Holey moley, you’re now 42 weeks pregnant!
Your ‘due date’ (more like your guess date) has come and gone.
At post-term, you can really feel the pressure of still being pregnant.
So what’s the plan? Are you happy to continue to wait?
Or will you have a labor induction?
It can be challenging to stay the course if you’re committed to waiting for labor to start on its own.
Let’s talk about your rights to agree or decline induction at week 42 of pregnancy.
42 weeks pregnant risks
What are the risks of going past 42 weeks?
There’s a lot of conflicting research that looks at whether the risk of stillbirth increases once a pregnancy is past full term (37-42 weeks).
There’s also an analysis of studies that suggest the risk of stillbirth after 42 weeks is no greater than at 37 weeks.
You should discuss your particular risks with your doctor before making a plan for labor induction
Other risks for pregnancies going post-term include:
Macrosomia: This is an estimated birthweight of over 4500g. Ultrasound for size is notoriously inaccurate and doesn’t take into consideration ethnicity and previous birth history. Assessing for a big baby must look at other risk factors before considering induction.
Placenta failure: This is the belief the placenta has a time limit and will stop providing oxygen and nutrients to the baby after 40 weeks. This can happen at any stage during pregnancy. For more information read When Does The Placenta Stop Working During Pregnancy?.
Oligohydramnios: Low levels of amniotic fluid can be a risk, but it’s normal for amniotic fluid to decrease later in pregnancy. Be sure to read Low Amniotic Fluid Levels – Oligohydramnios.
Induction of labour at 42 weeks of pregnancy
The decision to have an induction of labour for post-term is up to you. It should be based on what’s best for your situation.
Your health and your babies are the important factors to consider. Having a healthy pregnancy is a good basis to take a ‘wait and see approach, with regular monitoring and reassurance.
There are risks of induction that need to be taken into consideration as well.
Women with pregnancy or health conditions that put them at higher risk for birth complications might choose labor induction as a safer option than waiting.
With your doctor or trusted health care provider, you really need to assess what your risks are, and where you place them.
If you and your baby are well, then there’s no reason to expect you won’t continue into healthy labor and birth.
Informed consent at 42 weeks of pregnancy
In recommending any intervention, your health care provider must make sure you have all the information you need to give what is known as informed consent.
You and your family should be able to ask questions and your health care provider should encourage this, to confirm your understanding and consent have been achieved.
True informed consent means you’re fully informed and understand the information presented to you
This article When Doctors Don’t Listen: Informed Consent and Birth looks carefully at what informed consent means and why it’s important your doctor ensures your rights are upheld.
It’s your right to decline any care you feel isn’t best for you and your baby. You can ask for another opinion or request evidence-based research to help you make an informed choice.
For women who don’t have English as their first language, offering an interpreter is vital for the understanding of both parties, and for informed consent to be given.
Your body, your baby – that’s it!
At all times you are in control of all the decisions that need to be made for your pregnancy care.
Many women want to avoid the cascade of interventions that come with labor induction before your baby and your body are ready.
The hospital has a duty of care to do no harm to you or your baby. When presented with all the information, you’ll choose the best option for you.
Your care provider must never coerce you into consent as this goes against the Charter of Healthcare Rights in Australia. The Charter is important as it puts you at the front and center of care.
Intervention and declining care
It’s your right to decline any care you feel isn’t best for you and your baby. Many hospitals and doctors have policies or guidelines that cover the sort of interventions you might be asked to consider.
Your care provider should present this information to you and discuss the policy with you, so you can make a decision that feels right for you and your baby.
If you have all the facts, you can consent or decline any interventions, such as:
- Induction – breaking your water, oxytocin infusion, catheter, cervical ripening with gels or tapes
- Continuous fetal monitoring
- Membrane sweep.
The hospital has a duty of care to do no harm to you or your baby. Your care provider will ask you to sign a form acknowledging you have refused the medical treatment they have recommended. This protects the care provider legally if your decision leads to a negative outcome.
Is 42 weeks of pregnancy normal?
42 weeks gestation is normal for those babies who are born at that time.
However, we don’t see many babies being born after 42 weeks. This is because in most countries caregivers have the policy to induce labor for post-dates pregnancy before the 42-week mark.
This makes it hard to know how many babies would normally be born after 42 weeks if labor wasn’t induced:
- Australia: Fewer than 1% of babies are born at 42 weeks or more
- UK: Many maternity units have the policy to induce labor before 42 weeks, so only about 2% of babies are born after 42 weeks
- USA: As with Australia and the UK, there are very few births that occur 42 weeks and beyond.
We must keep in mind there’s a high intervention rate of up to 42 weeks in most developed countries:
- 26% of babies are born in weeks 37 to 38
- 57 % in weeks 39 to 40
- 6% in week 41
- less than 1% at 42 weeks or beyond.
Even the World Health Organization states the number of interventions in developed countries is far higher than is needed to save lives.
What happens if you go over 42 weeks pregnant?
If you’ve sailed past your due date and made it to the post-term pregnancy club, it can feel like forever until your baby makes an entrance.
But really, you won’t be pregnant forever.
The difficult thing is knowing how to manage your anxiety and concerns against the pressure you’re likely to feel from loved ones and care providers.
Unless there’s a medical reason to indicate your baby needs to be born immediately, your care provider should support you in your choice. If not, you can negotiate for extra time by having regular checkups in that extra two weeks.
This can include regular monitoring of the baby’s heart rate. You may also have a biophysical profile (BPP), which is a combination of tests that check your baby’s wellbeing. One part of the BPP is a scan and the other is called a nonstress test.
The BPP looks at:
- Baby’s body movement and muscle tone
- How fast baby’s heart rate accelerates during movement
- How much amniotic fluid is around your baby in the amniotic sac.
The umbilical cord and placenta are also checked, to make sure they’re working to provide the baby with oxygen and nutrients.
Discuss all the information these checks provide with your care provider and make the best decision for you and your baby. If induction is right for you, that’s ok! You might like to read BellyBelly’s 8 Tips For A Positive Induction Birth.
Can I change care providers?
If you’re feeling unsupported or pressured by your care provider, it’s not too late to change your pregnancy and birth care.
Should You Break Up With Your Maternity Care Provider? 5 Things You Need To Know to take a look at how to make this decision and what your options are.
It can feel scary to make this move but it might also be the best decision you make.
You deserve the best possible team to support you through these last days of pregnancy – and on your terms.