View Full Version : What is your comfort level with number of weeks overdue?

09-07-2010, 10:38 AM
So, officially 41 weeks today by dated ultrasound. My OB is willing to go to 41.5 with no monitoring and she says she starts to get a little nervous but she will go to 42 weeks with biophysical profiles between 41.5-42 weeks. My doula/midwife agrees that with up to 42 (she said technically a couple of days beyond but she generally cuts off at 42 weeks too). Both OB and doula have some suggestions (e.g., castor oil) that they want me to try not quite yet but before an induction - - especially because I am vbac so OB will only induce with low level of pitocin.

Anyway, in deciding between inducing at 41.5 or waiting until 42 weeks, *I* am actually turning out to be the most conservative in the group. My specific concerns are that:

1. My ultrasound dating is excellent - - went to OB that only does ultrasound for that and did it at the optimal time during pregnancy. However, I know my date of conception and my cycle length and the due date from that calculation is about three days before the ultrasound date. Of course, this may be due to when implantation occurred but my basic point is that its possible that what I am viewing as 42 weeks based on ultrasound is actually 42 and a HALF weeks.

2. My mother had a stillborn after being overdue (I think between 42-43 weeks). It seems like the placenta failed. OB says its not known whether this is something where family history matters because people don't really go beyond 42 weeks now to measure this.

What do you all think? What was your own decisionmaking process?

09-07-2010, 10:52 AM
My ob office wouldn't induce me until the 41st week last time, but they generally don't let you go beyond 42 weeks. I ended up being induced 13 days late. DD was fine, and the nurses said she didn't even look post-date (even though I know she was). I probably would have been okay waiting longer with her for a natural delivery. On the other hand, with this one, I hope they don't make me wait that long. It feels different--my body is ready for the baby to be born, the baby is big enough, etc. I can understand why you would be concerned about going too long. I kind of feel that way, too. The baby's kicking, we know it's okay, let's get it born!!!

09-07-2010, 11:04 AM
42w, give or take 1-3 days assuming all looked great on BPP and non stress test. Babies don't have a calendar in there so even with good dates there isn't reason to assume arrival by any special time.

With me it would have been an induction vs waiting. In my mind I thought that there were more risks to the baby to inducing if past EDD (again, assuming mom and baby healthy) than waiting. Why? My thoughts were that if baby was already vulnerable because they were post date then the pitocin induced contractions might stress baby out even more than another day or 2 inside. I thought labor would be gentler without induction and that could be a safer thing.

42w had to be my cut off with ds2 if I wanted a birth center birth so I was stressed about getting it done in time (I did).

I really hate the stress that the calendar plays in decisions. I hate the guilt, worry and difficulty in making choices re. how long to go. Some babies just take longer and it isn't statistically a problem to go past 42w (I can't remember the stat but I know that most babies are healthy 42-43w). But, it's very emotional and hard when you know the not so good possible outcomes or people focus on those only. I was a wreck with ds b/c I didn't want to be selfish, which is what my OB basically said when I said I wanted to wait vs be induced. I didn't want to wait and have it be the wrong call.

I was scheduled to be induced 42w2d with another BPP and NST at 42w1d. i had decided to use that data to help me decide. At 41w5d all looked great still (healthy placenta...).

I had the tests starting at 41w. I would be more comfortable with that than waiting till 41.5w.

Membrane sweeping is what I think got both labors under way. IIRC you are GBS+ so you need to weigh risks/ benefits of that action but it might be worth the risks. Very best of luck!


09-07-2010, 11:14 AM
Thanks everyone. I think part of what is freaking me out too is that I don't have a history of delivering this late . . . DS1 was 38 weeks. I wish I had a situation like yours Beth where you know you just tend to go to 42 weeks and deliver healthy babies - - though I can certainly see how that was nerve-wracking enough and didn't help with #1!

My OB scheduled me for two visits last week to attempt membrane stripping and as of last Thursday my cervix was too posterior and things weren't "ready enough" - - she said it would be extra painful and highly unlikely to be successful. I am taking oral antibiotics and she is fine with membrane stripping even with the GBS. I am seeing her again today so hopefully that will have changed and my cervix will be ready for prime-time and she can try membrane stripping . . .

09-07-2010, 11:29 AM
I think you ladies are very patient!! My water broke at 37 0 weeks 0 days with #1, went into labor at 38 weeks 0 days with #2, and I'm scheduled this time at 38 weeks, 4 days for #3. (OB actually wanted to schedule me at 38 weeks 0 days with my history but I told her I wanted to hold out till 38.5 just in case, because I do think every day a full term baby cooks is a good thing!). Anyway, I don't know anything about pregnancy beyond 40 weeks...but I will say my friends who've had babies that went that long seemed to have especially mellow, easygoing infants who slept and nursed really well. So I wish you guys the best and hope that bodes true for you as well!

09-07-2010, 12:28 PM
It's a tough call, isn't it?

I have delivered at 41+ weeks each time. With DD#1, I knew very accurately when we conceived because we were seeking infertility treatment and being monitored via ultrasound during ovulation as well. She was scheduled to be induced on the 16th and I went into labor on my own on the 15th. (She's always had a mind of her own!) I had a very conservative OB and she started doing NST (?) and biophysical profiles at least at 41 weeks, maybe at 40, to check for amniotic fluid levels, growth, etc... I felt really comfortable with her approach.

With Ds#2, I also went 41+ weeks, but the OB (different each time I visited...grrr) believed that Ds was going to be at least 9 lbs., so they decided to induce me. I was miserable, but in hindsight, I might have waited just a couple more days to see what happened, to avoid an induction. They also did u/s, but not NSTs. Ds#2 came via a long, painful induction and I'm not sure I'd go that route by choice again. Not that I may have had a choice, as I think his positioning wasn't allowing my cervix to dilate, but still I'd prefer to avoid inductions if I ever get pregnant again.

So I guess my short answer is I'm comfortable going to 42 weeks, but only with monitoring from at least 41 weeks on. I think that's a fairly conservative approach.

09-07-2010, 01:42 PM
I think your doctor and doula/midwife are both giving you great advice, and that your own thought process is clear too. If you don't want to induce, perhaps you can request earlier/more frequent monitoring or biophysical profiles from the ob. Also, you can have your ob sweep your membranes, and take evening primrose oil vaginally to soften your cervix if you are not already.

Also, I am not an expert on dating pregnancies nor the maximum amount of time between ovulation/intercourse/implantation, but is it possible that your calculations leading to due date 3 days earlier is off?

Is there any chance that the longer the pregnancy goes, the more worried your ob will get that the baby is too big for you to deliver vaginally? That doesn't sound like your ob's take on things, but it is for many ob's. Are YOU at all worried about that possibility? Mindset means a lot in psyching yourself out of a vaginal birth.

How important is the VBAC to you? Based on your previous birth, your ob's management style, hospital policies and your own thoughts about induction, do you think an induction will seriously jeopardize your VBAC (or any other birth plans, like desires regarding monitoring or epidurals). If a VBAC matters a lot to you, I'd try to avoid an induction.

Lastly, how great are your fears of repeating your mother's story? If those fears are strong and you don't think you can work through them in just a few days - a very tall order for anyone - I would seriously lean towards inducing just for that reason. You don't want to feel worried, jumping at every lull in baby movement, or playing through what-if's before any have even happened. Peace of mind is worth a lot.

The longest overdue I went was 6 days and it was an easy decision - my midwives and I never even brought up induction. I had something - a stress test? a biophysical profile? - scheduled for 10 days overdue, but never got that far. The wait was easy because I did not have much confidence in my due date, since my cycle is so irregular I hadn't had a period for about 3 months before conceiving. Sicne I knew that no one on earth knew when I'd conceived, not even me, I wasn't going to go crazy over a due date created totally by a machine. So, that was my rationale, but it's not very applicable to you.

In general, I think I'd be willing to go 10 days overdue. Two weeks overdue is possible, but it makes me nervous. I might change my mind if the facts seemed to support that the original due date might be wrong, but in general, I do believe that you can go overdue enough to endanger the baby. At 10-14 days overdue, I would choose induction over that fear, even if it meant decreasing my chances of having the birth experience I wanted.

09-07-2010, 01:52 PM
I would've gone to 42 weeks only because I know that is where my mom was when she delivered my sister in 1987. Due dates just an estimate too. With DD2 I told myself I would not opt for induction because I had to have pitocin with DD1, but that's just me and I found pitocin to be totally evil (my labor had stalled, and my water was already broken). I was early both times so really no help there (37w6d w/DD1, and 38w6d w/DD2). Good luck! I had a friend deliver her baby (at home) a few months back 15 days late and it didn't phase her at all.

09-07-2010, 04:34 PM
You can't actually know your date of conception unless you had IVF. You can know what your window is, but sperm can live for up to 5 days. So it could be that your ultrasound is accurate.

09-07-2010, 08:25 PM
Update: Just met with OB. A little progress which is good (cervix now mid instead of posterior and from .5 dilated to 1 and still at 75% effaced). But still not enough to strip membranes yet . . . will see her again on Friday.

As swissair posted she said that date of conception is only a loose guide due to when things fertilize, implant, etc. AND she said that ultrasound dating has a plus/minus error range of five days.

But, overall she thought that while risk increases past 41 weeks most of that increased risk disappears with the profiling and monitoring. And I think I misunderstood when she wanted me to start the profiles because she had me go for my first one today (which was great on all measures).

Americanmama, I don't think my OB is big-baby inclined. She assesses based on her physical exam and last time she was right on with DS (who was average) and she seems to think this baby is a little smaller than DS at least at similar stages. With the vbac/induction, my OB has been upfront that induction will decrease my chance of VBAC success . . . though she still thinks the odds are pretty good. What she does - - and I am not looking forward to this - - is a physical induction with a balloon to open the cervix and then a very low-level of pitocin. She won't do higher levels of pitocin because of the vback tear risk so if that that induction doesn't work I am back in c-section territory. :(

Anyway, fingers crossed things improve by Friday and we can membrane-strip.