We often don't envision ourselves going past our due date, but it's actually a variation of normal. In fact, most first-time moms give birth closer to 41 weeks. As you get close to 40 weeks, you're likely looking at the calendar and wondering how much longer you'll be pregnant. In this blog post, I want to talk about going past 40 weeks. Why is it that many providers want to induce at 41 weeks and what are the risks of going past 40 weeks? 
 
I will start by saying that when a provider recommends an induction is based on their preference, their schedule, your and your baby's health, and the current and possible risks of remaining pregnant. In other words, there's never really a hard and fast rule to induce as it will vary according to those factors. Ultimately, you have the right to decide whether to induce labor or wait for spontaneous labor with appropriate fetal monitoring.
 
The distinction between elective versus medically indicated induction is not always clear. Some providers consider induction for 40+ weeks of pregnancy alone to be medically indicated because of the increased risks of complications that come with longer pregnancies. Others, look into your specific risk factors and manage your care at 40+ weeks with additional testing (NSTs and ultrasounds) to ensure you and baby are doing well. From my experience, with the clients I have worked with, truly supportive providers give them the option to stay pregnant beyond 41 weeks. They offer additional testing to check on baby's development and placental function and rarely induce unless there is a true need...not a possibility of risk.

Sometimes the amount of info out there regarding VBAC can be overwhelming, confusing, and at times plain false! It can be tricky navigating through all that noise, so I've narrowed it down for you. Read on to learn how YOU can stay informed and in control of your care.

Your provider is a key person in the success of your VBAC and it's very important to find someone who is supportive, not just tolerant. Remember that yes, no one can legally force you to have a C-section nor deny you care even if the hospital has a VBAC ban, but it's also important to know ahead of time if your hospital has the tools and staff to support a true C-section emergency. You really can't force a hospital to treat you if they don't have the means. And if your provider is suggesting a repeat C-section, don't dismiss the advice so quickly. Really talk to them about their concerns to find solutions and compromises. Sometimes having a repeat C-section is truly medically necessary and your best option.

Next time you see your provider ask:
•How long will you allow me to remain pregnant? Why do you prefer that date?
•Will we attempt an induction? Which methods will be used?
•How will I be monitored during labor?
•How do you feel about me laboring as long as possible as long baby and I are doing well?
•At what point during labor will a C-section be needed?

Also, ask yourself:​

I'm a straight shooter, so I'll start by saying that there is a time and place for an epidural. Personally, I believe it's overused, rarely necessary, and not fully understood by laboring people. If the immediate and future benefits and risks are truly considered then I see no problem with the use of an epidural. My biggest issue with it is that the promise of quick pain relief overshadows the uncomfortable prep work that is needed prior to administration, the potential risks during its use, and the effects after it's been removed. That being said, there are actual circumstances in which the benefits outweigh the risks.

I'll admit it, there's something about being in a hospital or doctor's office that just makes you want to say "yes" to everything and question your God-given intuition. But you CAN speak up, ask questions, get second opinions, ask for more time, or just say "NO!"

Having a doula who can educate you on the possible procedures and interventions is a great way of using knowledge to your advantage. She can let you know if you can opt out of something that doesn't sit right with you, help you start a conversation with your provider, give you unbiased info on the topic, and provide you with alternatives so that you can choose what's best.

Not many women know they can refuse cervical checks, routine IV fluids, membrane sweep, breaking your water, some monitoring, induction if mom and baby are healthy, unnecessary C-sections, and ultrasounds for non-medical reasons. 

TIPS FOR SUCCESS
•Create a birth plan and have a conversation with your provider regarding your wishes and how they can support it
•Understand possible procedures/interventions and identify the ones you're not ok with (unless necessary) ahead of time
•Providers are legally required to tell you the possible benefits and risks of any procedure, so ask before agreeing to anything
•Your autonomy needs to be respected and you have the right to informed refusal...but the doctor also has the right to disagree to provide care you may request

Click here to learn more about informed consent.

Short answer: No, but they're YOUR choice!
This exam allows the physician to know the status of your cervix...whether it's dilated, ripe, or effaced, and baby's position. However, the physical changes to your cervix aren't the only indicators of a progressive labor. You also need strong and effective contractions and a change in your behavior, where you become much more focused.
Many women don't know they can actually decline vaginal exams during labor. Studies show that routine vaginal exams during labor tend to lead to more interventions and aren't accurate because they're based on the staff's perception. A nurse might declare you to be 6 cm dilated but later an OB with much larger hands might say you're actually 5 cm dilated. The risk of infection also increases every time a check is performed, especially if your water has broken. Also, they hurt like a mother!
One of the biggest drawbacks to this exam is that it can negatively affect the laboring person's resolve and determination. If you're feeling great and in control but are then told you're not as dilated as you feel or haven't dilated enough since your last exam (failure to progress), then you'll likely stress out and begin feeling hopeless. These negative emotions will release stress hormones which can actually stall your labor.
That being said, if you really want to know how dilated you are... the recommendation is no more than one exam every 4 hours and be sure to always get CONSENT. It's important to let your provider know how you feel about vaginal exams during your prenatal visits. Be sure they understand your concerns, support your choice, and are able to provide you evidence-based reasons as to why they believe they are necessary. 
Remember that you're more than a number!