Inductions are one of the most common obsteric procedures today.
Teresa was 39 weeks and 4 days pregnant. The office nurse took her to an exam room to prepare for her prenatal visit with me. A few minutes later, the nurse poked her head into my office.
“She’s getting undressed so you can check her,” the nurse said. Since I was new to this practice, I hadn’t realized they routinely performed cervical exams from 37 weeks on. I went into the room and found Teresa sitting on the exam table, a flimsy paper sheet wrapped tightly around her. I introduced myself and asked her a few questions about her pregnancy, her family, and her desires for this birth. After listening to the baby’s heartbeat and measuring her belly, I told her she could get dressed and I would come back in so we could talk some. Her eyes widened: “Don’t you have to check me?”
I explained that checking her cervix would tell me nothing about when she would go into labor, and in fact, could increase her risk of infection during labor. Teresa assured me that she’d rather not be checked unless it was necessary; she had only complied with the nurse’s instructions because she thought she had to. We spent some time discussing her right to decline any procedure we suggested to her. Tersesa seemed appreciative of my approach, and we cordially said goodbye and planned a return appointment for the following week.
Heading back to my desk, I was again interrupted by the nurse. “Are you sure you want her to come back in a week? Didn’t you intend to schedule her for an induction?”
“An induction? Why?” I was suprised.
“She’s going to be 40 weeks and 3 days in one week!” the nurse exclaimed. She went on to tell me that, although the practice’s written policy recommended induction at 42 weeks, everyone in the practice encouraged women to submit to induction at 41 weeks.
“Is there evidence for inducing everyone by 41 weeks?” I asked. The nurse wasn’t certain, and I told her I’d prefer to wait until the next week to discuss induction with Teresa. Meanwhile, I went back to her chart and did some quick calculations.
At her first prenatal visit, Teresa had reported having periods every 45 days, not every 28, as the “due date” calculators are based on. What’s more, she had not had an ultrasound until she was 20 weeks pregnant, at which time an ultrasound can be as much as two weeks off on the dates. Since a woman normally ovulates 14 days BEFORE her next period starts, I calculated that Teresa had probably ovulated about the 31st day of her cycle. That would put her due date 17 days later than the one we had given her based on her last menstrual period. In fact, I noticed her due date based on her ultrasound was 9 days later than the one based on her last menstrual period, but her due date had not been changed because the rule of thumb for 20-week ultrasounds was that you don’t change the due date unless it’s greater than 10 days different than the date based on the last menstrual period. So here’s what Teresa’s numbers looked like:
Last menstrual period (LMP): April 15
Due date based on LMP: January 22
Due date based on a 45-day menstrual cycle: February 8
Here it was January 19, I was being prodded to schedule Teresa for an induction on January 29, because she would then be 41 weeks pregnant. Yet by my estimations, on January 29, she would only be 38 weeks and 5 days pregnant. In fact, if we waited until the last moment to induce her–42 weeks–she would still be three days shy of her due date based on her longer menstrual cycle!
Unfortunately, this is not an uncommon occurence. I have delivered numerous babies who were induced for being “overdue”, yet were born appearing very obviously NOT overdue. What’s happening here? Why are we so paranoid about going more than a few days past the due date?
In my next post, I’ll tell you the rest of Teresa’s story, and unpack the motives behind the push for inductions by 41 weeks.
Oooo – that was such a tease. Now we have to wait for part 2 to find out what happened with Teresa.
This is just another example of HCP refusing to really listen and treat patients on an individual basis. In both of my pregnancies, I was charting and new within 2 days of when I ovulated/conceived. But altho I have only 30/day cycles, I am a late ovulator with a short LP, which means the DD wheels are about a week early with their predictions of my due date. Both times I was pregnant, I offered my chart to my HCP to show them why their date was wrong. They refused to change the due date till an ultrasound confirmed MY date as the correct one.
My due date according to a very early ultrasound (done Oct 22, 2010) was June 11, 2011. I knew that was incorrect. There was only one possible time I could have conceived (as there was only one time I had intercourse during the month of September) so I knew it was more like June 17th or 18th. I told my OB this and I informed him that I would not consider being induced until at least June 24th unless of course there was a problem. I also did not allow him to perform any internal exams until I was 38 weeks along. I told him there was no need for him to do an internal before that as it won’t tell him anything except that I will be having a baby in the near future plus it opens up the chance for infection. He performed his first internal on June 1st and said that it would be at least until my due date if not after that before I had the baby. After 8 hours of drug free labor and delivery, I had the baby on June 2nd at 11:55 PM. He was only 5 lbs. 7 oz. but he was healthy. I think I went into labor early from mowing the lawn that day. Had I gone until June 18th like I expected, he probably would have been about 7 lbs.
I wish more OB’s would be as flexible and understanding as mine. It is my body and baby after all.
Ladies,
It is your body and you have the right to refuse.
A correct due date is also important if you are planning a birth at a birth center – after 42 weeks, it’s no longer an option. My midwives were willing and able to assist a 42+ weeks home birth, but not all midwives are. I can’t imagine being forced to birth in a hospital simply because my baby wasn’t paying attention to the calender. Luckily, he wasn’t quite that “late”, and I was able to give birth where I pleased. We were expecting a big baby, but his little 6 pounds 7 ounce self surprised us all. My midwife said, “He doesn’t look overdue to me.” Me neither!
THANK YOU!!! I am glad you are sharing this story, and as a care provider PLEASE don’t change. I am a L&D nurse and see this kind of care all the time. You are advocating for patients best outcomes, and following good practice. THANK YOU again!!!
My first pregnancy I new exactly when I got pregnant because of a trip to the emergency room the next day for my husband (kidney stones!). However, I did not know when I had my last period, and the initial EDD was based on my estimation of LMP. However, early u/s moved my EDD back almost two weeks! I *knew* this was wrong, because I have PCOS and don’t ovulate on a 28 day cycle. I kept insisting that the EDD was wrong, but of course, technology can’t lie! LOL I kept telling them that their technology wasn’t in the room when I conceived. My daughter was born either at 39 weeks (if you go by technology) or 41 weeks (if you go by when I knew I had sex). With my second pregnancy, I was charting and using ovulation predictors, so I knew exactly when I ovulated and when my LMP was. My son was born at 38 weeks (possibly due to a threatened abruption the night before he was born, but not induced or augmented labor). My kids know when they need to be born!
I only had 1 period between my 2 children, and it was something like late February. However, I know when I was fertile and when conception was likely to have happened, which was on day 31-32 of my cycle.
Fortunately, I had an early ultrasound and their dates supported my dates and the midwifery group used MY estimated due date as the 40-week point. Otherwise, it would be off by several weeks if they went by LMP!
My daughter was born at 40w1d. Totally awesome birth.
To avoid this kind of confusion, I told the doctor’s office ONLY the date of conception. I never gave them LMP, so they couldn’t use it. My daughter would have been 9 days “late” if I had gone by their little wheel; as it was she was born the morning after my due date. Fortunately I had read TCOYF before getting pregnant and was forewarned.
I hope the story has a happy ending!
I’m another one who has a longer than 28 days cycle. With my third pregnancy, I knew the exact date I conceived, so I used that a figured out my due date myself. At my first midwife appt, I told her what day I conceived and what day I was due and she charted that. It ended up being useful in the end because I went to 41w1d. At 41 weeks, the midwives increase monitoring, including NSTs and ultrasounds. I didn’t want to deal with that, I was 5cm dilated at 40w1d, so we’d made plans to have my water broken at 41 weeks. Since that fell on a Sunday, the plan was to meet Monday morning (bought me another day). My daughter was born a few hours before we were supposed to meet the midwives. Using the wheel with a standard 28 day cycle would have put her due date 4 days prior and certainly changed the course of her birth.
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My dates were off. It can be very frustrating. We held out and he cane right on time for us!
I was fortunate with my first baby. My due date was November 15, 1985, my Dr. told me that since it was my first baby I probably wouldn’t have it till the first week of December…I had him on December 7th! That’s 22 days “past due”, he was healthy and wonderful. On the other hand, my third was due mid January, I went into labor what we thought was three weeks early, I had to have a c-section because I was placenta previa, they didn’t stop the labor because it wasn’t too early….his lungs were not developed, he is fine now.
My Dr. didn’t concede to my calculations until the week my baby was finally born! I tried explaining it to him several times through the months, but he still wouldn’t not change the date. And in my case I was over a week further than what he calculated! So my baby was measuring quite large! She was born at 39 weeks 6 days (by my calculations) at 7 lbs 7 oz with good health. And by the way he’d wanted to induce on top of that! (I did schedule bc I was anxious about waiting longer due to my proximity to the hospital, but fortunately I went in to natural labor without needing to be induced).
Ridiculous over-zealous use of harmful drug procedures! I know exactly the day I got pregnant, only gained 18 lbs during my pregnancy, never had a single ultrasound, and gave birth at home to a 8 lb 5 oz. boy exactly 16 days after my due date. Babies do not always follow the norm or a schedule. I even told everyone I knew that my baby was due a full month after his actual due date because I did not want annoying people harassing me about being overdue.
both of my girls were born naturally at 44 weeks 3 days, God knows when your children should be born, as long as they are not in stress, LEAVE THEM IN THE WOMB
My baby girl was almost 3 weeks “late” their dates and mine were the same in the beginning but then moved back later because of the small baby. ( my mother in law is very tiny and we just seem to have small kids ) really don’t think that an induction was warranted. I feel that she knew when to come and would have when she and I were ready within a few days i was totally comfortable and she was super healthy and had plenty of fluid. In the end we had a healthy 8 pounder and a helish experience. I wish Dr’s and midwives went more by whats going on with their patient than what the books say or what their dinner plans are for that week. Here is hoping that our baby boy Due January 21st is allowed to come when he is ready. God bless!
My first baby was given a due date of May 13th based on LMP. I had been charting for several years in my attempts to get pregnant in spite of my PCOS. I KNEW my cycles were NEVER 28 days, yet that is the way they calculated my due date. Thankfully I was able to avoid induction by refusing it and I did do one NST at what THEY considered 42 weeks. My beautiful baby girl arrived on her own schedule on June 5th at 43.2 weeks – but did not appear to be post term at all. Now I am a doula, and my experience has shown exactly what you have pointed out here. I have clients tell me they are scheduled to be induced at 40.1 and cannot tell me the Drs reason for it other than – the baby looks big, or The placenta can deteriorate. So many times they are hesitant to question the Dr. I then have to watch a difficult induction (have yet to see an easy one) and several times have seen babies with signs of late prematurity. It is SO refreshing to hear an OB with your perspective!! Can I send you my clients?!
I have loved reading of everyone’s experiences. I had one C-section, one vaginal birth, one miscarriage, and one ectopic that just about killed me. I am SO grateful there are websites like this out there for women to turn to. I say, KEEP GOING! Don’t give up, and by all means, do NOT stop talking about it! Continue to educate yourself, know your rights, find health care providers that will support you in your rights, and continue to listen to your body. I so wanted to give birth naturally, and was totally devastated with the C-section. I didn’t know enough, and therefore, didn’t feel supported. That very robust, and chubby, 8lb. 13 oz., healthy baby boy is now 21, and skinny as a rail!
Great effort amazing will come back here):
Healthy births are anywhere from 37 to 42 weeks. This is all within “normal” range and as long as there are no other reasons to make any interventions then the baby will come when he/she is good and ready! There is some odd idea circulating that babies need to come ON 40 weeks gestation. Let things take their course.
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