DUE DATE VS. DUE TIME, June 2005

In the majority of prenatal care in this country, women are given a due date - one day, calculated on the basis of the last menstrual cycle, that is the estimated to be the completion of her 40 th week of pregnancy.    Interestingly, one never can know the *exact* day conception happened, and if a woman's period (and therefore, ovulation) is not the typical 28 days (which most women's are not), then ovulation may not be 14 days before, as is commonly thought.   So that one day, the due date, is an educated guess (occasionally it is even changed sometime during the pregnancy if the baby appears to be, for example, one week earlier in gestation than previously thought - but again, it is only a guestimate).   4% of women actually give birth on the due date.

Even more interesting is that a due date is really just the middle date in a whole month that is scientifically considered the due time.    In other words, a baby is full-term, and neither early nor late, if she is born from the 38 th week through to the completion of the 42 nd week!    Very few practitioners take the time to explain this - instead, most women think that their baby should appear in a very short window of a few days before or after the due date.   In fact, many a woman has been surprised if her baby comes even 10 days before her due date (well in range of the overall due time) and many a woman has been frustrated and needlessly worried if her baby is still happily growing inside when the due date has come and gone 7 days before!   

This is important information to consider in today's medicalized birthing world.    Doctors and some midwives don't always honor those 30 days - in many Boston hospitals, it has become protocol to chemically induce women just one week after their due date.   There is no medical reason to do this (in some cases, if a doctor notices something irregular, like low amniotic fluid, there may be a medical indication to consider inducing labor), and in fact, induction leads to a much higher incidence of medical interventions during labor, including a much higher rate of Cesarean surgery.   Also, first time mothers often go past their 40 week due date - one study showed that white women with private care averaged 8 days past their due date (non-white women and women with non-private care generally have shorter pregnancies, for undetermined reasons).   So you can see that if a typical protocol is to induce just 7 days after the due date, many first time mothers will be induced before they're ready, and when it's unnecessary. Additionally, induction at its very basic starts your baby being born before he has sent the signals that he's ready to be born.   Ask your doctor early in your care when she typically suggests induction.   Know her policy, and then let her know if you do not want to be induced unless there is a medical indication.    

I propose that when you are given your due date, start immediately to change your language and your thoughts, and direct them towards your due time instead. ACOG (the American College of Obstetricians and Gynecologists, the main professional body for ob/gyns) even stated in 2002 that doctors should start giving a due month instead of due date.   So, for example, if your due date given is September 1, your due time is between August 18 and September 15!    That probably really changes your perspective on when you should be prepared!    When people ask you when you're due, give them that range instead of one date to fixate upon.   Know that if your baby is born within this range after you spontaneously go into labor, she is not early or late - she is right on time and ready to be born!   Also, just a note:   babies occasionally make their entrance outside of this 30 day period, and that is ok - there are increased risks associated with pre-term or post-term babies, but if babies are close to the due time, they often only need minimal extra care, if at all. Some babies just march to the beat of their own drummer right from birth, and are completely healthy and at full maturity even if they're outside the 4 week due time.   Also, some women, after having more than one baby, see that they have a pattern of always carrying their baby outside of the normal 30 days due time -   3 weeks past the due date for example.   In part this could be because of faulty due date calculation, or just their bodies way of growing a baby and taking a little longer (or shorter, as the case may be).

If you've passed your due date, there are a couple ways you can encourage labor without chemically inducing:

1) Keep practicing yoga - energy flow stimulates all your hormones and your baby.   Moms who practice yoga regularly seem to fall right in their range the majority of the time.  

2) Check in with yourself - are you ready?    Making all the physical preparations lets you psychologically become open to letting labor begin.    I've talked with women whose labors wouldn't start until they stopped working, or until their in-laws left town!   Again, yoga can help you ask these questions and find out if there are any barriers preventing you from letting go.

3) Know that induction (and all interventions) should be a *choice* that's offered to you, and take the responsibility to treat it as such.   Your provider should always be willing to explain the medical indications of any procedure, and then give you time to talk with you partner/family/doula in private before deciding what you'd like to do.   Insist on these things - it will likely make a positive difference in your care, in your birth, and in your satisfaction with your experience.

4) Talk to your baby if you're getting antsy, or feeling pressure from your provider for labor to begin.   Let her know that you honor that it's her decision to start labor, and that she should come when she's ready, and let her know that you're ready now if she is.  

5) There are more holistic ways to induce labor, including using herbs.    Under the guidance and advice of an experienced midwife, doula, childbirth educator, or doctor, you might consider trying these versions of induction before chemical induction.   Common ways to induce are: castor oil, specific herbs ingested, sex, spicy foods, physical activity (brisk walking, swimming, yoga!).   Ultimately, using herbs is still inducing labor, but it works through the whole body, not just in one area (chemical induction with pitocin simply starts the uterus contracting - if your cervix has not yet ripened, it is a painful and often inefficient induction).  

Knowing this information can empower you to make choices, find out your options and explore alternatives.    This can also open a dialogue with your care provider about what their practices are, and give you a platform to express what is important to you.    Lastly, having a due time instead of a one-day due date gives you the most accurate picture of when you may actually go into labor and finally, meet your baby!