Counting Down

What's Wrong With Going Past 40 Weeks?

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.

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There have been many studies looking into the stillbirth and C-section rates of induced labor vs. waiting for labor to happen, but oftentimes these studies are flawed/missing info. Ultimately, they yield different results and recommendations because of the population they use, the types of providers used to manage pregnancy, the cultural acceptance of what an appropriate length of pregnancy is, and the induction methods that are used.
 
One thing is fairly true for most of the studies- the risk of stillbirth does slightly increase at 41+ weeks, but so do your chances of getting a C-section if you get induced. Other risks of waiting include postpartum hemorrhage, meconium-stained amniotic fluid, meconium aspiration syndrome, and shoulder dystocia. The risk of stillbirth is actually very small, rising from about 0.1% (1 in 1000) at 40-41 weeks to about 0.3% (3 in 1000) at 42 weeks and about 0.5% (5 in 1000) at 43 weeks. Chances are low but are still there.
 
If you choose to go past 40 weeks, you have the right to request additional ultrasounds, non-stress tests, and Doppler flow testing. These tests can help assess the health of your baby and the placenta. Speaking of placentas, you might hear that your placenta is aging, and although many providers blame an "aged" placenta for the risks of stillbirth, this is actually just a theory, and not all researchers can agree. Placental aging during the last few weeks of pregnancy in a healthy mother and baby, is likely just a normal process and poses no risk. It's like having wrinkles when you're older, but still healthy- just aging. However, if a 20-year-old had the wrinkles of a 60-year-old there'd be concerns. Conversely, an aged placenta when you don't have an advanced pregnancy is also a concern. 

If your provider only tells you about the scary risks of going past 40 weeks but fails to mention the risks of induction, then a deeper conversation needs to be had. Both waiting and inducing carry their risks and benefits. Do your research, tap into your gut, and ask yourself which option aligns with your birth outcome. Be sure to trust your body, and your care team, and make decisions fearlessly. I want to be very clear about my opinion. I know inductions can save lives and improve outcomes, but I also know that oftentimes, mothers are coerced into having unnecessary inductions that at times, can be long and traumatic. I stand with the mother and her choices!