Ah..the due date. The question everyone always asks. “When are you due?” Of course this day is then circled, highlighted and little stars are drawn around it on your calendar. It is so easy for the awaiting mother (and not to mention her family) to get very attached to this date. However, According to the American College of Obstetricians and Gynecologists (ACOG), only 5% of babies arrive on the exact due date.
Full term gestation is seen as 37-42 weeks- so it’s more like a due month than a due date. There are a few different ways to determine a due date. One way is by ultrasound and another is by measuring the uterus. The third and commonly used method is called the Naegle’s rule, in which the due date is calculated by taking the first day of your last period, counting back three months, and then adding seven days. This calculation is assuming that every woman regularly has a 28 day cycle and ovulates on day 14. If the pregnant mom has a longer cycle, therefore ovulating later, she will likely have a longer gestation period and her given due date may be off. A study done through the department of Epidemiology at Harvard School of Public Health concluded, that when estimating a due date for private-care white patients, one should count back 3 months from the first day of the last menses, then add 15 days for primiparas [first time mother] or 10 days for multiparas [mother that has already given birth] , instead of using the common algorithm for Naegele’s rule.
Given the wide range of interpretation and accuracy of determining the due date, it is important to discuss with your health practitioner what his/her protocol is for passing the due date. Throughout my years working with the pregnant population, I have encountered some care providers that allow up to the full gestation period of 42 weeks before induction, while other care providers induce 10 days, one week or one day after the due date.
If the mother passes her due date of 40 weeks and would like more time before a conversation ensues about induction, she can ask can try some natural alternatives to induce labor. If the care provider is open to the mother’s need for more time, the expectant mother will likely go through a battery of tests to assure the continued health of both herself and her child.
Kick counts This is a completely noninvasive test that can be done at home, and can be reliable way to keep track of the baby’s well being. The mother is to count the kicks from the baby in a given time and keep track of the pattern. ACOG recommends to write down how long it takes the baby to make 10 movements.
Nonstress test This test is measuring the baby’s heart rate at rest and during an active period. It is done with an EFM (external fetal monitor) and an external monitor measuring uterine contractions.
Biophysical Profile This test combines the results of the nonstress test and an ultrasound machine to give the measured volume of amniotic fluid and to check the baby’s breathing, movement, heart rate and muscle tone.
Contraction Stress Test This test will measure the baby’s heart rate during a contraction to asses how the baby is handling the reduction of oxygen during the contraction.
Mother’s Blood Pressure and protein in urine The care provider will continue to monitor the mother’s blood pressure and check for protein in the urine to assure the mother is not developing pre-ecclampsia.
It is rather uncommon to actually pass 42 weeks of gestation. In fact, only about 7% of babies are not delivered by that point. Pregnancies bypassing the 42 week marker are referred to as “post-term pregnancy.” Note “post term pregnancy” is NOT defined as simply passing the due by a few day, but passing it by a significant amount of time. For mothers that do pass the 42 week mark, the care provider will likely want to induce labor to avoid serious complications that can arise with post-term pregnancies.
June 16th, 2010
A main component of the prenatal yoga class is the exploration of pain management and relaxation techniques that can be used during labor and delivery. My favorite (and most effective) exercise is the mock contraction. This is a 60 second wall squat that is meant to simulate the timing of a contraction and is frankly, rather uncomfortable. I know that contractions are not experienced in the thighs, but maintaining this position for a minute will certainly make you figure out how to relax and get through it. In class we typically run through this pose two or three times. After the first time, I ask the students, “So, how was that? What did you do to get through it?” Sometimes I get blank stares, but often women speak up about what techniques and tricks they found helpful: breathing, rubbing the thighs, counting, rolling their shoulders, and the list goes on.
“Good!” I say, “These are all techniques that you can acquaint yourself with now to learn how you best deal with discomfort.” I go on to say “It is very unlikely that you will not experience some sort of discomfort or pain during labor.” This is where it gets interesting, and knowing smiles and smirks emerge from some students. “Unless you have a planned induction and get the epidural immediately, or have a planned cesarean, you will be dealing with contractions on your own for a while. Most care providers do not want you at the hospital too early. And even then, you will likely have to wait in the waiting room, go through triage, get admitted to the Labor and Delivery floor, and then have to wait for the anesthesiologist to arrive.” The smiles and smirks disappear.
Over the weekend, I attended a very long birth. We had intended to use the Birth Center, but as labor hit its 27th hour, the laboring mother opted for rest and relaxation by taking the epidural. After moving out of triage (which took about 45 minutes) and into a room, we ended up waiting almost 2 hours for the anesthesiologist to be available. There was a cesarean that was just getting started, and then an emergency arose which bumped us to third on the list. To withstand this two hour wait, we breathed, rocked, moaned, visualized, and created counter pressure with a hot water bottle.
My reason for telling this story is in no way meant to scare people, but instead to give a clearer idea of what may happen. Realistically, those wanting an epidural will still have to employ some pain management techniques for a period of time. It is much better to have a a variety of techniques learned and readily available than be surprised by the power of labor.
Think of learning these relaxation and pain management techniques as homework for you and your partner! You can either do the mock contraction or the One Minute Ice Cube test (I got this from my Lamaze training). This exercise requires you to put your hands in a big bowl of ice water for one minute. Again, it is very uncomfortable and requires concentration and support to get through it. On a side note- if you are practicing these at home with your partner- have the partner try a round of two- the exercises can provide some perspective and empathy.
There are so many ways to find some relief during labor. I have written blogs on several techniques and ideas that I would like to share as well as my top 3 favorite techniques.
Paging Dr Feel Good
Breathing for Labor, A Yogic Point of View
The Gate Control Theory of Pain Management in Childbirth and the Epidural
7 Tricks of the Trade to Help You Have a Better Labor!
My top three favorite pain management techniques:
Breathing and Progressive Relaxation
I find that deep breathing and systematically relaxing the body from the top down can be very effective in creating concentration and relaxing the body. Deep breathing helps shift the body into the parasympathetic nervous system which is the “rest and relax” state as opposed to the “fight or flight” response to pain.
Hot water bottle with counter-pressure and massage
The heat from the hot water bottle applied to the lower back or lower abdomen can create immediate relief as well as applying pressure or massage to the sacrum area .
Movement
Next time you stub your toe, notice the immediate desire to move around to relieve the pain. Movement decreases tension and relaxes the muscles which will lessen the perception of pain.
Hopefully your labor will unfold as desired. If there is a bit of a snag in the plan and you have to deal with unexpected turns, you will have the tools to get you to the other side.
June 4th, 2010
