Here is a question (slightly rephrased and summarized) I received by email recently:
“I am currently 29 weeks pregnant, and my doctor told me he would like to induce me if I don’t go into labor by 40 weeks. I was slightly surprised to hear that, because I thought the cut-off point was generally 42 weeks. I was told that after 40 weeks, the rate of sudden fetal death goes sharply upward, and my doctor said I don’t want my baby to “overcook”, since he personally knows of three cases when babies died because their mothers went postdates. I know you refused to be induced and gave birth to your last baby at past 43 weeks, and would like to ask what you think.”
I’m not the person, of course, to be giving out medical advice, but I believe that when it comes to our health, we should make an informed choice. Thankfully, we live in a period of time when information is easily accessible, and by comparing various sources, we can do our own research and make our own considerations. You don’t have to discard your judgment just because you are not a doctor – you are still allowed to think and ask questions.
40 weeks is the time when an average pregnancy usually ends, which means at least half of all pregnancies will naturally end beyond 40 weeks (most, but not all women will naturally go into labor by 42 weeks). That’s the normal course of things. By saying he doesn’t want you to go past 40 weeks, your doctor basically says there is at least 50% possibility you will be induced – and that is not normal. Interfering with normal pregnancy should be a last resort, not a routine procedure.
It’s true that there is a slight increase in the rate of sudden, unexpected fetal death past 40 weeks of pregnancy, however, this increase is not as dramatic as doctors would like us to think while they frighten us into unneeded inductions (many of which are performed for legal, not medical reasons). I currently don’t have internet access so I can’t provide a link, but you can find the actual numbers online.
Even with the help of ultrasounds (and many doctors discard even that and just go by the arbitrary and very imprecise line of LMP), it isn’t always possible to know exactly when a woman became pregnant, and therefore, when she approaches the “cut-off” point of 42 weeks. The woman’s own instinct often provides a far more accurate estimate of when she is due. During my second pregnancy, I just knew I could not be as far along as the doctors said, and the fact that all along, I was told the baby is “small for gestational age” was additional proof. She was eventually born at 43 weeks and 3 days, at a very respectable weight of nearly 3,5 kilos, and with no signs of being “postdates”.
Some women are naturally inclined to have longer pregnancies. It is helpful to know medical history of the family, as well as the woman’s personal history (though if she was repeatedly induced shortly after 40 weeks, there’s no way of really knowing).
Had I fallen into the hands of a doctor who would convince me to be induced at 40 or even 41 weeks, my baby may well had been born with prematurity issues and at a low weight. That’s one risk of inductions doctors gloss over. There is also the fact that use of pitocin and the unnaturally strong contractions it causes increase the rate of fetal distress and emergency C-sections (and of course, if you are induced most likely you will need an epidural, which carries its own risks). Such a scenario only recently happened to someone I know, a young woman only 25 years old. She was talked into an induction at 41 weeks, the induction didn’t work but caused fetal distress, and she was rushed to a C-section where the life of her baby was “heroically” saved. Now, every subsequent pregnancy will be considered high-risk for her, and the chances of a repeat C-section are far higher, carrying with it the risk of more complications.
Taking all this into account, I believe that for a healthy woman, with a healthy pregnancy, going past 40 weeks (and with observation, even past 42 weeks) is less risky than consenting to an induction when there is no obvious medical reason for it (apart from going “postdates”). However, most importantly, I hope you make your own, truly informed choice, without giving in to pressure and scare tactics.
I was blessed to experience two uncomplicated natural births, and it saddens me to think many women would like to have a natural birth as well but are robbed of the experience for no good reason. Good medical care does not mean “medicalizing” a normal physiological process. During pregnancy, labor and birth, I believe medical care should be used as back-up, ready to step into action should anything go wrong, but otherwise not interfering.