Induction of labor versus expectant management for post-date pregnancy: is there sufficient evidence for a change in clinical practice?
A woman gets closer or past her due date, she will often face the question about whether to induce labor or wait for labor to start on its own.
Using an ultrasound, your health care provider will take a measurement of various parts of your babys growth and development.
However:many women cannot remember the exact day of their last period, which makes it hard to predict a due date.
But the true finding is that only the women who were expectantly managed but then had an induction had really high c-section rates.
In the past, researchers figured out the average length of a normal pregnancy by looking at a large group of women, and measuring the time from ovulation (or the last menstrual period, or an ultrasound) until the date the women gave birthand calculating the average.
If so, your doctor may decide to wait until you go into labor on your own.
Addition to this sort of calculation, your health care provider might use other means to try to predict a more accurate due date.
What does due date really mean
Will only need a c-section if:your labor cannot be started by your provider with the techniques described above.
Baby's heart rate tests show possible fetal distressyour labor stops progressing normally once it has started.
For example, it may be very important to a healthy first-time mother who very much wants an unmedicated birth to have a spontaneous labor, while it may be very important to a woman who has experienced miscarriages or stillbirth in the past to lower the absolute risk of stillbirth by any means necessary.
If your menstrual cycle is typically longer than 28 days, you are likely to deliver a few days after your due date.
Purpose of this evidence based birtharticle is to look at the evidence on due dates.
Naegeles rule assumes that you had a 28-day menstrual cycle, and that you ovulated exactly on the 14th day of your cycle (note: some health care providers will adjust your due date for longer or shorter menstrual cycles).
"they try to establish a reasonable date to allow for time in the supply chain and pharmacy shelves," he says.
Due date is estimated based on the first day of your last period, the size of your uterus (womb) early in your pregnancy, and with an ultrasound early in pregnancy.
What does your due date really mean
This means that babies who are small for gestational age may be more post-term than we realize they areincreasing their risk while also leaving us unaware of their true gestational age (morken et al.
So, they did not think there was any increase in risk with going past your due date.
1744, a professor from the netherlands named hermann boerhaave explained how to calculate an estimated due date.
On the average, your pregnancy will last 280 days from the time that your last menstrual period began until the day that you deliver your baby.
So this brings us to today, where almost all doctors use a form of naegeles rule that adds 7 days to the first day of your last period, and then counts forward 9 monthsa rule that is not based on any current evidence, and may not have even been intended by naegele.
If you do include these induced women in your average, then you are including women who gave birth earlier than they would have otherwise, because they were not given time to go into labor on their own.
You have not gone into labor on your own, your provider will help you start.
Your baby is going to come whenever he or she is ready to come, and not any sooner or any later.
This is a special method that allows you to include all of these women in your study, and still get an accurate picture of how long it takes the average woman to go into spontaneous labor.
Other factors that may make your pregnancy more likely to go longer include:Higher body mass index before you get pregnant (halloran et al.
The researchers found that women who had an early ultrasound to date the pregnancy were less likely to be induced for a post-term pregnancy.
Some babies are born before the due date, and others are born after the due date.
You have not given birth by 42 weeks, there are greater health risks for you and your baby.
The only items required by federal law to be labeled for expiration are infant formula and some baby foods; some states also mandate pulling dairy from store shelves on the expiration date.
If pregnancy goes much past your due date, your health care provider may suggest that you should have labor induced.
This is the last date recommended for the use of the product while at peak quality.
They should not be used beyond the expiration date -- more than five years after the date of manufacture.
In other words, using the lmp to estimate your due date makes it more likely that you will be mislabeled as post-term and experience an unnecessary induction.
You hit 40 weeks of pregnancy and become overdue, your health care provider will probably suggest some stress testing in order to make sure that your baby is still doing all right.
To get an accurate picture of stillbirth in women who go past their due date, it would be best to look at studies that took place in more recent times.
True meaning of the hannah post-term study was hidden by the cross-over that happened between groups.
For example, in the hannah postterm trial (the biggest study about induction for post-dates), about a third of women who were assigned to the expectant management group were actually induced, while about a third of women who were in the induction group went into labor spontaneously.
.One of the major benefits of going past your due date and awaiting the spontaneous start of labor is the hormonal benefit of experiencing spontaneous labor.
The 45 weeks and 6 days sounds really long but this particular woman actually gave birth 40 weeks and 4 days after ovulation.
And although the stillbirth rates may seem really low overall, if you happen to be a parent who experiences the 1 in 1,000 event at 42 weeks, then the risk doesnt seem so low anymore.
Also, some hospitals and providers will not provide inductions with vbacs, which means some women who reach the required deadline will only have one option repeat cesarean.
In other words, you have to include the healthy, living babies that have not been born yet in your denominator.
About 68% of women gave birth 11 days of their estimated due date as calculated by ultrasound at 11-14 weeks.
We also have an evidence based birth lanyard and flash drive that includes all the due dates handouts here.
The listening to mothers iii study, one in four women (26%) reported that their care provider changed their estimated due date based on a late pregnancy ultrasound.
Risks of some complications go up as you go past your due date, and there are three recent studies that have shown us what the risks are.
Your water (rupturing the membranes which hold amniotic fluid) can be done for some women to help labor start.
When ultrasound was used instead of a certain lmp (in other words, the mother is certain about the date she had her last period), the number of post-term pregnancies decreased from 10.
, researchers found that half of your chance for having a post-term birth comes from genes.
Far, the most important predictor of a longer pregnancy is a family history of long pregnanciesincluding your own personal history, your mother and sisters history, and your male partners family history (jukic et al.
They will still be edible after the date, but will not be at peak freshness.
. increasingly, more women are being induced because they have reached their estimated due date of 40 weeks.
A perishable product is frozen, it doesn't matter if the date expires because foods kept frozen continuously are safe indefinitely.
You are not up on your julian calendar and dating seems sort of a hodgepodge, how about memorizing some basic rules?
But if your baby will be larger than average, it will be perceived as closer to done when the ultrasound is done, and your due date will be moved up (incorrectly).