ACOG: Post Dates is Past 42 Weeks

The American Congress of Obstetricians and Gynecology, also known as ACOG:

“Founded in 1951 in Chicago, Illinois, ACOG has over 52,000 members and is the nation’s leading group of professionals providing health care for women.”

From their website: 

ACOG works primarily in four areas:

• Serving as a strong advocate for quality health care for women.
• Maintaining the highest standards of clinical practice and continuing education for its members.
• Promoting patient education and stimulating patient understanding of and involvement in medical care.
• Increasing awareness among its members and the public of the changing issues facing women’s health care.

Basically they are…medical.

What does ACOG say about women who go past the estimated 40 week due date? I wanted to find out and they indeed have their recommendations and opinions on post dates in a handout here. I would like to take a look at it and break down what is recommended to OB’s when it comes to due dates of pregnant women and babies.

“Waiting for the birth of a child is an exciting and anxious time. Most women give birth between 38 and 42 weeks of pregnancy. But very few babies are born on their due dates. It is normal to give birth as much as 3 weeks before or 2 weeks after your due date.”

That’s right, most women give birth between 38 and 42 weeks. NOT 38-40 weeks. Very few babies are born ON their due date, because it’s just an EDD…ESTIMATED due date! Giving birth between 37-42 weeks is NORMAL according to ACOG.

“The average length of pregnancy is 280 days, or 40 weeks from the first day of a woman’s last menstrual period.

Your due date is used as a guide for checking your pregnancy’s progress and the baby’s growth and age. Doctors often use more than one method to check the age of the fetus and set the due date. The size of the uterus may help assess the age of the fetus. Ultrasound also may be used to help confirm the age of a fetus.”

Your due date is a GUIDE for your OB or midwife to check progress of baby’s growth. As ACOG states here, there is more than one way for an estimated due date to be given. Meaning there is fluctuation and differences in how a due date is determined. A due date is not the exact day your baby must be born by, it’s just a guide to know around when baby will be ready to be earthside. Talk to your care provider about different methods to check due dates including basing it off of your last menstrual cycle, your date of ovulation, an ultrasound (earlier the better) and the Naegele’s Rule.

“A postterm pregnancy is one that lasts 42 weeks or longer. Women who are having a baby for the first time or who have had postterm pregnancies before may give birth later than expected.”

Did you get that? Let me write it again. A postterm pregnancy or a post date mama is once she passes 42 weeks. Not 40 weeks, not 41 weeks 2 days, but 42 weeks is considered post dates. ACOG even says that first time mamas or other women who have previously had postterm pregnancies prior may in fact give birth later than expected!!!

AGOG goes on…

“Health risks for the baby and mother increase if a pregnancy is prolonged. The more prolonged the pregnancy, the greater the risks. But problems occur in only a small portion of postterm pregnancies. Most women who give birth after the due date have healthy newborns.

After 42 weeks, the placenta may not work as well as it did earlier in pregnancy. Also, as the baby grows, the amount of amniotic fluid may begin to decrease. Less fluid may cause the umbilical cord to become pinched as the baby moves or as the uterus contracts. For these reasons your doctor may recommend delivery before 42 weeks of pregnancy.

If pregnancy goes past 42 weeks, a baby has an increased risk of certain problems, such as dysmaturity syndrome, macrosomia, or meconium aspiration. There also is an increased chance of cesarean birth.”

Remember…prolonged is past 42 weeks. It is OK to awknoledge there is a small increase of risk the longer the pregnancy. The more time there is, the more chance for an increse of risk. ACOG states though that although there is a tiny increase past 42 weeks, that risk is very small and most women who give birth after their due date do in fact have healthy babies.

Yes, the placenta is going to keep maturing. It is my belief that if the placenta is done doing it’s job, labor will begin. I have had four placentas nourish my babies between 42-44 weeks as have many other women. Do I have a study to back up that belief? Nope. I think that would be rather hard to study. Once again, placentas are going to do their job and while there may be a small risk of lower fluid and the other problems listed past 42 weeks, this is where you can talk to your doctor or midwife about keeping a closer eye on baby if that is what you are comfortable with.

Personally, with three of those pregnancies I had ultrasounds past 42 weeks to check on baby. No shame in that! I could see my placenta was doing well, there were plenty of fluids, growth was good, heart was healthy, the position of the baby, etc. On a side note, I think ultrasounds are overused and can cause unnecessary interventions. However, they can be a very beneficial tool. It’s about being educated so you can know if there is a cause for concern and an intervention is necessary or if it is something as ‘baby is big’ you know you can continue to gestate in peace.

Speaking of ultrasounds, ACOG continues with tests for fetal well being…

Tests can help the doctor check on the baby’s health. Some tests, such as a kick count, can be done on your own at home. Others are done in the doctor’s office or in the hospital. These are called electronic fetal monitoring and include nonstress test, biophysical profile, and contraction stress test.

A kick count is a record of how often you feel your baby move. Healthy babies tend to move about the same amount each day. Your doctor will explain how to do a kick count.

Electronic fetal monitoring uses two belts placed around the mother’s abdomen to hold instruments that measure fetal heart rate. This method is used to perform the following tests for fetal well-being:

Nonstress Test—The mother pushes a button each time she feels the baby move. This causes a mark to be made on a paper recording. Sometimes, a device may be put on the mother’s abdomen to make a sound every few seconds. This is called acoustic stimulation. The fetal heart rate is expected to increase when the fetus moves.

Biophysical Profile—This test combines the results of electronic fetal monitoring and an ultrasound exam. It looks at the baby’s heart rate (using the nonstress test) and estimates the amount of amniotic fluid. The baby’s breathing, movement, and muscle tone also may be checked.

Contraction Stress Test—The baby’s heart rate is measured when the mother’s uterus contracts. The contractions are induced, and changes in the fetus’s heart rate are noted.

You can discuss all of these options with your OB or midwife. You can do all or none of them. Yes, I’m going to say it…listen to your intuition. Listen to you gut. Do not underestimate the connection you have with your baby. This goes both ways though. You may feel all is well and you do not need any tests. I have been there and continued to gestate in faith and good health of myself and my baby. However, you may feel that you need a test, an ultrasound, an intervention. Although it may not be what you want, but respect that and follow through! Been there too and I listened.

For more on what ACOG says about due dates, you can read their Education Pamphlet (you could even print it off for your OB). Looks like ACOG and I have found a middle ground on something that I mostly agree with. Now, if only this belief and faith in the women’s body was practiced in Obstetrics. That would be something!

Just for fun…