Post Date Delivery

A. What does it mean to be post dates 

Most pregnancies last 37 to 42 weeks on average, or 280 days, from the first day of your last menstrual cycle. Your pregnancy is post-term (or post-date) when you are at41-42 you are considered late term and a pregnancy that is 42 or more weeks is considered postdate or post term. When you get to 40 weeks, your doctor will look at your health and the little one's health and decide whether to wait for natural labor. 

You may have tests to make sure everything is okay. If you and the little one have no problems, you may be told to wait for natural labor. But if the doctor or midwife thinks it would be safer for you and your little one, if you deliver sooner rather than later, then you may get medicine to induce your labor. If the medicine doesn't start your labor or your labor doesn't keep going, you may have a C-section.  

B. What risks are associated with post date pregnancy 

The health risks for you and your little one may increase if a pregnancy is late term or post term, but problems occur in only a SMALL number of post term pregnancies. Most women who give birth after their due dates have uncomplicated labor and give birth to healthy babies. Risks associated with post term pregnancy include the following: 

• Stillbirth- The incidence of stillbirth is increased in pregnancies that continue beyond 42 weeks. However, the actual risk is relatively small, with 4 to 7 deaths per 1000 births. By comparison, the risk of stillbirth or infant death in pregnancies between 37 and 42 weeks is 2 to 3 per 1000 births. 

• Macrosomia- Post term little ones usually continue to grow after the due date, so they have a greater chance of developing complications related to larger body size and macrosomia (macrosomia is defined as a little one weighing more than 4000 grams, or approximately 8lbs 13 ozs, risks increase greatly when your little one is 4500grams or 9lbs 15 ozs or more). Complications can include prolonged labor, difficulty passing through the birth canal, and birth trauma (eg, fractured bones or nerve injury) related to difficulty in delivering the shoulders (known as shoulder dystocia). 

• Post maturity syndrome- Some post term little ones stop gaining weight after the due date. "Dysmaturity" or "post maturity" syndrome refers to a little one whose weight gain in the uterus stops after the due date, usually due to a problem with adequate delivery of blood to the little one through the placenta, leading to malnourishment. 

• Meconium in the lungs of the little one- Beyond term, the little one is more likely to have a bowel movement (called meconium) into the amniotic fluid. If the little one is stressed, there is a chance it will inhale some of this meconium-stained amniotic fluid; this can cause breathing problems when the little one is born 

• Decreased amniotic fluid, which can cause the umbilical cord to pinch and restrict the flow of oxygen to the little one 

Other risks include an increased chance of an assisted vaginal delivery or cesarean delivery. There also is a higher chance of infection and postpartum hemorrhage when your pregnancy goes past your due date. 

After birth, these infants have a distinctive appearance. Their arms and legs may be long and thin. Their skin may appear dry and parchment-like with peeling and may appear loose, especially over the thighs and buttocks. The skin may have meconium staining if the little one had one or more bowel movements into the amniotic fluid in the days or weeks before birth. Scalp hair may be longer or thicker, and the fingernails and toenails may be long. These infants are typically very alert and may have a "wide-eyed" look. 

Few studies have examined long-term outcomes (eg, growth and development patterns, intelligence) of post term infants. In general, the outcome appears similar in both post term and term infants. 

Risks to the mother — Risks to the mother are related to the larger size of post term little one and include difficulties during labor, an increase in injury to the perineum (including the vagina, labia, and rectum) at vaginal birth, and an increased rate of cesarean birth with its associated risks of bleeding, infection, and injury to surrounding organs. 

C. How to stay occupied while waiting for labor to begin 

As your pregnancy gets closer to your due date (or even past your due date), waiting for your little one can be a lesson in patience. If you find yourself in the waiting game here are some tips and ideas to get through the frustration: 

• Distract yourself. Don’t keep focusing on when/if/how… Watch movies, read books, have baths, play board games or cards. 

• Do the things you won’t get a chance to do after your little one arrives. Get your hair and/or nails done, going out for dinner with family and friends, or having a little one free lunch with girlfriends. 

• Stay active. Being active can both get labor going and be a great distraction in itself. Try going for walks (they may be the slow end of pregnancy walks but that’s ok), dance around your house, or bounce on your exercise ball. Of course, make sure that being active is ok with your medical provider first. 

• Stay off social media. With everyone being so much more accessible it can be frustrating when people keep messaging you or inquiring over Facebook or Instagram if you’ve had the little one yet. This doesn’t help your headspace. 

• Have some good laughs. Watch some funny movies, check out a comedy show, watch funny clips on Youtube. Laughter releases endorphins which will improve your mood and is an important hormone during labor. And share the laughs with your partner too… 

• Have sex! Sex is one of the best ways to bring labor on. When mom has an orgasm (or several) this releases oxytocin, the very same hormone that brings on contractions. Also, the prostaglandin in Dad’s sperm helps to soften the cervix. And after the little one is born most couples aren’t interested in sex for some time so “get it” while you can. Again check with your medical provider to make sure that this is ok. 

• Try to treasure this time. If this is your first little one this will be the last time in your life that you are childfree… revel in these last few days the best that you can, I will always the savor time that I had with friends and family during that period. 

• Last but not least – TRUST! Do your best to trust your little one will come when the time is right, and that your birth will happen when it’s supposed to. Do your best to turn your waiting into an enjoyable time. 

D. Safe options for starting labor 

You’ve hit that 39-week mark, and the moment you’ve been waiting for is just around the corner. Oh, the anticipation, uncertainty, exhaustion, and above all, the discomfort. 

It can make those last few weeks, days or hours crawl by. If you find yourself scouring pregnancy blogs and internet message boards for anything you can do to help nudge your body into labor, you’re definitely not alone. 

But are there any natural ways to induce labor that actually work? 

“There’s a difference between generational advice, internet myths and what’s actually been studied and shown to be helpful,” 

We’ve got some bad news for you: There’s no surefire way to induce early labor short of, being induced. So you’ll just have to wait. 

Your body will labor when it’s ready. But there is one natural way of moving things along that has been shown to help. 

Nipple stimulation is the only method that works 

Nipple stimulation is a natural way to increase oxytocin levels. You may be familiar with this hormone’s synthetic doppelgänger, Pitocin®, which is often used to induce labor. Oxytocin kicks childbirth into gear by sending signals that tell your body to start contractions and labor. 

And nipple stimulation is the only method with hard data to back it up. 

more of the women who did nipple stimulation were in labor after three days than those who didn’t. That’s a statistically significant change, and it does not appear to increase C-section rates or bad outcomes. 

Nipple stimulation can be especially helpful if your water has already broken but you’re not yet in labor, or if labor has started and then slowed down. 

I sometimes have people try nipple stimulation before we start Pitocin, but it should only be done under the supervision of a healthcare provider who can monitor the little one to make sure it’s tolerating the stimulation. 

Home remedies for inducing labor 

What about the methods that your family insists will work, and the ones suggested by the well-meaning cashier at your grocery store? Some people swear by natural techniques to get labor underway, but most of them are merely urban legends, with little or no research to back them up. 

Here’s the lowdown on some of the most commonly recommended methods, if they work and, most importantly, how safe they are. Remember: If you’re planning to try any method to jumpstart your labor, discuss it first with your healthcare provider. 

1. Taking a walk 

This is one of the simplest ways that people attempt to get labor underway, but no study has found it to be effective. 

Some people also swear by “curb walking,” an uneven type of walking that is said to cause your pelvis to open. You put one foot on the street and the other foot on the curb, walking with an uneven gait. But there’s no evidence to support this one either. 

That doesn’t mean that walking isn’t worth a try, as it has other health benefits — especially in the lead-up to labor. 

I encourage people to stay active and walk 30 minutes most days, this helps with labor preparation, fetal positioning and endurance.” 

The verdict: Walking won’t help you go into labor, but it may help you feel refreshed and invigorated or, on the other hand, so exhausted that you stop worrying so much about when your baby will arrive. 

2. Eating pineapple 

Pineapple is loaded with an enzyme called bromelain that is sometimes used to help get the bowels moving. It hasn’t been well researched, but the idea behind this tip is that because your uterus sits right next to your intestines, it might also become irritated and start to contract. 

The verdict: If you’re not yet in labor, it’s worth a try, but it’s also probably not going to do anything. It is a healthy snack that will provide a nice dose of vit C, fiber and manganese. 

3. Snacking on dates 

Eating dates may help soften the cervix and promote spontaneous labor, Women who ate date fruit for four weeks prior to their due date were less likely to need a formal induction. 

The verdict: More research is needed, but dates are healthy enough that even if they don’t bring on labor, they’re still a worthwhile snack. Just make sure to buy whole, pitted dates, rather than the kind that come diced up and covered in sugar. 

4. Drinking red raspberry leaf tea 

This herbal tea is rich in iron, calcium and vitamins. It won’t induce labor, but it’s been thought to be safe and potentially beneficial during the third trimester of pregnancy. 

It’s a uterine tonic, so it won’t stimulate or shorten labor, but  it may help spontaneous labor occur and make labor easier. 

The verdict: There’s not enough evidence to say whether red raspberry leaf tea has a positive impact on labor. As long as you’re close to or past your due date, it’s probably OK to drink a cup a day, but check with your healthcare provider to be sure. 

5. Having sex 

Sex can stimulate the body’s natural love hormone, oxytocin, which is what causes contractions. And, semen has prostaglandins, which can soften the cervix, If the body is ready, orgasming can also help contract the uterus.” 

The verdict: If your healthcare provider has given you the all-clear to have sex while you’re pregnant, feel free to give it a whirl, if you’re in the mood. Sex during pregnancy isn’t safe for everyone. 

“If you have placenta previa, bleeding or other pregnancy complications, you shouldn’t have intercourse while you’re pregnant.” 

6. Trying acupuncture or acupressure 

Acupuncture inserts tiny needles into specific locations on your body to try to kick-start labor. Acupressure follows the same principles but swaps the needles for firm pressure and massage, like on your hands and feet. 

The verdict: Feel free to try, but keep your expectations low. 

7. Eating spicy food 

One of the oldest suggestions in the book says that grabbing your favorite hot sauce or getting a fiery takeout dish will hasten baby’s arrival. Not so. 

Spicy food stimulates the intestines, which may then release hormones or mediators that could stimulate contractions in the uterus, but it won’t put you into labor. 

As you may know from past bouts with spicy food, it can also cause diarrhea, which can lead to dehydration — and that’s never a good thing, especially not when you’re pregnant. 

The verdict: Spicy food won’t help induce labor, but if you’ve got a hankering for heat, proceed with caution and keep your own standard spice tolerance in mind. Be sure you’re drinking lots of water to stay hydrated 

Spicy foods is also known to cause reflux, so it’s smart to keep an antacid on hand. Options include TUMS®, Alka-Seltzer® and Pepcid AC®. 

8. Taking castor oil 

If you’ve ever been told to take some castor oil to induce labor, take a pause first. Made from the little-known castor bean, this type of oil is a powerful laxative. 

Castor oil often induces diarrhea, which stimulates the intestines. The intestines then may release hormones or mediators, which could stimulate contractions in the uterus. But neither will induce labor. 

Importantly, diarrhea can also cause dehydration that may lead to decreased blood flow going to the placenta, which can stress the little one. Dehydration can also impact how you feel, especially as you head into labor. 

The verdict: Skip it. Castor oil comes with more possible risks than benefits. 

9. Getting a membrane sweep 

Membrane sweeping, can be done by your physician or midwife once you’ve hit 39 weeks and your cervix has begun to open (known as dilation). They use a finger to separate the amniotic sac surrounding your baby from the area around your cervix (aka your uterine wall). 

One study showed that 90% of women who had a membrane sweep gave birth by 41 weeks compared to 75% who didn’t have the procedure. 

There are risks, like infection, breaking water or causing irregular, irritating contractions that don’t lead to labor, but for some people, it may shorten the length of pregnancy or help lower the chances of needing a formal induction.” 

The verdict: Only your healthcare provider can tell you if this option is right for you, and it’s not safe for everyone. 

For this procedure, you need to be sure you’re GBS negative because of the risk of infection to your little one, it’s also not recommended if you’re showing signs of needing to give birth via c- section 

Other methods that won’t work 

Let’s quickly debunk a few additional myths about ways to induce labor: 

• Bumpy car rides: Seems like gravity and jostling should help, right? Alas, they don’t. 

• Herbal remedies: There’s no evidence that herbal options work 

• Hypnosis: Some people try deep breathing and guided imagery. These methods are safe and may help you get through the process, emotionally, but they won’t get you into labor. 

Is it safe to induce labor naturally? 

It’s not always safe to give Mother Nature a nudge, to try any natural induction methods, you should be at least 37 weeks pregnant and have approval (and, ideally, monitoring) from a prenatal provider. 

The best way to induce labor 

When you’re waiting for your little one to make their debut, the most important thing to do is also the hardest: Have patience. 

I tell people to enjoy the last days of the pregnancy as much as possible, sometimes, you just need a little time. 

No pregnancy lasts forever. Soon enough, you’ll welcome your little one into the world, and after one look at that cute little face, you’re sure to forgive their fashionably late arrival.