to get labour started naturally. They broke my waters and LO had passed his meconium (and it was thick-looked like diarrhoea, not waters!) and was really struggling to regulate his heartbeat. I ended up having an emergency c-section as when they tried to induce me, his heart either stopped or nearly stopped. He was also only 7lb1oz, so I think his growth had stalled too. I would never let myself go that far over again.

I personally would go by the LMP date if your cycle is regular. When was the dating scan done? If it's done after 14 weeks, they're not as accurate (mine was done at 13+5, so I never trusted it!)

In the end, in trying to avoid induction I ended up with a c-section. My cervix was 3cn dilated, so I believe that if I'd been induced a few days earlier, things would have gone smoothly, as my cervix was ready.

Hope everything goes smoothly for you and this isn't a problem you actually have to face

 

[1hopefull]

i was worried about my dr's views on this (after reading more about induction etc) so at my last appt, i asked him. he is very reasonable and said he is fine with me going 42.5 weeks before thinking of doing anything as long as the baby is OK. he says with his experience, most women hit their due date and expect to give birth so dr's end up inducting them for that reason (stress, wanting to be done with pregnancy etc). i think the natural birthers are a very small percent, so remember your dr might be fine with it, but just treats everyone the same unless it is brought up my the patient... my dr was totally FOR waiting bc induction is the number 1 risk fast for c-section (he actually said this, totally made my day).....

as for the dating, you never really know (unless you get IVF), as we all know, when the baby was concieved. we had fertility treatments but still could be plus or minus a day (ok probably less than that for us). BUT on top of that, every baby is different. why does anyone expect all of them to be ready for birth at the same time or by 40 weeks? so there are two things going against trying to predict when the baby should be born (but we still do it )

 

[madasa]

MANY first time mothers do not go into labour "by 40weeks". There is nothing wrong with that. Going into labour at 20something weeks... Well, yeah there IS something "wrong" with that. The two are not at all comparable.

Since it is now thought that the baby starts labour by releasing a hormone when his brain and lungs have reached a certain point of development, NOT waiting for the baby to reach that point of development before evicting him seems worrisome to me.

Induction has its place (though often when it works well it's b/c the woman was about to go into labour ANYWAY) but it is NOT benign. There are risks either way (inducing or waiting). The issue I have is that people believe that induction is the same as spontaneous labour; it isn't. It's harder and riskier. What docs should be discussing is what those risks ARE, as well as what the risks and benefits of waiting are... and let the mum weigh all this up and decide what she wants to do.

 

[indigo_fairy]

By my dates (I temped so I think mine were more accurate) I was due 9th July, scans put me at 1st July so I continually said there is a discrepancy with dates. Once it got to 41wks it started to get really stressful, at 42wks I was so stressed with the monitoring etc... my consultant did say he'd co-operate and support me with my planned natural homebirth up to 43wks but from then he'd not support me basically and recommend a c-section. 2nd sweep on 40+17 got labour started, but it didn't go too well as you can see from my sig. I did what I thought was best at the time, I was the 1 in 200 though. I don't think it was preventable really as growth scans aren't always accurate. I'd say just go with your instincts and do what you think is best, that way you won't have any regrets