Babies Don’t Read Calendars: The Dilemma of the Holiday Due Date
Published on: December 06, 2019
Midwife Emma McNerlin explores the topic of elective induction of labor for low-risk pregnancies, especially at holiday times.
By Emma McNerlin
Picture the scene, its April and you notice you are feeling a little under the weather and sooo tired! You take a pregnancy test and those two little lines appear. After the initial shock and surprise, you count on and realize that your New Year celebrations might include a hospital gown and ice chips, rather than a party dress and Champagne! For those facing the same scenario in August, waters breaking rather than water fights may be in your Songkran plan. Lucky you, you are having a holiday baby!
It’s important to clarify that this article is not discussing induction of labor in cases where it is medically indicated, either for complications for mum or baby. In those cases, doctors will monitor the pregnancy closely, balance the risk of any complications with that of delivering baby early before agreeing together with expecting parents on the best course of action.
When the time comes to share the news of your impending arrival, friends and family will no doubt have lots of opinions on how you should birth, where you should birth and most definitely on WHEN you should birth; but what do you want? It might take some research for you to come to the decision that is best for you, whether to induce labor to avoid uncertainty around the holidays; or leave it to nature and let baby decide.
The first thing to realize is that due dates are not highly scientific. A term pregnancy is defined as 37-42 weeks, and that most babies are born between 39 and 41 weeks. Only 5% of babies are born on their due date, and the date your baby will be born will depend on multiple factors, genetic, hormonal, placental, emotional and fetal. So now you have a due month, not a due date. Does this make it easier to decide on induction or not? It really depends on your outlook and how you view labor and birth and medical intervention.
Being due in the holiday season, while inconvenient is not a medical complication. In an uncomplicated pregnancy, there is not a lot of good quality evidence for electively inducing labor. A recent trial called the ARRIVE trial was hailed as a breakthrough in the Obstetric community. ARRIVE tested elective induction at 39 weeks versus expectant management to 40+5 weeks for maternal and neonatal outcomes. This trial took 4 years to complete and recruited just over 6,000 first time low-risk expectant mums across 41 hospitals in the USA and looked at maternal and neonatal outcomes of inducing labor at 39 weeks versus expectant management of waiting until 40+5 for any elective induction. This study found that inducing labor at 39 weeks did not significantly improve the outcomes for babies.
The ARRIVE trial also found that women who had an induction at 39 weeks were statistically less likely to have a c-section (19% vs 22% for the non-induction group). However, this study has significant limitations. Only 27% of eligible women consented to the study, indicating the ethical challenge in introducing medical intervention without clinical reason. The parameters of the study were also quite narrow, not accounting for women’s emotions or experiences of their labor and birth. This trial reduces the women taking part to only their cervix, which was scored and randomized, sometimes medicated and always observed invasively throughout their labor. The mechanics of how a birth unfolds is only part of the puzzle. Like every woman is an individual, so every cervix is different. It did not account for the length of labor, or the support available to the women. Also, it’s difficult to extrapolate the findings beyond the hospitals involved in the trial, as methods of induction of labor vary widely from doctor to doctor.
On a practical note, when meeting with OB/GYNs, find one that you trust and can communicate openly with, that will be available throughout the holiday period and who also shares and supports your philosophy for birth, be that one of active management and intervention or one that is more naturally leaning.
Deciding on a medical induction will introduce more intervention and monitoring of labor and birth. Your doctor should explain the risks and benefits of all interventions before seeking your consent to induction. Commonly women experiencing induction will be required to have vaginal exams to assess their cervix, prostaglandin medication to ripen the cervix and to have their waters broken by their doctor, in order to have an IV infusion of Pitocin (synthetic oxytocin) to speed up contractions. Continuous fetal monitoring, restriction of food and oral fluids and dissuasion of movement and mobilization are common in induction of labor care pathways. It’s easy to understand how epidurals are also common among women having an induction. In addition, induction is a one-way street, once started there is no option to opt back into a natural pathway. If your pregnancy is low risk and your hope is for a natural and unmedicated birth, induction will significantly impact your birth plan.
On the other hand, you may value more the ability to plan your baby’s birth around the holidays and family commitments, than having spontaneous labor and birth. This is also a valid position provided that the decision is entirely yours and you haven’t been coerced or forced to induce because your doctor has holidays planned. It is better for baby if you wait until at least 39 weeks to induce, do your research and make sure you understand the process before consenting.
In truth, there is no right or wrong when it comes to the “holiday induction”, you have to do what is right for you. Doing your research and being informed is important. Waiting until as close to the due date as possible for any induction is always best for low-risk healthy babies. If you decide to wait it out, there are many natural ways to try to induce labor such as nipple stimulation and sex, reflexology and acupuncture. Some doctors will offer to sweep the membranes of the cervix with a vaginal exam to help labor start naturally. Whichever route you take to motherhood, natural, induction or even planned C-Section, be kind to yourself and settle into the baby bubble, the champagne bubbles can wait until next year.
Labor Induction versus Expectant Management in Low-Risk Nulliparous Women ARRIVE Trial. Available online at https://www.nejm.org/doi/full/10.1056/NEJMoa1800566
Induction of Labor literature review: https://evidencebasedbirth.com/arrive/
Photo by Christian Bowen on Unsplash.
About the Author
Originally from Ireland, Emma is a UK-trained midwife who worked in the maternity unit at a busy NHS hospital just outside London. Emma moved to Bangkok with her husband in 2014; they have a 14-year old son, Toby. Volunteering with BAMBI Bumps and Babies since August 2015, Emma regularly conducts sessions on pregnancy, birth, breastfeeding, and infant first aid. In her spare time, she enjoys baking and Muay Thai, and is an active member of her son’s parent group at school.
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