Belly Up

* bellies * birth * babies * breastfeeding *

Thursday, January 12, 2012

Fads At 40

Looking like this
was a fad in the

Forty weeks that is!  As mom gets close to that magical date of 40 completed weeks of pregnancy it seems several concerns tend to come up by careproviders, usually in the context of  "We may need to induce because....(fill in the blank)....." 

Major disclosure here.  I am not a doctor, I am not a midwife...I am barely even a midwife student.  I am not saying that if you are told you might have any of these issues that they are not real or a potential concern.  I *am* saying that if they come up that I suggest doing some research and perhaps even getting a 2nd opinion before you make choices about scheduling an induction or a c-section as the risks of those procedures may carry risks higher than the risk of the original potential concern.  Even better, think about them before they are brought up so you can better discuss your options if and when they do. There, my legal disclaimer. Please don't sue me.

I hear a variety of things said to my friends and clients as to why they should induce either before or by their EDD, but a few keep coming up and I will call those the Fads at 40 because these seem to be the "in" reasons given for inductions right now.  These inductions sound medically legit and there may indeed be some medical basis for the concern but they are areas where the research is either inconclusive or has outright shown that the concern is not a reason to induce.  In the end the real reason may boil down to to a careprovider covering his assets, so to speak..  So what are my the top Fads at 40?  Here you go:

1) Your baby is too big
Nobody gives birth
to a toddle
What is too big?  Obviously this is a very subjective.  A baby and mother will work together in labor to birth and at the point the size has a lot less to do with the baby navigating through the pelvis than its position and the circumstances surrounding the labor.  ACOG defines a "big baby", or macrosomia, as a birth weight of  8 lb 13 oz to 9 lb 15 oz.  However macrosomia in medical terms, is not bad in and of itself, and the real thing to understand is that studies show time after time that there is NO way to accurately weigh a baby in utereo.  Sonograms are often characterized as accurate late in pregnancy, but the research shows otherwise. If a provider says a baby is big (or small for that matter) based solely on sonogram measurements, that statement is not much more than a guess.

Moms that have gestational diabetes have more concern in this area as they can grow babies that are bigger due to that condition than they might have otherwise, so this is something to consider if you are suspected to have macrosomia.  However if you are not diabetic and ate healthily, you probably grew the right size baby for you, even if it is 10lbs.  ACOG also recommends against inductions for large babies so if your careprovider recommends an induction for macrosomia he is going against the standard of care as well as the logic that for a bigger baby you will want to reduce the need for an epidural because the supine position used with an epidural will reduce the pelvic dimensions giving baby and mom less resources to do what they need to do.

I know the idea of having (ok, pushing out) a big baby scares many moms, but really even tiny moms can deliver huge babies just fine and often without tearing given good positioning and support.  If you need more of a pep talk on how much our pelvis's rock, go back and read the post 
2) You don't have enough amniotic fluid
Amniotic fluid is a tricky and sometimes controversial subject.  The normal range for an AFI (amniotic fluid index) is 5-25 with low levels sometimes associated with placental insufficiency as the pregnancy reaches term and beyond.  However, fluid levels fluctuate almost hourly and obtaining a reading is very subjective based on who is doing the measuring and the position of the baby not to mention when in the day it is done.  To confuse matters more, what the reading actually means is very subjective as well.  In a term pregnancy, some providers consider 7 or below a low reading, others 5 and below and many don't even bother to measure the fluid until the pregnancy gets past 41 weeks.  Then there are a few others who are more conservative and want to see a 10 or higher. You can see how an induction based on fluid levels alone should really be explored before going forward!

If mom is testing on the lower end of her care provider's comfort level, other tests can be done to get an overall picture of the health of the pregnancy.  A mother can also increase her fluid intake either orally or with IV fluids for a period of time and have the fluid tested again at a different time of the day to compare results. Obviously if the care provider is one of whose comfort levels is on the very high end, the couple will have to have some discussion about their own comfort levels and then see if they can work things out with their current provider.

3) Its 40 Weeks and Nothing is Happening
Neither babies nor their moms
come with a printed expiration date
I've written about this one before so I won't be"labor" the point.  If your cervix is closed up tight at 40 weeks it means nothing.  The cervix will dilate when contractions start and when contractions start  has nothing to do with how open, or closed. the cervix is.  Cervixes react, they don't initiate.

A woman who is induced because her body is showing no sign of being ready usually means she will have a failed induction and a c-section...because she wasn't ready, particularly for 1st time moms.  If a careprovider suggests an induction because nothing is happening yet, yet, just remember that no one stays pregnant forever.  If a careproider suggests an induction because mom is 4cm and not yet in labor, just remember that babies don't fall out.  (unless you are 16, at the prom and didn't actually know you were pregnant.) It is fine to walk around at 4cm for as long as it takes for labor to start.

4) Nothing Good Ever Happens Past 40 Weeks
Normal gestation is 38-42 weeks so good things certainly do happen after 40 weeks.  Things like spontaneous labor.  It's a cliche in the birth world, but it's true: EDD stands for estimated due date, not expiration date.

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