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.

Simple things can make a huge difference in improving your labor experience. 

​When we know better, we do better!
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Bonus: Not sleeping or resting in the beginning of labor, especially if you're being induced.

Maybe the hospital amenities or sense of safety have drawn you in. Or maybe you can't imagine delivering without your rock star team. Or maybe hospital births are just the way things are done. Whatever the reason, I'm sure you want to make it the best possible experience and avoid any unnecessary interventions. 

BEFORE YOU GO
•Read up on your hospital's policies and discuss the ones you aren't comfortable with to try and find a compromise or alternative with your care team.
•Tour the hospital and learn how to enter the labor and delivery department (after hours too). Find out what the in-processing procedure looks like, what you can sign ahead of time, and what is done during triage. Ask what signs you need to show before being admitted.

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.

\Let's talk perineal prep and care! Many women wonder if they will tear during a vaginal birth and if they can do anything to prevent it. 

WHY DO TEARS HAPPEN?
Contrary to popular belief, a baby with a larger head isn't always the cause of tears. They typically happen when the perineum doesn't have enough time to gradually stretch due to a baby who's emerging very quickly or if the skin doesn't easily stretch even with a slowly emerging head. During the pushing stage, you might have a provider tell you to slow down your urge to push if they believe the skin hasn't fully stretched. This is easier said than done, but some controlled breathing, small grunts, or laying on your side can help slow down the process.

Tears may also occur if baby is malpositioned. Getting in certain positions can encourage baby to turn into an ideal position to prevent a tear. Laboring upright for too long can also apply too much pressure on your perineum. I suggest you switch positions every 30 minutes. Pushing with an Epidural means you may end up with directed pushing, where the nurse tells you when and how long to push. Directed pushing could sometimes be ineffective and exhausting because you can't properly feel the urge to push or recognize the muscles required to push. I recommend you turn down/off the Epidural at 8-9 cm. so that you can feel your pushing urges and listen to your body. It'll know how and when to push.
Lastly, you're more likely to tear for your first vaginal delivery than subsequent ones.

CAN TEARS BE PREVENTED?
While no one can predict if you'll tear, you can definitely help yourself during labor by forgoing numbing meds such as an epidural or getting a low dose of them. If you are unable to feel your urge to push, the staff will likely direct you to push before your body is ready, before your perineum is ready. This unnecessary pressure against your perineum can increase your chances of tearing.

During labor, a warm compress to the area can help relax the muscles, provide counterpressure, and help you focus on where your pushing muscles are.

Studies have also shown that laboring with a midwife or at a birth center/home setting reduces your chances of tearing. Midwives are known to do fewer interventions, which can lead to tearing. Laboring in a comfortable environment such as your home leads to better outcomes due to your relaxed nature.

Almost fourteen years ago, my husband and I carefully crafted the birth plan for our first child. We attended the 12-week Bradley Method course, read What to Expect When You're Expecting, and Ina May Gaskin's Guide to Childbirth. In my last trimester, I began attending La Leche League meetings and my baby's nursery was stocked and ready for her. On paper, we were prepared, informed, and diligent. We deserved a good birth experience. We were sorely mistaken and looking back at the plan I had saved on my Google Drive only reminds me of how poorly prepared we were. Sure, my plan detailed what I wanted to avoid, how I would labor, and the newborn procedures we preferred. It all checked out...it was easy to read and even buttered up the hospital staff. The goal: healthy mom and baby. Who doesn't want that?
Me. I wanted more.

If I could redo my births, I'd do them at home! But alas, I was young and uninformed. It goes like this: You're pregnant, you see an OB, and you deliver at a hospital, right? Well, I sure wish someone had told me I was an excellent candidate for home birth and that I didn't need to be a hippie to give it a try. In fact, home births and the use of midwives are on the rise but only 1% of births are at home.
The benefits of home birth appeal to many first-time and repeat moms, including those seeking to avoid a repeat C-section. But a home birth is not for everyone and it requires more preparation and responsibility from the parents.

No nurse interrupting your laser focus with her monitoring and cervical exams?
No time restraints or restrictions on movement or nourishment?
No nurse waking you every few hours after you've had baby? Trust me, sleep is hella precious after birth!
Less risk of infection and use of forceps and C-section?
SIGN ME UP, LIKE YESTERDAY!

Still unsure? Read on to calm those doubts.