OverdueOverdue? When you first see your midwife or doctor they give you a date that your baby is due. Sometimes this date changes during the course of your pregnancy, but mostly it stays the same and women look forward to it with great anticipation. The reality is however that only five per cent of babies arrive on the expected day. Ideally you should allow two weeks either side of your due date. Giving birth anywhere between 37 to 42 weeks is normal.

There is evidence to suggest that the current methods of estimating the due date may in fact not be as accurate as we think. One study found first time mothers gave birth on average 5 days over their due date and second time mothers gave birth on average 2 days after their due date. Most studies I reviewed suggested that first time mothers had longer pregnancies than women who had a baby before.

Around 10 per cent of pregnancies do go beyond 42 weeks. When this occurs it is known as post-term or a prolonged pregnancy. Concerns regarding problems with the baby increases after 42 weeks. While research findings are contradictory about the risks of post-term pregnancy, it is generally accepted that there is an increase in the death rate of babies over 42 weeks. Part of this increase is likely to be due to babies with malformations – as these babies have a tendency to go overdue. In the majority of cases the outcome is good for prolonged pregnancies. It’s only a minority of cases where problems occur.

Commonly, they offer induction of labour once the pregnancy exceeds 41 weeks. Research has found that induction of labour at this time slightly reduces the number of babies who die and decreases the chances of the baby passing meconium (the baby’s first bowel movement) into the amniotic fluid. There isn’t research to support inducing labour before 41 weeks.

How can I avoid going overdue?

We have not got very much control over the actual length of pregnancy, when waiting for labour to start naturally. Each woman and baby are biologically tuned for a certain length of pregnancy. Some women find their mother and other relatives routinely go two, three or more weeks overdue. They themselves may be predisposed to a longer pregnancy.

However there are a number of alternative strategies which aim to stimulate labour.  They have varying degrees of success. Here are some of the common strategies:

  • Sweeping membranes – during a vaginal examination the midwife or doctor gently separate the membranes from the opening of the uterus.
  • Sexual activity – A woman’s orgasm causes the release of oxytocin, as does nipple stimulation. Oxytocin is the hormone that causes the uterus to contract. Semen also contains prostaglandins, which can help soften the cervix.
  • Acupuncture or acupressure – consult a qualified practitioner
  • Homeopathic remedies – consult a qualified practitioner
  • Herbal preparations – consult a qualified practitioner
  • Walking
  • Good hot bowl of curry

Avoid using castor oil. Castor oil can cause cramps, nausea, vomiting and spasmodic contractions of the uterus. Basically it is downright unpleasant.

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If I choose to wait for labour to start naturally, what tests are available to check my baby’s wellbeing?

There are a number of tests available to women who go ‘overdue’. Unfortunately the research evidence on the benefits or otherwise of the tests is inconclusive. While the tests may pick up a problem, there is not a lot of evidence to say these tests actually improve outcomes of a postdate pregnancy.

The following tests may be available.

  • Fetal Movement Counting: A baby who is well moves frequently. A baby who is unwell (or compromised) may decrease the number of movements they make. Counting baby’s movements is a simple way to ensure that the baby is moving adequately and hopefully will pick up babies who aren’t doing so well. A baby who decreases their movements can then have other tests (see following points). Even though this is an easy and non-invasive test, current research hasn’t found that formal fetal movement counting improves the outcome of pregnancy.
  • Non-stress test: electronic monitoring by a CTG (cardiotocograph). A CTG monitors the baby’s heart rate along with any contractions of the uterus. The midwife can compare the print out of the baby’s heart rate with the contractions.  A CTG can assess the health of the baby at the point in time of the test. A CTG cannot predict the health of the baby in the future.
  • Amniotic fluid index: this assesses pockets of amniotic fluid by ultrasound and gives an overall score. If there is adequate amniotic fluid present, it can indirectly indicate that the placenta is functioning adequately. Assessment of amniotic fluid is usually alongside a non-stress test.
  • Biophysical profile: ultrasound can give a a biophysical profile. The ultrasound will check for four factors: baby’s breathing, baby’s muscle tone, baby’s body movement and the amount of amniotic fluid.  It gives a score on these four factors. This is alongside a non-stress test. If the result is good, you usually have the test again in a few days. A biophysical profile can better predict the health of the baby than a non-stress test alone, but its use does not improve the outcome for the baby.

Overdue: If I choose induction, what methods are available?

There are three main methods of induction of labour. These methods include:

  • Breaking the waters: The waters are broken with an instrument shaped like a large crochet hook. The cervix needs to be open a couple of centimetres before the bag of waters can be broken. Breaking the waters can be an uncomfortable procedure, particularly if the cervix isn’t open very far. Breaking the waters may be enough to start labour on its own, but usually a woman also needs a Syntocinon intravenous infusion.
  • Prostaglandin gel: placing prostaglandin gel in the back of the vagina can help soften and ripen the cervix. In some women, labour may start without further intervention. Prostaglandin administration increases the risk of developing a temperature, diarrhoea, fetal distress and haemorrhage after birth.
  • Syntocinon through an intravenous infusion: Once the waters have been broken, an intravenous drip containing the drug Syntocinon can be used. Syntocinon is a synthetic hormone that makes the uterus contract and is a fairly reliable method for starting labour. Problems associated with induction with Syntocinon include failure to progress (resulting in a caesarean birth), increased need for pain relieving drugs, need for continuous monitoring of the baby through labour, increased risk of baby becoming distressed and increased risk of haemorrhage after the birth.

My doctor has said that she would like to do an internal exam and sweep my membranes to help bring on labour. Can you tell me more about this?

Sweeping the membranes (or ‘strip and stretch’ as it’s sometimes called) is where the midwife or doctor conducts a vaginal examination and separates the membranes from the opening of the uterus with their fingers. Sweeping of the membranes before or on your due date can help decrease the chance of your pregnancy going beyond 42 weeks and the need for an induction. The procedure its self can cause discomfort and women often report some vaginal bleeding and irregular contractions afterwards.

Published 30th August 2001

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