Pregnancy: I’m over My Due Date. FAQ
I’m over my due date
What is happening to my baby after 40 weeks?
In many pregnancies, there are no changes to your baby’s activities after 40 weeks and his movement patterns will be the same, although your baby’s head will probably move lower into your pelvis as he gets ready for labour, resulting in a lighter feeling under your ribs and a heavier feeling down in the pelvic area. In other pregnancies, mothers may notice a slowing down of movements as the pregnancy progresses. The placenta, which feeds the baby, operates on a lower efficiency after about 38 weeks, and certainly after 41 weeks This means that your baby’s growth tends to slow down the further your pregnancy goes. As it is not possible to accurately predict whether or not the placenta will continue to function well, most hospitals have an induction policy to avoid the risk of distress to the baby, which increases the longer the pregnancy continues.
What happens if you go over your due date?
This varies slightly from area to area, however you would normally be offered an induction of labour between 41 and 42 weeks of pregnancy, which means that your labour will be started off artificially (see opposite). Different hospitals have their own criteria for how long past your due date they will wait before suggesting an induction of labour, but this is usually between 10 and 14 days after your expected date of delivery (EDD).
If an induction is considered, your doctor or midwife should discuss all your options with you before any decision is reached. Although you are within your rights to decline induction, you should make sure that you are fully aware of the reasons why it has been suggested so that you can make an informed decision.
I have a long menstrual cycle. I don’t think I’m as overdue as they say. Can nature take its course?
The ”due date” is calculated from the first day of your last period, and assumes you have an average 28-day menstrual cycle. However, if you have, for example a 35-day cycle, your due date would be a week later If this is the case, an ultrasound scan during the first 20 weeks of pregnancy would have measured the growth of the fetus and this would have given you a due date that reflected your menstrual cycle more accurately.
Current guidelines recommend inducing labour between 41 and 42 weeks of pregnancy if it has not begun on its own. If you choose not to be induced, you will be monitored regularly.
What is a “membrane sweep” and could I have this instead of being induced?
Prior to an induction of labour, at 41-plus weeks of pregnancy, it is recommended that all women are offered a membrane stretch and sweep to assess the readiness of the cervix for labour. A membrane sweep involves your midwife or doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. The aim of this is to stimulate the release of hormones that may start labour contractions. Although this is likely to be an uncomfortable procedure, it should not cause you actual pain; you may also experience a mucus/bloodstained ‘’show” -like a discharge - following this, which is quite normal (see p.167).
Membrane sweeps have been shown to increase the chance of labour starting naturally within the next 48 hours and therefore reduce the need for other methods of induction.
I don’t like the sound of the amniotic hook. What exactly is this?
An amniotic hook is a long thin piece of plastic with a hook shape at one end. This is used to make a hole in the membranes surrounding your baby to release the amniotic fluid in an attempt to kickstart labour. The procedure, known as ”breaking the waters”, amniotomy, or ARM (artificial rupture of the membranes), is as uncomfortable as an internal examination, and isn’t usually painful, although some women do need some form of pain relief, such as gas and air, during the procedure. An amniotomy is carried out by the midwife or doctor, who will carefully guide the hooked end of the instrument into the vaginal canal with his or her fingers He or she will then press the end against the membranes to pierce them, which can help to stimulate contractions and in turn start labour.
In some cases, contractions become established quite quickly after this procedure. If this is not the case, then you will need to remain in hospital and be induced with an oxytocin drip (see p. 191)
Fetal monitoring in labour
During labour in hospital, you may spend some time attached to a cardiotocograph (CTG) machine This monitors your contractions and your baby’s heartbeat to check whether your baby is showing any signs of distress in labour Two straps are placed around your waist. One records the movement of your uterine muscle and the other measures your baby’s heart rate. The machine you are attached to produces a printout of the two readings so that the midwife or doctor can review the progress of you and your baby. If your labour is straightforward and the CTG readings show no problems, then you can be unstrapped and disconnected from the machine so that you are free to move around. Your midwife may then want to monitor you and the baby again at regular intervals throughout labour.
Can an amniotic hook harm my baby?
An amniotic hook, which is rather like a long crochet hook used to tear a little hole in the amniotic membrane surrounding the baby and the amniotic fluid, is actually fairly blunt and shouldn’t come into contact with your baby at all, so there isn’t really any risk that he could be harmed
Why do I need to be induced?
The main reason for induction of labour is when your pregnancy continues past your EDD, or estimated delivery date, as after this stage the efficiency of your placenta can decline, which can put the baby at risk.
Can I refuse an induction of labour?
You have a right to say no to any intervention
and when induction is considered, your doctor or midwife should discuss all your options before any decision is reached. However, if you wish to delay induction beyond 42 weeks, then it may be suggested that you attend the maternity unit for regular monitoring to check on your baby’s and your own health which may include a Doppler ultrasound to check the blood flow in the placenta You will also be offered an ultrasound scan to check on the amount of water surrounding your baby, as this can be a good indicator of how efficiently the placenta is working and the overall wellbeing of your baby
I’m scared about sudden full-on contractions after induction. Will it be more painful?
Some women do report that an induced labour is more painful than a spontaneous labour. This may be because induced labours can be longer, although this is not always the case. In a spontaneous labour, the body responds to the gradual onset of contractions with the release of natural painkillers called endorphins. In the case of induction, where the onset may be more sudden the body has less of a chance to do this However, some women do still get a gradual build-up of contractions after induction.
It is quite natural to be scared of pain, but -you may find it a help to be prepared mentally and physically by planning which pain relief options you are going to consider and ensuring that your birthing partner knows your plans so that he or she can give you plenty of support Many women opt for ”low-tech” forms of pain relief, such as TENS, massage, being active and changing position, and aromatherapy, in early labour, and these are all options with an induced labour. If you find these
are not enough, you can try gas and air, drugs such as pethidine, and even consider an epidural. If you know in advance how you are going to cope then you will be better able to deal with the pain
Will I need to be monitored continuously throughout labour if I’m induced?
If a syntocinon (hormone) drip is used to stimulate the contractions then, yes, continuous monitoring
of your baby’s heart rate is normally recommended. This is so the midwife and doctor can ensure that the
contractions are not too close together and that your baby is coping with the contractions and not becoming distressed. During the early stages of induction you will be monitored before, during, and following induction procedures Then intermittent monitoring of your baby’s heart rate will take place If you do need continuous monitoring, many units now have “wireless” monitors, which means that you are not physically attached to the machine and can still move around during labour.
Can my partner be present throughout?
Yes, -your partner can be with you throughout your induction and labour, and his continued support is likely to have a positive impact on your wellbeing and help your ability to cope with the pain and stress of labour. Ensure that your partner is aware of your birth plan too (see p.149) so he can support you in any decisions you need to make A lot of units allow up to two birthing partners, which can be a good idea if things are going to be long and drawn out.
What if I don’t go into labour after the induction?
Very rarely, women will experience an unsuccessful induction. especially if their cervix is unfavourable, meaning that it has failed to soften and dilate. This may ultimately result in a Caesarean section being performed As always, discuss the options with your midwife or doctor so that you are fully informed about the procedures being offered.
Types of induction
When your baby is overdue
Induction, when labour is started artificially, may be necessary for health reasons (your health or your baby’s) or if you are over your due date. If the baby’s health is at risk, your obstetrician may consider it better for your baby to be born rather than stay m your womb. For instance, a scan may show that your placenta is not working properly and your baby not growing - in this case it would be better for your baby to be born and fed orally
How will I be induced? There are several methods that can be used to induce labour. To start with, your cervix needs to ripen (soften) and begin to dilate (see p.181) You can be given gel or pessaries of prostaglandin for this to happen These are placed at the top of your vagina so that the drug can work on your cervix. Most units keep you in hospital after this, as the midwives will be regularly recording the baby’s heartbeat on
the cardictocograph machine (CTC) to ensure that you and your baby are coping with the induction drugs Occasionally the cervix does not ripen; if this happens, you may be given a second gel or pessary in six hours.
What happens next? If the gel still does not work, the midwife or doctor will break the bag of waters around the baby (artificial rupture of membranes, or ARM), which may cause discomfort. If you still don’t have contractions, a drip will be inserted into your arm and a synthetic hormone, syntocinon, is given to start contractions. Your baby’s heartbeat will be monitored while you are on the drip, as there is a risk that you may contract too much and the heartbeat be affected. Some women find this type of labour more painful and may need more analgesia, such as an epidural. If none of these works, you will be offered a Caesarean.