Post-term Pregnancy Management

nicholssquared

Hey ladies,

This is my third child, and I gave birth to the first two naturally. However, my first child was almost considered "post-term;" I delivered him at 41/6. I went into labor spontaneously on this day, but I had previously consented to be induced later that morning. I still consider myself lucky to have avoided it. I am very familiar with the risks associated with artificial labor induction. However, I also read that perinatal morbidity and mortality increases when the pregnancy exceeds 42 weeks. My question is this: what is less risky; induction of labor, or expectant management of a post-term pregnancy? If I am faced with the decision again, what should my decision process be/what should I consider? Thanks!

aylafsu88

From what I have read there are many issues with going past 42 weeks.  These risks include  issues with the placenta, stillbirth, meconium aspiration, and fetal dysmaturity.  IMO the risks to the baby out weigh the risk of an induction. H and I had many discussion about induction.  We decided that if I hit 41 weeks 5 days I would be induced.  We felt like that was a good compromise as many women deliver around 41 weeks. Modern technology is pretty good at dating now so we felt confident in our EDD and induction after 41 weeks 5 days.

lrj85

It depends on what "sources" you use. Ina May talks a lot about "post term" labor. EDD are just that estimates so if you were a week off your baby may not be as late as you think some/ many women will be induced with babies who are actualy early because of the hospitals strict interp of EDD. Even ultrasounds are best guess as far as weight is concerned can be a up to 2lbs either way towards the end. the BEST results are those that occur naturally. Ina May's birth center has a les than 2% c-section rate and they havent had any deaths. They also do not chemically induce. When you induce you start a chain of intervention that more than likely ends with a csection.

F47

aylafsu88 said:

From what I have read there are many issues with going past 42 weeks.  These risks include  issues with the placenta, stillbirth, meconium aspiration, and fetal dysmaturity.  IMO the risks to the baby out weigh the risk of an induction. H and I had many discussion about induction.  We decided that if I hit 41 weeks 5 days I would be induced.  We felt like that was a good compromise as many women deliver around 41 weeks. Modern technology is pretty good at dating now so we felt confident in our EDD and induction after 41 weeks 5 days.

This is my first pregnancy, so I don't have first hand experience. However, a close family member refused induction and gave birth late in her 42nd week. The good news is, her child appears to be absolutely fine now (which is a miracle). In fact, the child is a thriving 3 yr. old. But, she was very, very ill. Suffered severe meconium aspiration, followed by a series of strokes.

I hate to even post something like that on these boards. But, since you asked for advice I wanted to share that. I would agree with PP who said the risks to the baby outweigh the risks of the induction after a certain amount of time. It's up to you, your DH and your midwife/doctor to decide what that date should be.

nosoup4u

I'm personally comfortable going until 42 weeks. 

KatetheGreat79

I'm 41 weeks today, and my doctor is a VERY natural birth friendly doc. He is the doc all the natural birth moms in my area seek out. He says he gets nervous after 42 weeks and prefers to induce at that point. I am going to trust his advice if I reach that point. I am very sure of my EDD (I was doing fertility charging using temps and OPKs and my date matched the ultrasound perfectly) so this probably factors into my decision. I plan to do a membrane sweep Thursday if I'm dilated enough and will try the Foley induction before trying a medical one. But if it comes to it, I'm just more comfortable doing what needs to be done to have the baby around 42 weeks. This is just my take on things; you need to do what you are OK with. Good luck to you, and keep us updated!

shiway

There are many things to do to monitor how baby is doing around this time. They do ultrasounds to check fluids and all the stats. They due nonstress tests I think they are called and so you can be keep an eye on how you and baby are doing. If anything looks ify then you can make an appropriate decision. There are other natural induction methods that can be done as well. My birth center only does these natural methods and only when mama is a day or so from 42 weeks. I hear that a first time mom on average goes 9 days past "due date". If you are confident in your conception date than that's one thing but one reason I dot like due dates is so often they aren't completely accurate.

sschwege

aylafsu88 said:

From what I have read there are many issues with going past 42 weeks.  These risks include  issues with the placenta, stillbirth, meconium aspiration, and fetal dysmaturity.  IMO the risks to the baby out weigh the risk of an induction. H and I had many discussion about induction.  We decided that if I hit 41 weeks 5 days I would be induced.  We felt like that was a good compromise as many women deliver around 41 weeks. Modern technology is pretty good at dating now so we felt confident in our EDD and induction after 41 weeks 5 days.

This is along the lines of what I think too, though my limit would have been 41w6d because that was my MWs' recommendation.  As one of my MWs once said the placenta is the only 'disposable' organ, so eventually it just starts to get old and doesn't work as well.  

huntjul

lrj85 said:

It depends on what "sources" you use. Ina May talks a lot about "post term" labor. EDD are just that estimates so if you were a week off your baby may not be as late as you think some/ many women will be induced with babies who are actualy early because of the hospitals strict interp of EDD. Even ultrasounds are best guess as far as weight is concerned can be a up to 2lbs either way towards the end. the BEST results are those that occur naturally. Ina May's birth center has a les than 2% c-section rate and they havent had any deaths. They also do not chemically induce. When you induce you start a chain of intervention that more than likely ends with a csection.

Early ultrasounds (before 12 weeks) are very accurate at dating a pregnancy.  It is true that late ultrasounds are not accurate as far as estimating weight, but that's a different time and a different measurement altogether.

Yes, there comes a point when an induction is less risk than allowing the placenta to further degrade.  Practitioners may disagree about when that is, some putting it as early as 41 weeks, others as late as 42.  I don't know any traditionally trained practitioner who recommends going over 42 weeks, so that will be my cutoff.

jess9802

lrj85 said:

It depends on what "sources" you use. Ina May talks a lot about "post term" labor. EDD are just that estimates so if you were a week off your baby may not be as late as you think some/ many women will be induced with babies who are actualy early because of the hospitals strict interp of EDD. Even ultrasounds are best guess as far as weight is concerned can be a up to 2lbs either way towards the end. the BEST results are those that occur naturally. Ina May's birth center has a les than 2% c-section rate and they havent had any deaths. They also do not chemically induce. When you induce you start a chain of intervention that more than likely ends with a csection.

The majority of inductions end in a vaginal birth. This is increasingly true with the use of cervical ripening agents.

OP, my mother and her sister both had stillbirths at 43w. The post-term risks are relatively small, but it is a greatly increased risk of a number of complications, including meconium aspiration and fetal death.  Given what happened to my mother and aunt, as well as my own my (stable) chronic hypertension, I wanted to be induced at 39w. As a FTM I needed a cervical ripening agent and pitocin. I had an epidural and delivered vaginally after 10ish hours of labor and 50 minutes of pushing. As a multipara woman you are far more likely to have a successful induction and may only need minimal interventions to get labor started if you hit 42w.

Good luck.

sschwege

lrj85 said:

It depends on what "sources" you use. Ina May talks a lot about "post term" labor. EDD are just that estimates so if you were a week off your baby may not be as late as you think some/ many women will be induced with babies who are actualy early because of the hospitals strict interp of EDD. Even ultrasounds are best guess as far as weight is concerned can be a up to 2lbs either way towards the end. the BEST results are those that occur naturally. Ina May's birth center has a les than 2% c-section rate and they havent had any deaths. They also do not chemically induce. When you induce you start a chain of intervention that more than likely ends with a csection.

While it's true that early dating u/s are not perfect it can get pretty close +/- 6 days is what I have read.  The concern to me about discounting it and saying, "Well I might actually be 6 days earlier" is that you could also be 6 days later.  I charted with both my babies (temping every morning, checking CM and position) and my MWs wanted a dating u/s with my second because I was BFing when I got pregnant.  The u/s gave me an EDD of two days after what my charting EDD was.  

huntjul

sschwege said:

lrj85 said:

It depends on what "sources" you use. Ina May talks a lot about "post term" labor. EDD are just that estimates so if you were a week off your baby may not be as late as you think some/ many women will be induced with babies who are actualy early because of the hospitals strict interp of EDD. Even ultrasounds are best guess as far as weight is concerned can be a up to 2lbs either way towards the end. the BEST results are those that occur naturally. Ina May's birth center has a les than 2% c-section rate and they havent had any deaths. They also do not chemically induce. When you induce you start a chain of intervention that more than likely ends with a csection.

While it's true that early dating u/s are not perfect it can get pretty close +/- 6 days is what I have read.  The concern to me about discounting it and saying, "Well I might actually be 6 days earlier" is that you could also be 6 days later.  I charted with both my babies (temping every morning, checking CM and position) and my MWs wanted a dating u/s with my second because I was BFing when I got pregnant.  The u/s gave me an EDD of two days after what my charting EDD was.  

I was temping, charting, and using OPKs.  My early ultrasound gave an EDD one day earlier than my charting EDD.

bleusimp

I think you are wise to ask for an induction just before 42 weeks. A lot of the medical journals and info I have read warn of the much higher increase in complications after 42 weeks.

nicholssquared

I've read all the responses and, while I certainly don't want to be induced, I have decided to stick with my plan of action from before and induce sometime between 41 and 42 weeks if it becomes an issue again. Thanks for the different perspectives!