Labor Challenge

Overdue

Overdue (also called post-date) refers to a pregnancy that has gone beyond the generally accepted 42 weeks from the last menstrual period. It only refers to the expected due date, it does not suggest anything about the health of the mother or the baby.

Between 4 and 14% of pregnancies complete the 42nd week. There is an increase in perinatal mortality when pregnancy goes beyond 42 completed weeks. One of the reasons is because babies born after 42 weeks are more likely to have congenital malformations - but remember they had those malformations the whole time, they were not caused by the overdue pregnancy. The other main cause of death is asphyxia (suffocating).

Why is being this a labor challenge?

Even though the term over due does not specifically refer to any health problem, some practitioners become concerned by an overdue baby's higher risk of developing problems, specifically postmaturity. In an attempt to prevent problems from happening, the mother is induced (artificially caused to begin labor).

There is no standard of treatment when it comes to inducing for overdue, instead policies vary between caregivers and regions. Some caregivers require routine induction at 40, 41 or 42 weeks. Other caregivers recommend selective induction based on abnormalities. Some caregivers practice what is called expectant management, which means they wait for spontaneous labor unless there is another issue with the pregnancy. There is no evidence of a benefit for routine induction at less than 41 completed weeks of pregnancy. After 41 weeks have been completed, one death is prevented for every 500 inductions and there is a small but significant decrease in the frequency of cesarean surgery when induction is used.

Many women become concerned about being overdue because of induction policies. A woman may have wanted to give birth without medications, she may have heard that induction is more painful than a labor that starts spontaneously, or she may be concerned about the readiness of her baby to be born. These are all legitimate concerns and should be discussed with your health care provider.

Potential Solutions

Consider fetal kick counting or other assessment to monitor the baby's well being. As long as baby is healthy allow the pregnancy to continue.

If necessary seek a caregiver who is supportive of your choices.

Things to discuss with your caregiver

You may be able to undergo regular fetal well-being tests, such as non-stress tests or by using fetal kick counting to determine the health of your baby. If your baby is healthy, there may be no need for inducing labor. One study found that when women with healthy pregnancies who were allowed to go beyond 42 weeks gestation there were very few statistically significant differences, the main difference being in the size of the baby and lower 1 minute APGAR scores. There was a greater rate of cesarean, however it was not a significant difference.

The due date is only a best guess based on averages of gestation. It may be desirable to delay an induction if there is question about your due date. This would give your baby the time it needs to be properly developed before being born.

Some women feel more comfortable attempting to start labor using "natural" labor stimulation methods before trying a chemical induction. It is important to understand that using natural labor stimulating techniques that are not a part of your everyday life is still an artificial way to begin labor. However, by using low risk methods of stimulating labor you may be able to cause labor to begin preventing the need for chemical induction methods.

Review with your caregivers any fears or anxieties you have about going into labor or becoming a mother. Some women find that not addressing fears causes labor to start and stop repeatedly.

Studies indicate that stripping the membranes is an effective way to encourage the start of labor. In one study only 20% of the women receiving membrane stripping needed to have further action to begin labor, compared with 69% of the women who did not have membrane stripping. Readers are cautioned to investigate the need for induction beforerequesting this procedure which may cause cramping and backaches in early labor.

References:
Magann EF, Chauhan SP, Nevils BG, McNamara MF, Kinsella MJ, Morrison JC. Management of pregnancies beyond forty-one weeks' gestation with an unfavorable cervix. Am J Obstet Gynecol. 1998 Jun;178(6):1279-87.

Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.
Carlomagno G, Candussi G, Zavino S, Primerano MR. Postmaturity: how far is it a clinical entity in its own right? Clin Exp Obstet Gynecol. 1996;23(1):41-7.