Post-Date Pregnancies - Article
I came across this article on the web and thought many bb members would find it an interesting and somewhat empowering read. It challenges some of the modern-day precepts surrounding birth. XX
Article by Caroline McCullough
In Their Own Sweet Time
Caroline McCullough explores the emotional minefield of post date pregnancies in a world where nearly every baby is born ?on time?.
My first baby, Liam, was born at 39 weeks gestation by emergency caesarean section - a product of the cascade of intervention. I didn?t have any idea what my gestational age was when I became pregnant with baby number two.
At 36 weeks I thought ?any day now?. I just had a feeling that Daniel was going to arrive early and I couldn?t wait. Thirty-eight weeks came and went and Daniel had turned breech.
By 39 weeks he had decided to turn around and dropped into my pelvis. My belly was so low I could practically bounce it on the pavement. By 40 weeks I was about the size of the Titanic. Well meaning old ladies would stop me in the shopping centre and say, ?you?re taking quite a risk being out now?. You should have seen their faces when I told them I was due any moment.
At 41 weeks I was starting to get nervous as none of the induction ?tricks? I had been told about were working. I had taken Evening Primrose Oil, had acupuncture, sex and went for long walks, all to no avail. When was this kid going to come out?
My doctor eyed me over and said, ?Well, I?ll see you in the labour ward this weekend then.? But the weekend came and went and still nothing. I was getting desperate. I knew that if I got to 42 weeks and there was no sign of a baby, I was going to be under enormous pressure. Sure enough, at 42 weeks I found myself sitting in my doctor?s office still pregnant!
He said, ?I think it?s time for you to have this baby.?
I said, ?Sorry, time?s up is not a good enough excuse for me.? Two days later we went to see a Sonographer to check the baby?s wellbeing and were informed that due to the lack of fluid surrounding the baby, intervention would be prudent.
The next morning, at nearly 43 weeks gestation, Daniel James McCullough was born by elective caesarean section. And you know what, he was perfect. Apgar scores of 8 and 9, no post-mature appearance, just gorgeous and raring to go.
So what happened? Why the urgency to get the baby out? Why couldn?t we just wait? These are questions that went through my mind many times after Daniel?s birth along with feelings of disappointment, discouragement, anger, frustration, hurt and resentment. Somehow I managed to work through all of these and find a sense of peace and now that I am pregnant with baby number three, I can draw strength and wisdom from these experiences.
So what is the big deal about being post-dates? Fifty years ago a gestation period of 10 months wouldn?t have been a predicament. At that time, most women weren?t aware of when they?d conceived and nor could they tell from test results. So, if a woman went past the 41st week everyone was none the wiser - no one panicked! The wards weren?t full of women on Tuesdays and Thursdays for scheduled inductions and babies came in their own sweet time.
Nowadays it is a different story. Very few women are ?allowed? to continue being pregnant past 41 weeks and are routinely scheduled for inductions should they reach that point. Some more enlightened doctors will leave it until 42 weeks and even some until 43 or 44 weeks, but they are rarities. Regardless of an obstetrician?s viewpoint on what constitutes post-dates, the one thing they seem to have in common is the idea that all pregnancies have a use-by-date. One reason for this is that a study was done in Canada which showed the risks of unexplained still-birth were increased to 1 in 500 after 42 weeks gestation and doubled at 43 weeks gestation. Therefore for every baby that may die after the 42nd week, 499 are routinely subjected to intervention which can carry its own set of risks and problems .
So, once a woman reaches the magic 41 week mark she can suddenly feel pressure to perform. This pressure does not only come from doctors. It comes from partners, families, work colleagues, friends, acquaintances, neighbours and little old ladies in shopping centres. However, pressure put on women to birth their babies to a strict time schedule could potentially prolong pregnancies as when the clock is ticking it can create enormous anxiety.
So what is this pressure cooker like? All of sudden, the phone won?t stop ringing. ?Have you had that baby yet?? asks my well-meaning 90-year-old great aunty. ?Yes, I had it and didn?t tell anyone!?? well that?s what I wanted to say. ?No, I?m still here!? I would say with a smile on my face and my fist clenched. Later the phone would be found in the rubbish bin.
Needless to say, the phone became my enemy those final weeks. Eventually we recorded a message informing callers the baby had not arrived and we would tell everyone when it did. Then when that didn?t stop callers we took the phone off the hook and stopped checking the email. In fact, me, an email addict - couldn?t even look at the computer without feeling sick. ?Why won?t they just leave me the #$#&$%%! alone!?
Beyond the social pressure there is also an internal struggle to deal with. There is such little information available on post-date pregnancies that it is very difficult to make an informed decision about the well-being of your baby based on medical research alone. I had researched my options thoroughly during my second pregnancy but was unprepared for the anxiety that came along in those final weeks. I constantly questioned myself and worried about my baby. If the baby didn?t move for a few hours I would call my midwife in a panic, race over to her house and get her to check that he was still alive.
Every morning I woke up without a baby in my arms I would cry bitterly. Then I started to get contractions and thought ?this is it? but alas, by the time I flopped into bed they would disappear. It was extremely frustrating and I was an emotional basket case by the time I reached 42 weeks. This was despite knowing that my baby was fine and that it was okay to have a baby past 42 weeks.
At that stage I felt very alone. The only person, apart from me, who seemed to think everything was okay was my midwife. She was such a rock and I needed that support. I certainly wasn?t getting it from anyone else. Friends told me later they thought I had lost the plot and my husband thought I was being hormonal and emotional and even accused me of wanting to put my birth experience before my baby?s well-being.
Every time I got in the car to go to the shops or pick Liam up from Kindy, my mother, who was staying with us at the time, would freak out. Eventually, my husband hid the car keys. I just wanted to crawl into a great big hole and birth my baby in silence and alone. It felt like everyone around me had abandoned me in my hour of need. No wonder I felt sadly relieved when we made the decision to have the caesarean. I felt battered and bruised and just wanted it to be over.
One of the benefits of hindsight is that you can analyse an event without all the emotional baggage weighing down on you. It took a long time for me to process and accept what had happened. Sometimes I felt tricked into having another caesarean but then logic would step in and remind me that the circumstances were such that it would have been very difficult to do anything else. I had to forgive myself but I also had to take responsibility for my actions. After all, I chose to have a private obstetrician as my primary carer even though I was forewarned this could increase my chances of another caesarean. I also chose to shut out anyone who disagreed with my opinions on birth and this included my partner. I would throw books on the night stand but when they were left to collect dust I assumed my partner was ambivalent about the birth of our baby. The truth was that he learned more by listening than by reading and I wasn?t talking because I didn?t think he was interested.
This time around I have made some very different choices. I have chosen primary midwifery-care with a team of two midwives I know and trust who support both VBAC and post-date pregnancies. I have chosen to decline the 18 week scan and may not have any scans for the remainder of my pregnancy because I feel a need to connect with my baby more intuitively rather than judge him or her based on size, weight, expected due date and any potential ?defects? that might present during an ultrasound. I have chosen not to tell most people when my baby is due. I have accepted that what will be, will be. I have made a real effort to communicate openly with my husband, inform him as I become informed in a way that suits him, and involve him in the decision-making process.
Whatever choices a woman makes it is vital they feel supported and safe. It is important to be fully informed prior to making a decision regarding a post-date pregnancy and to also trust our intuitive guidance. Caregivers that are willing to respect and support women during this time can also make an enormous difference and take the ?lid off? that pressure cooker environment. At the end of the day, our babies make their journey in their own sweet time.
Adam Samual Nicholas McCollough was born at 5.35am January 14th, 2005. He was 24 days past his due date. Caroline went into spontaneous labour 52 hours before and had two days of early labour before her established labour kicked in. Another 4.5 hours later Adam was born quickly and was caught by Caroline?s wonderful midwife. He showed no signs of postmaturity at birth and his placenta was big and healthy with a cord of a metre long. After Caroline and Wayne?s previous experiences, waiting for Adam to come was challenging but well worth the wait.
What you can do to ease the pressure if you go past 40 weeks:
? Consider being cared for by a known and trusted midwife antenatally. If a medical problem becomes apparent your midwife will refer you to a specialist. That is, after all, what they are there for.
? Accept that some babies take longer to ?cook? than others and that it is normal to have a 42 week pregnancy or longer, especially if your menstrual cycle varies.
? Consider taking homeopathics, having sex, having your careprovider do a membrane sweep, taking Evening Primrose Oil, taking castor oil with apricot nectar as options to move things along if you think you need to.
? Take the phone off the hook, or get people to phone or SMS your partner so that you are unaware of unwanted inquiries.
? Get your partner to check the email.
? If you agree to a sonogram or CTG (external continuous foetal monitoring) to check for foetal well-being, get a second opinion from a qualified specialist before making a decision if there are any doubts about the baby?s wellbeing. A second opinion rules out a false positive result.
? Don?t be hard on yourself for the decisions you make. All you can do is educate yourself as much as possible on your options and make an informed decision. No decision can be made lightly when it comes to the well-being of our babies and ourselves.
? Make sure that if you do allow intervention, you negotiate with your care providers that your birth rights be respected. I had a six page caesarean birth plan when Daniel was born and my midwife and partner made sure it was followed as much as possible. It made a huge difference to my sense of well-being and to Daniel?s health and well-being.
? Above all, listen to your body, to your baby and to your heart. Get to know your baby?s sleep patterns and if your baby is moving a lot and your heart rates are fine take that as a good sign, relax and wait for baby to arrive.
Cas McCullough
Cas (Caroline) McCullough is national spokesperson for and co-founder of Caesarean Awareness Network Australia and a past president of Maternity Coalition (MC) as well as the current editor of MC's journal, Birth Matters. A prolific writer and speaker on birth and parenting, Cas is married and a mother of three boys, two of whom have a diagnosed disability. She has had a VBAC after 2 caesareans and is a survivor of post-traumatic stress and depression following a traumatic birth.
