Past Your Due Date? When and When Not to Consider Inducing Labour

Worried about inducing labour? Here are some tips to help move things along when your baby is past due

When Aimee* was pregnant with her now 14-month-old son, Leo*, she wanted to avoid having her labour induced unless there was a compelling medical reason to do so. “I’d watched (the U.S. documentary) The Business of Being Born, about how some members of the medical profession want to hurry birth along,” recalls the Brandon, Manitoba mom, “and I’d heard about the risks of induction.” Among other things, induction is linked with an increased likelihood of vacuum or forceps delivery and Caesarean section. Aimee wanted as little intervention as possible.

In the United States, one hospital has halved neonatal intensive care unit admissions for babies between 37 and 38 weeks gestation simply by instituting policies to discourage elective induction before 39 weeks. (This move is due to mounting evidence that those babies born before 39 weeks run a higher risk of various problems, including breathing difficulties.) Guidelines from the Society of Obstetricians and Gynaecologists of Canada say that induction should be considered when it is felt that the risks of waiting to go into labour naturally outweigh the potential maternal and fetal risks of induction. So is it still possible to reduce your chances of having labour induced artificially?

Review Your Due Date

First, ensure your pregnancy is dated as accurately as possible—you may think you’re due when you’re only, say, 38 weeks pregnant. One of the best ways to determine this is to have an ultrasound between 11 and 14 weeks, which is when the margin for error is lowest.
“Research shows that when obstetricians, midwives or family doctors follow a policy of performing ultrasounds for dating, then the number of patients who fail to deliver near their due dates goes down,” explains Eileen Hutton, PhD, a midwife and director of midwifery education and professor of obstetrics and gynecol-ogy at McMaster University in Hamilton.


Read More: Creating a Birth Plan


A Natural Nudge

Another measure that can reduce the likelihood of being induced for post-date pregnancy is something called “stretch and sweep” or “stripping the membranes”—basically an internal exam where your doctor or midwife gently “sweeps” a finger around your cervix to separate the amniotic sac surrounding the baby from the uterine wall in order to stimulate labour. Typically, this is done weekly, starting anywhere between 37 and 40 weeks.

Still pregnant past your due date? Keep in mind that the main risk of going overdue—a slight bump in the risk of stillbirth (less than one percent)—doesn’t start rising until 42 weeks, so unless there are indications your baby isn’t doing well, you can delay (an induction can sometimes take two or more days). Until then, you can also try methods that have been suggested for generations—spicy foods, sex or going on long walks. All are said to stimulate the uterus and ultimately jump-start labour. At the very least, they will pass the time without causing any harm.

Medical Considerations

The decision to induce may be made when your health or your baby’s health is at risk. This may include pre-eclampsia (dangerously high blood pressure in Mom), premature rupture of membranes, pre-existing medical conditions such as Type 1 diabetes, low fetal growth rate, or being at least 10 days past your due date. Worry about delivering a larger than average baby is not a good reason. “Inducing for a big baby has been proven to cause more Caesarean sections and not reduce the incidence of complications from a large baby,” says Ellen Giesbrecht, head of obstetrics and gynecology at BC Women’s Hospital & Health Centre in Vancouver.

If your caregiver raises the possibility of induction, ask questions “so that you understand the reason for the recommendation and the wiggle room you have in changing the date of the induction (if any),” says Toronto doula Amanda Spakowski. “In asking questions, parents can either better understand the reason for an induction and feel more resolved about it, or they may discover they have more time to let their body go into labour on their own.”

Ultimately, Aimee was medically induced at 41 weeks, when her previously active baby stopped moving and tests suggested he’d be better off outside the womb. “If he hadn’t stopped moving, I would have let the pregnancy go longer,” she says. Thirty-six hours later, she gave birth vaginally to her healthy baby boy.

 

*Names have been changed
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