Overdue and over it? We talk about Induction of Labour with our sassy midwife…

At last the much anticipated due due date is here and (drum roll please)… . nada, nothing. Over due and over it? What happens when you are past your expected due date and what does Induction of Labour actually mean?

Firstly, it is very important for mammas to know that only 5-6% of babies will ever be born on their due dates. When having your first baby, it is very common to go a few days, even up to two weeks over your due date. Don’t forget the acronym EDD stands for EXPECTED due date, not precise due date.

What is actually considered “overdue” (post term)?

Post term is actually defined by many world health leading organisations as not being one or two days past your due date, but up to 14 days past your due date.

The American College of Obstetricians and Gynecologists (ACOG) defines post term pregnancy as “a pregnancy that has extended to or beyond 42 weeks of gestation”. The National Institute of Clinical Excellence UK, defines it as “a pregnancy that has reached to 41 + 3 days (10 days over due). And the Royal Australian and New Zealand College of Gynecologists state that no active measure for inducing birth for healthy mother and fetus should be considered until the pregnancy has reached at least 41 weeks.

So, you can see that setting your focus and plans on the one day given by your doctor may be setting your expectations up for disappointment. There are some theories on the groups of women who are most likely to go past their due dates such as wrong conception dates, being a first time mum, having a male baby (apparently they like to lounge around from conception!). Really, no one can actually say why our babies take their sweet time choosing their own birthday.

What to do?

Well if you and the baby are well, the reality is that we need to trust what our bodies are doing and quite frankly accept it!

It’s a pretty valuable lesson: our bodies and babies do not work to clocks or calendars, but work to a complex series of hormones and timings that we have little control over.

In a world where many women are used to hectic work pressure deadlines from everyone around us, this is when you can give yourself and your baby time, which will be a precious commodity in the months and years to come.

How long is too long?

Generally speaking, we professionals always say that the longer the baby can stay with you and attached to the placenta, the better. The placenta is a truly miraculous organ that is the foundation of life for your baby. It passes on nourishment, nutrients and oxygen to the baby and helps filter “waste products” away from the baby.

However the reason we have a due date is because our placenta actually has a “use-by” date, which can be around the 42 week mark depending on individual cases. (Please note that some women will be forced to deliver early. For some reason, their placenta starts to get tired much earlier than this).

Of course, the main and most important factor in all of this is that the risk for still birth does increase by a small percent when pregnancies go beyond the 42 week mark. It is why it is not common for doctors in the UAE to allow you to do so.

What will your doctor do?

As soon as you are overdue, your doctor will want to keep a closer eye on you and your baby. They will ask you to pay close attention to your baby movements or kicks (10 per day minimum), they may even want you to head to the clinic or hospital for regular checks of the baby’s heart beat reading. They will also pay close attention in your scans and watch their Doppler flow, which just means they will watch the pressures and volume of blood going to and from the placenta to your baby.

Your doctor will also keep a close eye on the baby’s weight (making sure baby isn’t getting too big) and the amount of amniotic fluid around him or her to make sure it isn’t decreasing.

These are very important key factors that will tell your doctor how things are going and what decisions can be made. If any of the above factors are worrying, your doctor will not and should not hesitate in deciding on a measure to help induce your labour.

However, if you have had a low risk pregnancy and your checks show that you and your baby are healthy, your doctor may let you go anywhere from 5-14 days past your due date. This very much depends on your individual case and of course your doctor’s practice.

Allowing your body to go into natural labour is the most preferable plan for most cases. Every day you are left overdue, your body has a better chance of going into labour naturally.

BUT…..what about my sore back, my utter exhaustion, my mother’s return flight home in a week, the fact that my swollen feet in my ugly shoes (the only ones that fit) resemble Nana’s homemade sausage rolls, you ask???

Worry not, all of this is taken into consideration when you speak to your doctor about your choices.

Induction of Labour

This term simply means assisting and stimulating your body to promote the initiation of labour symptoms, when they have not occurred on their own.

Induction of labour is ALL about hormones, either naturally stimulating your own, or artificially introducing them into your body to trick the body into the onset of labour.

Natural methods

If you wish to take a more natural approach, then your doctor may choose to “sweep” your cervix. It involves no brooms I assure you, it is as simple as peforming a vaginal examination of your cervix and manually “sweeping” or massaging your cervix. This will help to release some natural birth stimulating hormones called prostaglandin into your body.

If your body is receptive, this may just do the trick to start you contracting.

Now I know you all have heard about this… so I shall briefly mention that yes, sexual intercourse can be a safe and great way of bringing on labour naturally if you feel comfortable (cue eyebrow raise) as again prostaglandin is stimulated in the body. If you have been bleeding in your pregnancy, then this is not recommended.

Medicalized Methods

Again all medicated methods of induction, involve introducing labour stimulating hormones into your body. This may be done by three main methods:

Vaginal hormones tablet
This tablet is called “Prostin” and you guessed it, it’s an artificial version of the hormone prostaglandin. You will be asked to come into the hospital and after having your baby monitored, will have this tablet inserted into your vagina, near the entrance of the cervix. This tablet will slowly dissolve into your body and hopefully start to “soften” your cervix into dilating. This hormone will also start you to have some cramping and contractions.

Artificial breaking of waters 
If your cervix is already a little dilated, after admission to the hospital, your Doctor may be able to break your baby’s water bag, known as membranes. The water bag is filled with many nutrients and hormones, that when released into the body, send alerts to your labour factory to wake up and get working!

Oxytocin IV drip
This hormone is giving to you intravenously so it travels directly into your blood stream. This methods is nearly always used in conjunction with the other two methods to keep your labour progressing and moving forward. It is a potent medication that is monitored very carefully.

What else should I know?

All three methods will require you to be in hospital with your baby monitored at all times when you are in active labour. It is important to know that induction of labour is a process, not a direct delivery method. Your body will be given time to go into labour and you should not be rushed. The main goals are to ensure you and your baby are safe. Your support person is encouraged to be with you during this process.

In my experience as a midwife, having an induction does not mean you have to let go of all the goals you had for your labour. You may just have to be more open to other options. It is likely you will need a higher level of support with pain relieving medications; your midwife and doctor will make the best recommendations for you.

There remains mixed studies and opinions if whether or not inductions cause a higher rate of C-Sections, but it is widely recognized and agreed with that having an unnecessary induction of labour in the absence of medical reasons does indeed increase the risk of cesarean section and other postpartum complications for the woman, as well as her baby.

This is why communication between you and your doctor remains such an important thing, in all aspects of your pregnancy care.

So let us be patient mama, our babies will arrive to us in good time, in their own time and at the right time. It is important to allow your body to take its time… but if you are getting over it, then time to book in that date night with your husband! Good luck ladies!