Sunday, June 27, 2010

Waiting, on a Soapbox

Warning:  If you find this post offensive.....well, I do too.

I have approximately 5 weeks to go until this baby is expected to arrive.  At 36 weeks, that does not mean I failed math.  It means I am not expecting him to arrive until some time around week 41.  That's right, I don't expect him to arrive at week 38, 39, or even 40.  I don't expect him to arrive on the midwife's estimated due date, which assumes he will arrive at 40 weeks past some guesstimated ovulation date based on a 28-day menstrual cycle.  And based on prior experience, I also don't really expect him to arrive at 40 weeks after what I guess to be my ovulation date based on my actual cycle.
My daughter was born 41 weeks and 5 days after the assumed 28-day cycle ovulation date.  I talked to my OB about an induction at 41 weeks and 4 days for two reasons.  First, I was getting nervous about meconium.  Second, my family had been sitting in my living room staring at me, trying to break my water with their mind powers for two weeks and time was running short on their visit.
I was admitted that night to the hospital so that at 5AM the following morning, they could start pitocin and force my ever-so-cramped-but-obviously-comfy baby out.  At 5:30 AM, I awoke needing to use the facilities.  They had not been in to 'check' me yet, so I was excited that I could sneak a snack before the whole process got started and they had to deprive me of nourishment for their convenience.  No sooner than I sat back down on the bed did I feel a kind of snapish pop followed by a gush of warm fluid.  The mere threat of being forced out, and she decided she was ready to come on her own.  She was born 15 hours later, sans induction.  She weighed 8 pounds, 12 ounces.

Where am I going with this?
People don't wait for babies to be born anymore.  I didn't really wait last time either, I just got lucky; and not just because my water broke on a hospital bed covered in chux pads and not at home one my unprotected brand-new pillow-top mattress...
Did you know the NORMAL human gestational period is between 37 and 42 weeks?  That's right, 42 weeks of gestation is normal.  It's not typical, but it's not pathological.  People get so stuck on "due dates." And then, when they get close to 'the day,'  the thoughts start creeping in that maybe the baby will come closer to the 38-week end of 'normal.'  Next thing you know, you have someone who is 39.5 weeks pregnant but thinks the baby is a week and a half overdue.  Add to that the ridiculous impulse to 'estimate baby's weight' based on some cranial and abdominal circumference, biparietal diameter, and femural length measurements made via ultrasound.  Are parents ever given the disclaimer that 'these are estimates and can be off by as much as 2 lbs?'
I don't know if it's regional, or practitioner-specific, but with Aine, they did an ultrasound at ~20 weeks to check for normal development.  That's the infamous 'gender discovery' ultrasound.  We also had one at about 36 weeks because at 20 weeks I had a low-lying placenta and they were worried about placenta previa.  So was I - considering my spinal fusion, a c-section would mean going under general anesthesia and missing the whole thing.  Not appealing.  So at 36 weeks, everything looked a-ok.  I then had a third ultrasound at 41 weeks, just to make sure baby was not in distress and the placenta was still functioning properly.  Nothing looked 'old,' so my OB saw no medical indication for induction.  At no point during any of these ultrasounds was I told an estimate of the baby's size, nor was my due date 'adjusted' based ultrasound findings.  This time has been fairly similar.  Ultrasound at ~20 weeks - it's a boy - and everything looks normal.  At about 33 weeks, they did another ultrasound to measure fluid levels, as well as a non-stress test, because he wasn't as active as he had been in the weeks before and we needed to check on all the little fetus vitals.  Everything checked out ok.  There are no plans for another ultrasound before delivery.  If something raises concern there will be another, of course, but for 'standard procedure,' it's just the one at 20 weeks, unless we get as far as 41.  My midwife told me they make no attempt to estimate a weight, nor do they change the delivery plan based on some estimated weight because it can be so far off from the baby's actual size.
I hear stories from people about being induced 3 and 4 weeks early because of the baby's size.  I hear expectant moms talk about their plans to have an induction at 39 weeks, despite a healthy pregnancy, just because they don't want to wait anymore.  Where have we gotten it in our heads that a baby needs to be born before the 'due date?'  It's not a term paper.  You don't get extra credit for turning it in early.  In fact, it's becoming apparent that quite the opposite is true.

Two things that I have come across in the past 6 months:
1) Studies are showing that IQ is relative to gestational length.  Don't get me wrong, IQ is but a number and I know plenty of people with ridiculously high IQs who cannot function in normal society.  At some point, a high IQ becomes a definite hurdle.  But if a baby's intelligence for the rest of their life might be impacted by (or at least correlated to) their being permitted to fully develop before exiting their creation chamber, what else might be impacted?  We know that babies born prior to term (37 weeks or earlier) can have life-long health complications.  But now it appears as though, even amongst 'full term' babies, gestational length can make a difference.  I'm talking differences in babies born at 39, 40, and 41 weeks.  If we considered things like this, would we be so eager to have our babies at 38 weeks?
2) Inductions can, and often do, result in a snowball of other medical interventions that would have been otherwise unnecessary.  Don't get me wrong, the ability to perform a surgical delivery in cases where a medical emergency is present is a wonderful, wonderful thing.  It can truly be a life-saving procedure.  But what about emergencies that arise because prior medical interventions have placed mom and/or baby in danger?  I read once that, 'a failed induction is just the body doing what it was meant to do.'  In other words, our bodies are made to house, nourish, and protect a growing human baby until that baby is capable of thriving outside the womb.  When we artificially induce labor prior to this point of preparedness of the baby, the mother's body fights it.  It refuses to allow labor to progress so that the baby doesn't come out.  Usually, in the medical arena, this 'failure to progress' results in greater attempts to push the labor along, which can, in turn, push mom and/or baby into distress.  Now an emergency is on hand and surgery is necessary to remove the premature baby from it's life-source.  If we considered things like this, would we be so eager to have our babies at 38 weeks?

Where is all of this coming from?
I have reached the point in my pregnancy where perfect strangers think they need to tell me that my estimated delivery time must be wrong and inquire as to whether I think I'll 'make it that far.'  They seem shocked when I calmly tell them that I still have ____ time to go and don't expect him early.  They get frustrated when I don't give them a precise date on which my child will arrive.
I have watched friends become antsy about the impending arrival of their babies as early as 30 weeks.  I have seen babies end up in the NICU when their conveniently induced deliveries were actually too soon and they weren't ready for life on the outside.
I have been there, the expectant mother, feeling like a ticking time-bomb, being 'stalked' by friends and family who think, "surely, I should have heard something by now."
I want to give my child the best life possible.  And I do believe that life begins at conception.  And I believe that every decision I make, including those about his birth, can and will impact him for the rest of his life.  And they will impact me. Don't get me wrong.  My daughter has eaten candy.  She's been awake at midnight more than once.  She watched her first bit of TV before the age of one.  Sometimes, she even sips on a soda.  But there is moderation, and I try to make decisions based on what is best for her.
How do I determine what is the 'best' when it comes to birth?  I believe in God.  I believe God created us and designed us as we are.  I don't think he made every other creature (as well as women in every other geographical location on the planet) capable of delivering healthy babies without medical assistance, and then got it wrong with Americans.
I trusted in His timing with the conception of this child.  I will trust in it with the birth as well!  It's almost (or maybe it IS) offensive to me that people are so callous about tampering with something that was designed to work so perfectly.  Especially when the stakes are so high.


  1. Yes, too many people are quick to induce these days even when they have perfectly healthy pregnancies. Crazy how someone can go 9 months but not another week or so. Baby will come when baby's good and ready. Good for you for deciding to stick it out this time (but it worked in Aine's favor anyway). :)

  2. I'm sorry to have been "one of those moms" for all 3 of my pregnancies. I don't argue your points, in fact, I completely agree with them! I was induced with Tize at 39 w 6 days, with Wes at 39 wks and with Parker at 39 wks. Unfortunately for me, my inductions stem from another place. My MIL has Hep C. Completely life-threatening and non-treatable. My parents have 3 other kids that live at home, and are also at a point in their lives when they like to travel a lot. I HAVE to plan (I would prefer not to), in order to guarantee that my children will be taken care of by MY parents. It gives no option for my MIL to argue the possibility of her watching them. It SUCKS! I have wonderful friends, and some that I could use in an extremely worst case scenario, but do not agree with much of their parenting (or marraige skills, which I wouldn't want my children around for 3 days). I would trust my husband dearly with our children, but he does not agree with me in regards to his mother not watching our kids. Therefore, I want him with me in the hospital. It's too much to get in to on here, but I just wanted you to know that sometimes, there are other reasons than "I'm tired of being pregnant" (not that I wasn't). For me, I HAVE to protect my children from a disease that could kill them. Especially since my MIL is far from cautionary. =( I always hope that the next baby will come on his/her own, when MIL is out of town. I would LOVE to experience the "uncertainty" of labor.

  3. Sarah,
    There are always exceptions to the rule. It scares me when the rule is to tamper. I hope you don't gather that I am so callous as to think that there are no circumstances under which it is better for mom, baby, or the whole family to make those kinds of decisions. I'm just an idealist, so I stand on a very idealistic soapbox - that I know in real life isn't always strong enough to hold me :o)

    It's always a relief when things work out well despite our interventions!!