The Overdue Baby

Impatience, anticipation multiplies as the agitated mother (understandably so!) waits for her bundle to arrive. In such cases, pregnancy seems to almost go on forever, especially when it crosses the 40th week. Almost 10% of first time pregnancies result in babies being born two weeks later than the due date.

The Good Facts

• While it is a fact that some pregnancies have gone beyond the 44th week, induction mostly happens before the pregnancy crosses the 42nd week
• Studies reveal a good 70% of pregnancies are not postterm at all; the reason for the delay is miscalculation at the time of conception
• Miscalculation happens because of irregular ovulation or confusion over the exact date of the last menstrual period
• With ultrasound, when it is used to confirm the due date, there is a dramatic drop from 10% to 2% in postterm diagnosis
• Early ultrasounds and blood tests for hCG help in confirming the actual gestational age
• Doctors evaluate the situation by determining the accuracy of the EDD (estimated due date) and check to see if the fetus is thriving well
• Many babies continue to grow and do well even after the 10th month, so usually it is not an issue. It only becomes an issue if maternal or fetal health is at stake

The Not-so Good Facts

• Chances of baby becoming too big that vaginal delivery becomes difficult grows as the baby grows larger while still occupying the uterus
• Environment inside the uterus becomes far from ideal as the placenta starts to age and malfunction. This condition is termed placental deficiency or uteroplacental insufficiency. Oxygen and nutrient supply start to dwindle
• Amniotic fluid level starts to drop; sometimes it reduces to a dangerous level, making it increasingly an inhospitable environment for baby to dwell in
• Passing of meconium from the fetal's large intestines into the amniotic sac increases. Breathing in this thick, greenish material causes irritation to the lungs and may result in respiratory problems after birth
• These postmature babies lose some of the fat under their skin and are thin for their age with skin that is dry, peeling, cracked and wrinkled.
• The protective cheesy layering called the vernix found typically in term babies is lost.
• Post-date babies have longer nails and are generally wide-eyed and alert in comparison
• Overdue babies are usually larger in size with wider head circumference than term babies
• The wide head is too large to pass through the mother's pelvis making C-section a high possibility
• Labor becomes difficult because of the lack in proper nutrition and oxygen
• Labor problems intensify if baby inhales the meconium it produced while inside
• Postmature babies are at an increased risk of going through a difficult labor and most likely are delivered through C-sections
• Post delivery, these babies may have to be transferred to the neonatal intensive care nursery for a short while to receive special care

Prevent the Problems

• When it has been confirmed that the pregnancy is past 41 weeks and the cervix has ripened, induction should be performed
• If the mother has complications, regardless of the cervix being ripe or not, labor will be induced
• The cervix may be ripened using drugs such as Protaglandin E-2 gel after which it is either delivery by induction or cesarean.
• Complications in the mother include hypertension, diabetes etc
• Complications affecting the fetus include fetus is faring poorly, meconium staining, inadequate amniotic fluid or the placenta is not doing an adequate job
• Fortunately for most mothers, most pregnancies are not allowed to continue beyond 42 weeks
• Two measures that are thought to reduce the likelihood of having postterm babies are daily nipple stimulation and stripping of fetal membranes.
• These methods are not without drawbacks: nipple stimulation is risky because of the strong contractions it triggers. Membrane strip done by the doctor may rupture the membrane or cause an infection

Prevent a Miscalculation of EDD

• Keep track of the first day of every menstrual period just so you will know in case you become pregnant
• A preconception care visit a few months in advance if you are planning a pregnancy may help
• As soon as you suspect pregnancy, seek prenatal care

Other Highlights

• Before deciding on induction, your doctor will probably verify your records to determine the accuracy of your due date.
• Inaccuracy will be suspected if baby's heartbeat wasn't heard as early as 10-12 weeks using a Doppler device or weeks 18 to 20 using a fetoscope
• Measurements taken during early ultrasounds (before week 20) will also give a clue. Accuracy is pegged on benchmarks of a well-progressed pregnancy such as uterus size, fundal height, timing of the first fetal movements felt by the mother and the timing of the first fetal heartbeat detected by the doctor
• Routine induction done at 41 weeks result in healthier babies and fewer cesareans
• In cases when the pregnancy is prolonged, one or more of the following prenatal tests will be performed to assess baby's well being. These tests include nonstress test (NST), amniotic fluid index (AFI), biophysical profile (BPP) and a contraction stress test (CST)
• Decision will be influenced by the outcome of the test(s): it will either be wait-and-see what happens or induction.