Wednesday, December 30, 2009

Incentives for Cesarean Delivery?!

My stomach just lurched. Did you hear it? Some people tend to believe that my remarks about hospitals and doctors pushing cesareans are either paranoid or blatantly wrong. I ask you - if a hospital *wasn't* trying to make money off of this, why would they offer an open house with refreshments and door prizes?

It makes me absolutely ill to think of major abdominal surgery being talked about with such levity. "The one place where getting a 'C' is never average." ( Can't you just hear the airy laugh to go with that statement? )

This is a hospital in Ogden, touting it's newly opened Cesarean Wing. Aren't hospitals supposed to be making effort to REDUCE the number of cesareans performed? And I can assure you that they wouldn't have an open house complete with snacks and prizes if they were ONLY targeting the high risk women who NEED a cesarean to save the lives of their babies. That would be too small a number to open up a new wing in the hospital.

Where is their birth center wing, complete with birthing tubs, birth balls, and birth stools? Ah, but there isn't any money in drug-free, intervention-free birth. It's all about the surgery. The cesarean wing is complete with nice shiny flat screen TVs as well. Too bad mom will likely be in a drug haze and won't get to experience her "soothing, homelike ambiance" with said flat screen TV. :shrug: And don't forget to mention the state-of-the-art NICU that the cesarean babies will need, since we know that the majority of cesarean babies end up in the NICU for one reason or another. Coincidence? I don't think so.

Here is the ad for the open house:

New C-Section Wing Open House. You're Invited Dec. 18, 2-5 P.M.
The One Place Where Getting a `C' Is Never Average
The first of its kind in Utah, a dedicated hospital wing for C-section
births at Ogden Regional Medical Center in Weber County. Please make plans
to join us for light refreshments, tours, prizes and more, as we unveil the
beautiful Cesarean Suites at the Family Birth Place that feature:

- Eight, brand new, special C-Section/postpartum suites
- Single-room maternity care
- Newborn / Transitional nursery
- An attentive staff, specialized in caring for surgical patients
- Larger-than-normal hospital rooms (about 1 ½ times bigger)
- A soothing, homelike ambiance with a very nice bed, flat screen TV,
Wi-Fi access, chair sleeper, and more
- Fully equipped rooms to handle any emergency for mother or baby
- Ronald McDonald Family Room

Call for more information at 801-479-2546.

Disgusted yet? Outraged yet?

Monday, November 16, 2009

My Baby's Birthday, and My HBAC Anniversary

Four years ago today, I gave birth to my youngest child Megan. It was a triumph on multiple levels, as I had a cesarean with my second child, and was told that I would surely kill Megan or die myself if I "attempted" a VBAC. You see, I am prone to having larger babies ( those of you who have met my husband understand, lol ), I was closed with a single layer of suturing instead of double after the cesarean, *and* I got pregnant with her less than a year after my cesarean. I was told that all of these lined up would mean certain uterine rupture. The OBs who had agreed to "let me try", all gave me a gestation limit of 40 weeks. They all said that it would be an automatic repeat cesarean if I got to that point with no signs of labor in sight. And if she was looking to be "too big", it would be an automatic repeat cesarean. Basically, if I looked at them funny it would be an automatic repeat cesarean. It took some women from ICAN ( International Cesarean Awareness Network ) to challenge by beliefs about childbirth, for me to even look in a different direction.

Like most people, I believed that doctors know best. After all, they go to medical school for years and years, and HAVE to know all there is to know. It took me a while to learn that Obstetricians are NOT trained in natural birth. Most go through their entire residency without seeing a single truly natural birth, with the exception of the mom who walks in ready to push ... and even then everyone freaks out. Obstetricians subscribe to the belief that childbirth is a pathology, not physiology. Now, there are certainly exceptions to the rule ... just as not everyone home birth Midwife is trusting of the birth process, or best for mom and baby. But it took me from the beginning of my pregnancy, until 33 weeks, of research to come to this epiphany.

If there is one thing that I can tell women who have had a cesarean, and were told that either their body failed them ( pelvis is too small, labor was too long, cervix didn't open enough, body got too tired ), or their baby failed them ( baby too big, baby didn't come soon enough ) ... is to research their butt off. Because it is so much easier for a care provider to tell a woman that her body didn't work right, rather than to admit that baby and body just weren't ready, or that he/she ( the care provider ) unnecessarily intervened in the process, causing it to spiral into the operating room.

At 33 weeks I started calling Midwives. I was turned down by many. I was starting to lose hope of giving my daughter a better birth, because I knew it wasn't going to happen in the hospital. I was down to one last name ... and thankfully, God had us matched perfectly. Brenda is an amazing Midwife who serves women who need it the most, especially when many others would turn them away. Without her, not only would I not have given Megan a better birth, but I also wouldn't be the Midwife I am today.

I will premise my birth story by saying that four years ago, I wasn't where I am now in my beliefs about birth. There are certainly a few things that I would do differently. I do NOT advocate castor oil inductions by any means. Nor do I advocate artificial rupture of membranes. At the time, having my midwife break my water was a blessing. I was starting to pass out. But in my own practice, I have not yet found a valid reason to break the bag of waters ... leaving things to occur naturally in their own timing.

Now, without further ado, Megan's birth story. My triumphant ( and HARD! ) HBAC.

Megan Ohana Fiscer
November 16, 2005
10 lbs 10 ozs, 23" long

I had been doing the yucky prodromal labor think for what felt like forever. I had almost 6 weeks of contractions that would get so regular and start getting more intense, that I was sure it was "it" a few times. Even had my poor midwife drive out here in the middle of the night which ended up being for nothing. I had regular contractions all through the night on the 10th and called Brenda at about 4am. She came and when she checked me at 8:30 or so, I was a mere 2cm and not effaced much. Megan was also floating high still. I was crushed. Jeramy had the day off and since his grandmother had come up to help with the kids, we decided to go walking that evening to see if it would help anything. I had horrible pressure on my cervix and ended up passing some bloody show. Nothing more though.

The pressure on my cervix changed to a stabbing pain anytime I was doing anything other than sitting, so on Monday the 14th we decided to go walk around a shopping center that is a mile around. The pain was awful, but I wasn't having any contractions at all. I asked Jeramy to stay home on Tuesday because of the pain, and to help around the house. That evening I decided to call Brenda to see if we could try castor oil in the morning. ( Added note: At the point of Megan’s birth, I wasn’t at the point where I really believed that birth was best left alone … I still had a LOT to learn! ) The pain was really awful, and I was having an incredibly hard time getting around after my kids and doing much of anything. I was also a week past my due date and more than a little miserable ( I know, bad reason to try castor oil...but I felt I couldn't take it anymore ).

Right after I got the go ahead from her for the cocktail in the morning, I used the restroom and had at least 3 tissues full of mucous. I called her back to give her the heads up, as I went into labor the same night I passed mucous like that with Noah. I decided to go to Walmart to get some laundry detergent and some needed things and then came home and took a shower. I had been having very small contractions on and off all day, but not much of anything. After the shower, I began having really strong contractions all of a sudden. I went in to lay down to see if they were staying...and they only got stronger. Stronger to the point where when Jeramy checked on me I was in tears. I said it was time to call Brenda. He wanted me to make sure it was really time so she didn't come out again for nothing. I assured him it was! Jeramy filled up the tub, which I went back and forth from because I kept getting too warm. She got here at about 1 or so...and by that time I had already told Jeramy I wasn't sure I could do it. The contractions were very intense and I couldn't imagine it just getting worse. I was also afraid of how far I had progressed...not wanting to hear 3cm or so. When Brenda checked me I was happy to find myself at 5, and she could actually stretch me to 6cm. I tried getting back into the tub, but only ended up getting too hot again. I decided to go lie down in bed to try to cope with everything. I did okay for a while, until things got REALLY intense, at which point I would lose it when a contraction peaked and start shaking my head hard saying I couldn't do it. Brenda was amazing in helping me relax through some of them, reminding me to relax my entire body and even asked if she could pray over me...which I welcomed gladly. Back labor was awful, and my poor husband tried applying counter pressure when I almost felt like I jumped out of my didn't feel good at all, it only intensified things. I got up and labored on the toilet for a bit which felt good for a while, but then let out a grunt when it felt good to bear down. This alarmed Brenda, and she and Jeramy got the bed prepared. They got the shower liner under the sheet and the chux pads out on the bed. She decided to check me again to see if I was complete, but I was only at 7-8cm. The pressure was awful and I felt like I was having one big contraction and was starting to feel like I was going to pass out, instead of breaks in between. After lots of discussion, we decided to go ahead and break my water, and that helped TREMENDOUSLY. I was able to relax and sleep in between contractions somehow. By this point I had gotten REALLY vocal and was having a hard time relaxing during contractions at all. I started feeling pushy again, and when checked I was complete with just a little lip. Brenda said if I was feeling the urge to push, she could help move the lip out of the way. I began pushing and that became an exhausting experience. When I would push, burning pain would radiate through my hips. It felt amazing once I was really pushing effectively, but at the beginning of each push it hurt horribly. I was really becoming exhausted, and Brenda had me change to a side-lying position to push which seemed to be helping, but still not as effective. She suggested the toilet again, but I didn't think I could get up to it. So I rolled over and got on hands and knees and tried that way. Now I was REALLY screaming that I couldn't do it...I was too tired. Jeramy and Brenda kept reassuring me that I could, but I really needed to push. I was the only one that could get her out, and I needed to do it now. I ended up pushing more in a sitting/squatting position and even bit poor Jeramy's hand during one big push. Megan started crowning and I had never felt a burning sensation like that in my life. I was sure everything was going to split wide open. I remember the feeling of Brenda stretching me to keep me from tearing, hurting pretty badly as well. But getting her head out was the hardest. Brenda kept telling me I needed to push through the burning and get her out now, as she had been in that spot for a while and her head was kind of stuck behind my pubic bone. Megan was also going back up in between pushes because I couldn't hold it. So I pushed through the burning and felt her head come out, and then very quickly the rest of her slid right out. It was an amazing feeling.

I relaxed my entire body, still in that squatting position, onto the pillows in front of me. My hair was soaked with sweat and I was exhausted beyond belief, and also incredibly relieved that she was out. I smiled up at my husband and told him that I could feel her kicking against my thighs. They had me roll over, and Jeramy got to hand her to me, but had to be careful since the cord was short. She was beautiful. The first thing I noticed was how long her fingers were. She was so calm and alert. Jeramy was beaming and told me I did it and how proud he was of me. We waited for the cord to stop pulsating and then Brenda clamped and Jeramy cut. I spent some time admiring her, and then Jeramy took Megan out to the livingroom to meet her brother and sister and great grandma so that I could deliver the placenta. It wasn't hard at all, I just pushed and it came out easily. That also felt really good to get out. I was still burning quite a bit, but was laying back and relaxing knowing that the hard work was done.

Jeramy came back in with Megan, and I latched her on to nurse. She latched on immediately and did so very well. I asked if we could weigh her and get measurements...I was so anxious to see! When Megan was born, Brenda said she thought she was a good 8 1/2-9 lbs. Well, Jeramy was the one to weigh her, and he got wide eyed and asked Brenda if what he was seeing was correct. She looked at the scale and got the same look on her face! He then announced 10 lbs 10 ounces and I couldn't believe it. Furthermore, I couldn't believe when Brenda measured her and she was 23 inches long. I knew my belly had been huge, but never imagined she'd come near to 11 pounds. Jeramy went out and announced it to his grandma, who couldn't believe it either.

Brenda checked me for tears, and said it looked like I had one up towards my labia, and then one on my perenium and she could sew me up after I got cleaned up and showered. I tried twice to get up and shower, but while sitting on the toilet I almost passed out after the burning from peeing. So I was sent back to bed until I could get some fluids in and some toast. When I did take a quick shower and get back into bed a few hours after Megan was born, Brenda checked me to find that by me laying with legs together for so long, I was already starting to heal naturally. She had to really look for the tear she found before on my perenium, and she said there were only a few slits up towards my labia from the skin stretching, and those would heal on their own. As for the perenium, she numbed me, which didn't take too well...and I cried through the single stitch she put in. She said one would be enough along with me keeping my legs closed for a while. I was relieved not to have to endure another stitch. She gave me my instructions and a big hug and kiss and left us to our new family.

Recovery has been amazingly fast in comparison to both my previous vaginal birth, and the cesarean. It's amazing how things work perfectly when done naturally. My system didn't have to get over any drugs being pumped into me, or soreness from an episiotomy and stitches. Compared to a lot of homebirth stories I have read, I didn't feel mine went as smoothly, and I definitely didn't cry out that I would do it again after all was said and done...but it WAS beautiful. It was beautiful that my baby was handled gently at birth, not rubbed down and tagged with plastic and handed from one unfamiliar hand to another. She was treated peacefully and gently, and for that alone I would go through the pain all over again.

Friday, November 6, 2009

New Reason to Birth At Home : H1N1

Because of the H1N1 scare, Hospitals in Southern Utah are limiting visitors to only *2* pre-designated visitors for the entire duration of a patient's stay. This means that if you have older children, they will not be allowed to visit mom, or see their new sibling until mom goes home. Other members of the family will also not be allowed to visit, unless they are one of the two people allowed when mom was admitted.

This is from Dixie Regional Medical Center:

With the emergence of H1N1 cases earlier this year infection control professionals are anticipating a busy flu season. To keep the hospital as safe as possible for patients, Dixie Regional asks that all visitors be at least 15 years old. Children ages 14 and under frequently transmit viruses. Because the risk of H1N1 is higher for pregnant women and youth, on the 400 East Campus (where
women’s and children’s services are based) patients are also asked to designate two visitors for the length of their stay.
We have not seen a marked increase in flu cases yet, but believe it is wise to be proactive about potential spread of illness. Thank you for your support as we balance the desire for visitors to see loved patients with patient safety concerns. Further visitation restrictions may be implemented this fall or winter, if there is a significant increase in the number of patients being hospitalized with influenza. For more information about influenza or the most current updates on H1N1, please visit the Southwest Utah Public Health Department website: For more information about visitation at Dixie Regional, please call 251.2108.

When you birth at home, not only is the risk to baby and mom GREATLY reduced of contracting an illness ( common when visiting hospitals, after all, they *are* full of sick people! ), but mom is also allowed to have as many or as few people as she wishes to be present for her birth. Family centered birth is very important for families to grow and bond together. Don't cut your children or other loved ones out of your birth plan because of the flu season. Birth at home. :)

Saturday, October 17, 2009

5 Reasons to Avoid Induction of Labor

The Risk of Inducing Labor

By Robin Elise Weiss, LCCE,

The induction of labor can be done for many reasons, including many valid medical reasons. However, the rise in the rate of social inductions, or elective inductions is on the rise. As the induction rate rises there are more babies and mothers placed at risk for certain complications. Here are five risks of induction that you may not know about:

1. Increased risk of abnormal fetal heart rate, shoulder dystocia and other problems with the baby in labor.
Labor induction is done by intervening in the body's natural process, typically with powerful drugs to bring on contractions or devices that are used to break the water before labor starts. Both of these types of induction can cause the baby to react in a manner that is called fetal distress as seen by fetal monitoring.

The nature of induction like contractions may also be more forceful than natural labor. This can cause your baby to assume or stay in an unfavorable position for labor making labor longer and more painful for the mother. It can also increase the need for other interventions as well.

2. Increased risk of your baby being admitted to the neonatal intensive care unit (NICU).
Babies who are born via induction have not yet sent signals to the mother to start labor. This means that they simply aren't yet ready to be born. This risk is worth it if the baby or mother's lives are in danger, but simply to take this risk for elective reasons may not be well advised.

When a baby is in the intensive care unit there is less ability for you to be with your baby or to hold your baby. Breastfeeding usually gets off to a rocky start as well. This can usually be avoided by giving birth when your body and baby say it is time.

3. Increased risk of forceps or vacuum extraction used for birth.
When labor is induced babies tend to stay in unfavorable positions, the use of epidural anesthesia is increased and therefore the need to assist the baby's birth via the use of forceps and vacuum extraction is also increased.

4. Increased risk of cesarean section.
Sometimes labor inductions don't take, but it's too late to send you home, the baby must be born. The most common cause of this is that the bags of waters has been broken, either naturally or via an amniotomy. Since the risk of infection is greater, your baby will need to be born via c-section.

A cesarean in an induced labor is also more likely for reasons of malpresentation (posterior, etc.) as well as fetal distress.

5. Increased risks to the baby of prematurity and jaundice.
Induction can be done before your baby is ready to be born, because your due date is off or because your baby simply needed more time in the womb to grow and mature their lungs. Your baby may also be more likely to suffer from jaundice at or near birth because of the induction. This can lead to other medical treatments as well as stays in the hospital for your baby.

Being born even a week or two early can result in your baby being a near term or late preterm infant. This means that your baby is likely to have more trouble breathing, eating and maintaining temperature.

Tuesday, September 29, 2009

Birth Services in Southern Utah

Have you ever been curious about home birth? Have you had those "what if..." questions?

Have you ever been curious about waterbirth?

Have you had a cesarean, and were told you have to have another?

A great thing to do, is to ask questions, and interview multiple care providers. I offer free initial consultations, in which you can ( and are encouraged to! ) ask any and all questions you can think of. And the great part is, there is no obligation to hire me as your Midwife. Sometimes the first step is being able to ask all of the questions you are curious about. Like, what happens if an emergency arises?

Home Birth is a safe, healthy alternative for low risk women who want to birth on their terms and in their own environment. For reasons why home birth is safe and a great option, read the last post ( 10 Reasons to Birth at Home )

If you'd like to check out the services that I offer, you can go here: Joyful Birth Services

And to schedule a free initial consultation, email me at, or call 435-216-5411

Saturday, September 19, 2009

10 Reasons to Birth At Home

Many people still see home birthing as weird, crazy, or even dangerous. These same people usually don't take the time to research it, and see *why* women choose to birth at home. ( Well, other than the assumed crazy, paranoid reasons )

So, why don't we take a look at 10 simple reasons to birth at home. I could probably list 100 of them, but I'll start with 10. ;)

10. You remain an autonomous woman throughout labor and birth. You're not treated as a sick person, you don't have to put on a hospital gown, and you're not told what to do.

9. Your husband/partner can take breaks as needed, and he's in his own home. He doesn't have to wander the halls to look for a vending machine or a cafeteria. He can even play video games. ( The big plus to my husband )

8. You can eat and drink as you wish. You are not restricted to ice chips, you are actually encouraged to eat healthy, protein-filled snacks and meals.

7. You don't have an IV. In a home birth, you drink as your source of hydration. There is no IV placed in your hand, and you are free from that cumbersome IV pole.

6. There are fewer complications at home. This is from multiple studies done over multiple decades. At home, fewer ( next to zero ) episiotomies are done. In the hospital, some have a nearly 80% episiotomy rate. At home, fewer babies need help breathing at birth ( 17 times LOWER risk at home ). At home, shoulder dystocia is less likely, even for those HUGE babies. ( even though the HUGE babies are not the ones at more risk for this, despite the myths ) At home, fewer moms hemorrhage. At home, fewer moms tear.

5. There is never a risk of mixing up babies. There is only one brand new baby at home ( well, 2 if twins ), and you know he's yours.

4. There is never a risk of mixing up medications. There are no medications, but even if there were there would be no possibility of getting someone else's meds, and dying.

3. There are no drugs. Now, this may seem like a bad thing to some women, but it's a good thing for EVERY baby. A baby born without drugs, is a healthier baby. You don't put baby at risk for drug-related conditions at birth, when there are no drugs to begin with. And without an epidural, you're not at risk for the myriad complications to both mom AND baby that come with one.

2. As many, or as few people can be in the room with you when you birth. From children to grandparents and anyone in between. And, anyone you wish can catch the baby. It makes birth what it should be - a family event.

1. You are giving your baby the greatest gift of all - a non-interventive, drug-free, peaceful, safe birth...and on your terms, not a surgeon's. There are no birth do-overs, so why not give your baby the best birth possible?

Monday, September 14, 2009

Just beautiful! Woman sings at 10cm in labor...

I thought I would share this, even though it is a hospital birth. This woman has a beautiful voice, and had her nurse/doctor in tears. The video had ME in tears.

Saturday, August 29, 2009

Postdates: Separating Fact from Fiction

What is one of the first things that a pregnant woman hears once she reaches 40 weeks?

“When will your doctor induce you?”

Is there evidence behind this practice to support the routine induction of pregnancies that go beyond 40-41 weeks? What are the usual assumptions and beliefs surrounding this?

• There is a higher risk of the baby being born still
• The placenta will stop functioning
• There will be a decrease in amniotic fluid
• The baby will grow too large

We are going to take a look at the validity of these claims and beliefs, and compare them with what the research has to say. After all, your doctor would never do anything that wasn’t in your or your baby’s best interest, correct?
The first things to really look at are the definitions of the two key words with the pregnancy that goes past 40 weeks. Postdates, and Postmaturity. But is it accurate to start with these terms at 40 weeks?

Postdates – Defined as a pregnancy that goes beyond 42 weeks, based on LMP. The problem with this is that it’s not the same for every woman. Due dates are calculated depending on LMP, but does not usually take into account a woman who has shorter or longer than 28 day cycles. The pregnancy wheel that is commonly used by doctors and midwives, is based on 28 day cycles. If you have a longer cycle, days will need to be added to your EDD ( Estimated Due Date ). This is rarely done however, and women who have longer cycles are held to the same due date estimation as women with shorter cycles. So on paper, you might be 42 weeks according to the estimated due date, when in actuality you would only be 41 weeks. A more accurate way of dating pregnancy is by solidly known conception dates.

Postmaturity – Postmaturity, or Postmaturity Syndrome (PMS) can only be diagnosed after delivery and is defined as a postdates pregnancy accompanied with a combination of the following newborn assessments:

a) No lanugo ( fine body hair )
b) Long nails
c) Abundant hair on head
d) Calcified fetal skull
e) Hanging or wrinkled skin, with the appearance of weight loss
f) Dehydrated
g) Peeling skin

Postmaturity Syndrome also only affects less than 10% of pregnancies that go beyond 43 weeks. The vast majority of pregnant women do not go beyond 42 weeks with correct dates. Some studies show that less than 3% of women go beyond 43 weeks. So if the risk of postmaturity is less than 10% of pregnancies that go beyond 43 weeks, and the percentage of women who go beyond 43 weeks is less than 3% - how big of a risk is it really?

The problem with assessing risk for postmaturity is that modern Obstetrics, and even modern Midwifery, tends to treat all women as equal in pregnancy. Seldom is personal or familial gestation history taken into account, or abnormal cycle and ovulation schedules. These things are important to consider! How healthy would a midwife’s policy of inducing at 41 weeks , be for a woman who has a personal or familial history of going to 44 weeks? We are talking about potentially trying to induce a baby who will be 3 weeks “early” according to their own biological gestation clock. And if the induction “fails”? It will likely result in stress for both mother and baby and lead to more invasive intervention, and possibly a cesarean.

The condition of a baby and placenta all depends on the health and personal history of the mother, as well as the health of the baby – at any gestation. A placenta does not begin to deteriorate automatically beyond 42 or 43 weeks. A placenta can begin to deteriorate at 36 weeks, once again, depending on the health and over all well being of the mother and baby. I have often heard the fear in women of “placental deterioration” after 40 weeks. But as it has been seen, this has nearly nothing to do with length of gestation, as much as it has to do with overall health and maturity of the individual pregnancy and baby. I personally have seen a baby born at 43 weeks, solid dates, absolutely covered in vernix and attached to a very healthy placenta. In contrast, I attended the birth of a 37 week baby who had dry, wrinkly skin, and a calcified and very old looking placenta.

Other important factors include unhealthy habits and complications such as:

• Smoking
• Alcohol
• Drugs
• Diabetes ( Mellitus, NOT Gestational )
• Hypertension

When did 40 weeks become the magical number?

The interesting part in the discussion of postdates, postmaturity, and all that it involves, is the thought that 40 weeks is some sort of magical number. In the past, there was a general “due month”. Women were given an estimation of when they would deliver, based on the known fact that normal gestation is anywhere from 37 to 42 weeks. So when did 40 weeks become this magical number that women fret over and worry once they go beyond it? It has always been that 40 weeks is the general time frame when babies were “due”. But it wasn’t until a study by McClure-Brown came out with date collected from 1958, that showed the perinatal mortality rate doubled from 40 weeks to 42 weeks – from 10/1000 to 20/1000. So it might be logical to assume that inducing labor before 42 weeks would cut back the risk of stillbirth, correct?
The problem is, this study is inaccurate and too old to continue to be of use. Modern obstetrics contradicts the findings in the study published in 1963. And yet, the findings continue to be cited. If we accepted the outcomes in the McClure study, we would also have to accept a 10/1000 mortality rate at 40 weeks! And we know that is not correct. We know that in the 1950s, the majority of women were put under general anesthesia, or twilight sleep, and forceps were commonly used.
Modern Obstetric research actually shows there to be not much of a difference in perinatal mortality rates between 38 and 42 weeks, with a decline in between.
An identically set-up chart to the 1963 study, published in 1982 ( Williams, Creasy ) reads:

• 7/1000 at 38 weeks
• 6/1000 at 40 weeks
• 8/1000 at 41 weeks
• 9/1000 at 42 weeks
• 10/1000 at 43 weeks
• 11/1000 at 44 weeks

A graph from 1987 statistics ( Eden, Sefert ) shows:

• 6/1000 at 38 weeks
• 2/1000 at 40 weeks
• 2.3/1000 at 41 weeks
• 3/1000 at 42 weeks
• 4/1000 at 43 weeks
• 7/1000 at 44 weeks

So according to the second set of statistics gathered above, women were at higher risk of stillbirth at 38 weeks, than they were at 42. Interesting! In the first set, there was only a steady increase, resulting in a very small risk increase. Is the slightly increased risk worth the myriad risks that come with labor induction?

A large study done by Weinstein, et al. , compared nearly 1,800 reliably dated post-term pregnancies with a matched group of on-time deliveries ( between 37 and 41 weeks ). The outcomes were surprising. Perinatal mortality was similar in both groups ( 0.56 / 1000 in the post-term and 0.75 / 1000 in the on-time group ). The rates of meconium, shoulder dystocia, and cesarean were almost identical. What was most interesting, however, was that the rates of fetal distress, instrumental delivery and low Apgar scores were actually lower in the post-term group than in the on-time group.

What about the Amniotic Fluid?

There is a flawed belief that the amniotic fluid will somehow begin to “run out” beyond 40 weeks. There is a belief that women will have a “dry” birth. Let’s start with some basics.
What is amniotic fluid?

• Beyond 36 weeks, amniotic fluid is comprised of mostly fetal urine. When the baby’s kidneys are functioning properly, the baby will continuously produce and process amniotic fluid. The fluid is swallowed by the baby, and then urinated out, once processed by the kidneys.

As long as the mother is adequately hydrated, and there are no congenital abnormalities in the baby, the baby will continue to create amniotic fluid until birth. Whether this be at 37 weeks, or 44. If decreased amniotic fluid is suspected through palpation, an ultrasound can be done to measure the volume found. However, this is not an exact science, as the volume found can – and usually will – vary from ultrasound technician to ultrasound technician, and can also sometimes be dependent on baby’s position. If the levels are found to be on the low side, evidence based protocols suggest having mom orally re-hydrate and return within 24 hours for another AFI ( Amniotic Fluid Index ), preferably by a different technician. This has shown repeatedly to have improved outcomes, versus immediate induction for low AFI levels.
A study published in the Journal of Reproductive Medicine found a significant increase in amniotic fluid after maternal oral rehydration, as well as intravenous hydration, with neither one better than the other. In all, 62.5% and 44.0% demonstrated improved AFI levels.

What if the baby grows too large?

First, who defines “too large”? What is “too large” for one woman, might be the next woman’s smallest baby size. The most important thing to remember is that there is no fool proof way of knowing whether or not your body can naturally birth a baby of whatever size, until you have tried. Ultrasound has a 20% error rate in either direction, and many women have allowed an induction after being told that their baby would be nearly 10 pounds, only to give birth to an 8 pound baby. And, there is no reason for a woman to doubt her ability to birth a 10 pound baby unless she tries. I, for one, never would have believed that I could have birthed my nearly 11 pound baby, especially because I was told that I could not safely birth my 8 ½ pound baby that I was scared into a cesarean with. You never know until you give it a full chance.
Women are often told that a baby will gain approximately a ½ pound per week in the end of pregnancy. However, this is simply an approximation. Once again, this is NOT the same for every woman, or for every baby.

According to a fetal growth rate chart comprised by four studies , a baby will only put on approximately 0.56 pounds – that’s just over half of a pound – between 40 weeks and 43 weeks. And since we’ve shown that most women go into labor before 43 weeks, it can be assumed that it is even less than that. Babies hit a plateau with weight gain around 40 weeks. So really, is there a huge concern to be had over a baby being birthable at 40 weeks, but not at 42 if we’re talking about less than half of a pound? And, does less than half of a pound change the shoulder width or head size of a baby? Hardly. It may give baby chubbier cheeks, or chubbier buns, but will not change the overall structure of the baby, making baby automatically “too large” to birth between those two weeks.

When Should Monitoring a “Post Dates” Pregnancy Begin?

This may be different for each individual pregnancy, each individual woman, which makes cookie cutter policies surrounding post dates, arbitrary. To begin, we have now shown that according to research, doctors, and all basic “rules” that a pregnancy is not even considered postdates until after 42 weeks. Not 40. So if the pregnancy is not postdates until 40 weeks, why do doctors often begin Non-Stress Tests ( NSTs ), Biophysical Profiles ( BPPs ), and Amniotic Fluid Index ( AFI ) at 40 weeks? It goes back to the very flawed study from 1963.

It is up to each individual woman to decide if she is comfortable waiting on monitoring, but if a woman understands that there is virtually no risk difference from 38 weeks to 42 weeks, it should clarify that testing before 42 weeks is mainly unnecessary unless other pregnancy complications are present (i.e. Hypertension, Diabetes Mellitus, IUGR suspicion, Congenital Abnormalities ).

So, let’s take a look at what type of monitoring is available, and how effective they are in finding possible problems.

Biophysical Profile ( BPP ) – A BPP checks fetal body tone, fetal movement, amniotic fluid volume, and fetal “breathing” practices. Each of these are given a score, and then it is added up to give an overall score. A high score of 8-10 usually shows a baby in good health, while a baby who scores 0-4 indicates a baby who needs to be more closely monitored, or needs to be outside of the womb. Scores in between will usually come with more monitoring, including another BPP within 24 hours.

According to Enkin et al., in A Guide to Effective Care in Pregnancy:
There is some evidence that these tests can detect pregnancies in which there is 'something wrong,' but less evidence that their use improves outcome, or can eliminate the additional risk of post-term pregnancy. The only controlled trial shows no advantages of complex fetal monitoring with computerized cardiotocography, amniotic fluid index, assessment of fetal breathing tone, and gross body movements over simple monitoring with standard cardiotocography and ultrasound measurement using maximum amniotic fluid pool depth.

So as you can see, even the detailed testing may not prevent issues that may arise.
According to several studies that researched the accuracy of the BPP, the false positive rates were quite high, resulting in unnecessary induction or further monitoring.

One in particular showed a 21.3% false positive rate for the BPP, and a 39.3% false positive rate for the Non-Stress Test ( NST ). More studies have shown much higher false positive rates for the Non-Stress Test, which is the most common for women who go beyond 40 weeks in care under an Obstetrician.

Amniotic Fluid Index ( AFI ) – An AFI is basically a mini Biophysical Profile. It measures the maximum amniotic fluid pool depth in the uterus. However, as was shown in the beginning of this article, the AFI in a pregnancy can be contingent on several factors. Being dehydrated can lessen the AFI found. The baby’s position can affect how much amniotic fluid is seen. The skill of an ultrasonographer can make a difference in the AFI level found.
It was also shown that AFI levels can be improved with maternal oral rehydration. Often in modern obstetrics, this protocol is ignored, and induction is recommended very much against proven evidence.

Non-Stress Test ( NST ) – The NST is the most commonly used test with women who go beyond 40/41 weeks pregnant, under the average Obstetric care. An NST is electronic fetal monitoring for contractions, fetal heart rate variability, and overall heart rate strength. If a baby is found to be sleeping, stimulation is often used in the form of vibration, a cold drink with sugar ( such as orange juice or soda ), or palpation stimulation.

The NST comes with the highest false positive rates of all of the tests, which is why it has become a controversial test amongst some groups.
Studies have been done that conclude anywhere from a 50%-75% false positive rate on average, sometimes reaching as high as 80-90%. False positives will lead to more testing, more stress, and possibly unnecessary intervention in the pregnancy.

• A pregnancy is NOT “Postdates” until after 42 weeks.
• The risk of stillbirth is nearly a flat line between 38 weeks and 43.
• Amniotic fluid is dependent on maternal hydration, in the absence of congenital abnormalities.
• A baby’s weight virtually plateaus after 40 weeks.

Some things to think about :
• If I am not “overdue” until after 42 weeks, should I allow testing or intervention before this point?
• If NSTs come with very high false-positive rates, is it a test worth submitting to?
• If my baby will not put on much weight within a 3 week period, is it logical to worry about my baby being “too large” within a probable 2 week period?

Please, please always do your own research. Question what you are told - and go study the subject – regardless of whether your OB, Midwife, Family Member, or Friends are the ones giving you the information. Make informed decisions, and take charge of your prenatal care!


McClure-Browne, J.C. 1963. Comparison of perinatal mortality rates versus gestational age through the past three decades. Postmaturity, Am J Obstet Gynecol 85: 573–82.
Journal of Fetal Medicine 1996 Sep-Oct. 5(5): 293-97. Expectant Management of Post-Term Patients: Observations and Outcome. Weinstein D. et al.
Journal of Reproductive Medicine 2000 volume 4 pp 337-340. Effect of Oral and intravenous hydration on oligohydramnios. CHANDRA P. C.; SCHIAVELLO H. J. ; LEWANDOWSKI M. A. ;
(1)Doublet PM, Benson CB, Nadel AS, et al: "Improved birth weight table for neonates developed from gestations dated by early ultrasonography." Journal of Ultrasound Medicine. 16:241, 1997.
(2)Hadlock FP, Shah YP, Kanon DJ, et al. "Fetal crown rump length: Reevaluation of relation to menstrual age with high resolution real-time US Radiology." 182:501, 1992.
(3)Usher R, McLean F. "Intrauterine growth of live-born Caucasian infants at sea level: Standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation." Pediatrics. v.74, 1969.
(4)Wigglesworth JS. Perinatal Pathology, Second Edition. W.B. Saunders Company. 1996. page 24.
Hassan S. Kamel, Ahmed M. Makhlouf, Alaaeldin A. Youssef. Gynecol Obstet Invest 1999; 47: 223-228
Evertson LR, Gauuthier RJ, Schifrin BS, et al., Antepartum fetal heart rate testing. I. Evolution of the non-stress test. Am J Obstet Gynecol 1979;133:29-33
Miller, David A MD; Rabello, Yolanda A MSEd; Paul, Richard H. MD. Americal Journal of Obstet and Gynec. 174(3):812-817, March 1996.

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