Many moms become anxious when they’re 40 weeks pregnant and there’s still no sign of baby arriving any time soon. As a midwife and mother, I know that we remember two dates: the expected due date and the actual birth date. I was three weeks overdue, born on my sister’s first birthday. I don’t think she’s forgiven me.
Why some babies are overdue
We’re not really sure why some babies come late, but it may be because birth dates are miscalculated. The due date is based on a woman’s last period, but the actual date of conception happens some time between periods. Added to this, baby boys are conceived at the time of ovulation, but little girls can be conceived as many as five days after having sex.
First babies often come a few days to two weeks late. The mom’s muscles and ligaments are still firm and tight, which means labour takes longer to get started.
The cervix is where the baby emerges into the vagina, and it needs to be soft and ready to open. Hormones (mainly oxytocin, progesterone and prostaglandin) kickstart this process. But, it’s also important that pressure from the baby’s head pushing against the cervix stimulates dilation. That’s why babies lying breech (bottom first), or transverse (across) fail to do this, and other problems like placenta praevia (placenta first), a short cord, or insufficient amniotic fluid can all delay the start of labour.
What are the dangers?
Post-date babies can encounter some problems after 42 weeks, so your practitioner will take precautions to prevent these. To begin with, the placenta starts to “age” after 38 weeks, which means its efficiency in transferring vital nutritients and oxygen to your baby and taking waste and carbon dioxide away, is weakened. This can also make labour and birth more stressful for the baby. For mom, baby is getting bigger, the skull is becoming harder, and labour could be longer, the birth more painful, and interventions unavoidable.
What to do when you are overdue
Although vaginal examinations are preferably avoided until labour has started, your healthcare provider needs to know what’s happening to your cervix. The best way to do this is with an internal examination. If the cervix is long, firm, hard, tight and feels like a “nose”, it means labour is a long way away.
If the cervix is flat, soft, ripe and ready to open (and feels like “lips”), labour is likely to start soon. A good, old-fashioned remedy is ingesting castor oil, but this can make birth rather messy since it also causes diarrhoea. A much nicer way to stimulate labour is sex. Not only does it lubricate the vagina and stimulate the cervix, it also helps prepare the perineum (the area between the vagina and the anus). I don’t know why it’s not recommended more often.
Many women, midwives and homeopaths also swear by the benefits of Raspberry Leaf tea. It’s said to soften muscles and help with labour.
What can be done?
After 40 weeks, your healthcare provider may suggest keeping a kick-chart. This involves making a note of when and how often your baby moves, and making sure this happens at least 10 times during this period.
If you’re worried, go for a walk, shower or have something to eat. If your baby has not moved after two hours, call your healthcare provider. He or she may suggest monitoring your baby for a while to make sure there are no problems and your baby isn’t stressed. Women younger than 25 and those older than 35 will be monitored more carefully as they are more likely to have problems. After 42 weeks, an induction or C-section becomes unavoidable.
What not to do when you are overdue
Don’t ignore your healthcare provider’s advice if an induction or C-section is recommended. In African countries, the content of traditional herbal medications such as isihlambezo, imbelikosane and umchamo wemfene is questionable and not recommended. Don’t attempt to do anything to induce labour yourself. Simply relax and heed the advice of your healthcare provider.
What happens next?
The last few weeks of pregnancy are difficult. It’s almost impossible to sleep, you need to pee every five minutes, you’re uncomfortable and irritable and everybody says you look as though you’re ready to “pop”.
Going beyond your due date is like missing your flight, the next, and the next. Your healthcare provider may not be surprised to find you waiting in the consulting room in your dressing gown when the time comes for an induction.
Stimulating labour artificially is mechanical and invasive. Usually, using oxytocin or Pitocin, the cervix may be softened and stimulated, or your healthcare provider may use a combination of both these methods. The cervix is softened with a pessary (usually prostaglandin) inserted into the vagina.
Some midwives use dried seaweed stems that swell when they absorb vaginal fluids. Another method is to use a small balloon catheter (called a hygroscopic dilator) that’s inserted into the cervix and gently inflated. This usually falls out on its own when the cervix is about 3cm dilated.
If natural labour is imminent, inductions are usually successful, but if not, a C-secion will be done within a specific time frame.
Inductions are often said to be more painful. Contractions are monitored and an epidural usually helps the mother cope with pain, but a C-section will be done if either mom or baby aren’t coping. Recent research has found fewer C-sections are necessary when labour is induced before 42 weeks, but the incidence is higher when the pregnancy continues beyond 42 weeks.
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