Friday, January 22, 2010

"Term" Pregnancy Public Service Announcement

I realize I should really be posting pictures from Squirrely Girl's birthday, but I feel the need to share just one more opinion first. (Plus I'm having a hard time getting pics to upload that I took with my mom's camera.)

Being that my edd by lmp (how good are you with acronyms?) was last Saturday I'm getting a lot of, "How long are they going to let you go over?" "When will they induce?" questions. Let's explore exactly where a woman's "due date" comes from.


Georgeling the third, just this afternoon

An average menstrual cycle lasts 28 days. On day 1 your period starts, you ovulate day 14, and then enter the luteal phase through day 28 and start your next cycle on the 29th day, or day 1. Pregnancy is then assumed to be 40 weeks, starting from day 1 of your last menstrual cycle, so when a woman discovers she is pregnant she is already 4 or 5 weeks along. So assuming someone has a 28 day cycle and ovulates on day 14, she *should* have her baby around the estimated due date the doctor gives her.

Let's just start off by putting more of myself out there than is necessary and tell you that I do not ovulate on day 14. In fact, many women do not. I ovulate later and actually have a short luteal phase. When I was pregnant with the Squirrel I had been charting my cycles and my midwife actually changed my edd by a full week because she saw when I ovulated. If you take that into account, she was only 3 days "late". Similarly, the Monkey was "due" on the 7th but born on the 16th. If you add a week to his ESTIMATED due date that makes him only 2 days "late". You can see where I'm going.

My edd with this Georgeling was 1/16, adding a week makes it 1/23 give or take a few days. I'm not even in the realm of "oh this baby is way late" yet. In fact, the whole time I've figured the baby would be born on 1/24 because both of my babies were Sunday morning babies.

Back to "term" pregnancy. I'm not sure who decided that 40 weeks is the magic number and no baby should stay inside longer than that, but it is definitely the going theory out there. I can't help but wonder why. The human race has been in existence with a growing population for 6,000 years, yet birth has only become "medical" in the last 100. So what happened to women in the 5,900 years before that? Yes, I know there was higher maternal and infant mortality than there is now, but a lot of that has to do with hemorrhaging and sanitation, far more than a baby being "post dates".

I was talking yesterday with my midwife about it and we figure it's a combinaton of CYA and convenience. People are afraid of birth, they just are. In other cultures women give birth calmly and peacefully surrounded by people who love and care for them. Mom is expected only to nurse for weeks. In our culture we are alone in a hospital room, screaming, surrounded by people we've never met and a couple days later expected to cook, clean, and care for our older children. I'm not trying to idealize another culture because I know they all have their flaws, but I really hate the stigma around birth in our society. It's scary, it's painful, and someone please deliver me from this mess my husband got me into!

The one consistent thing about birth is that it's not predictable. There are certain "norms", but true "normal" is a very wide range. Hospitals like to put everyone into the same box, but we need to realize that everyone just doesn't fit. I understand crowd control, and it's difficult for the hospital staff to be sensitive to the different needs of each birthing mother since they can vary so widely. It is for that purpose that they set up "norms" and "standards" that they expect everyone to abide by. Unfortunately, as a birthing mother you often get little to no choice as to how things go, your body and your baby decide. It's up to you and your caregiver to read what your body is saying and work with it instead of change it. And that's where the CYA comes in. Who is going to sue an ob for doing a caesarean section? For saving their baby from an unsafe situation? No one, even if the situation was safe and the c/s unnecessary. But if an ob hesitates and the baby or mother are harmed because of it, a lawsuit is almost certain.

Convenience also plays a part. If they time things right a planned induction can be over by dinnertime. No one has to stay up late, get woken up in the middle of the night, miss their anniversary, or change their schedule. Of course this is *if* everything goes right, and it often doesn't. I have to friends who gave birth this fall, both were inductions. One as a result of some possible kidney trouble, the other because she was less than a week past her edd and she had partial placental abruption (the placenta started to detach before the baby was born). In each case there was a medical diagnosis to justify artificial induction. Both moms ended up with c/s. They both dilated fully, pushed for a couple of hours, and it was then determined that the baby was "stuck". My theory on this getting stuck stuff is that their water was broken and that gave the baby a more difficult journey. They were not surrounded by the protective bag of waters which would allow easier movement into an ideal position in the pelvis.

Neither of these stories are "horror" stories about the chain of events that can happen once an induction started. Remember that story about the woman at Christmas in CO who ended up in cardiac arrest? They "saved" her and her baby. Yes, they did, but the media left out the fact that they also CAUSED the event. Speculation is that the epidural either caused a "high block" and went up as well as down, or they got a bad batch of drugs (I have a friend who delivered emergency c/s at the same hospital a few days later and almost died with cardiac trouble). The woman at Christmas didn't *need* to be induced right away. Her water had broken, but they gave her no time to start contracting on her own and started an induction immediately. How different would their lives be if the doctors gave her a few hours to let labor begin on it's own?

The point of all this is perhaps just to raise some awareness, (vent) and discourage moms from thinking that the date the doctor gives her is THE date her baby should be here by. There are all sorts of factors that can change it - her normal cycle length and pattern, if she had stress pre-ovulation, and just the length of time it takes her body to "cook". We get so set on due dates and doctors start to get pushy once you pass 40 or 41 weeks. "Term" is as early as 37 weeks, which we all remember, but it also goes as far as 42 weeks. So until you start approaching 42 weeks please, just give your body and your baby a little extra time. It's worth it in the long run to avoid long-term complications or even the emotional trauma of a forced birth.

2 comments:

  1. I have the same rant about EDD. Doctor said I was due 5/9 with girly- girl, but she was born 5/19... MW called it at 5/16 because of my cycles. Hmmm... Maybe we should just teach all women how to chart so they *know* when they ovulate?

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  2. It certainly would make a difference! Women know so little about their bodies, charting my cycles taught me so much including a huge appreciation for an achieved pregnancy. When you know how everything has to line up perfectly for a child to be conceived it's hard to take fertility for granted.

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