As a doula and a student midwife the most common scenario that creates a complication towards the end of pregnancy is the issue of being “post dates”, which is defined as being past 40 weeks gestation. The time period in between the end of week 41 and the beginning of week 42 is the most precarious, where most women are pressured by their care providers to be induced chemically with pitocin, cervadil, artificial rupture of membranes or a foley bulb, or a combination of all of them. It’s certainly not an ideal start to labor if you were planning a natural birth to have the added stress of being a ticking time bomb, so here are 11 ways to prevent this scenario from occurring.
1. Get your dates right. An early ultrasound prior to 10 weeks will give the most accurate dating information to create a due date by. Your last menstrual period, when combined with the actual length of your cycle, ideally based on your conception date, will give the most accurate date that will also most likely give you the most lenient due date window. When there is an option of dating method, opt for the one that will give you the most time.
2. Choose a care provider who isn’t a scare provider. This usually means a midwife who isn’t an agent of the hospital, abiding by their standards. There are midwives who work in birth centers and attend birth at home who will go by your most lenient due date, and support you holistically in the ways I’m about to list below to ensure your baby arrives in divine time.
3. Eat dates! There is actually a scientific study about this: Women who ate dates daily between 36-40 weeks were more effaced and dilated going into labor than women who did not, had a higher incidence of intact membranes (less change of premature water breaking), and a significantly reduced need for augmentation of labor.
4. Get regular chiropractic, acupuncture and bodywork. A body that is aligned, balanced and relaxed has a better opportunity to get baby into prime position to engage labor, and when a mama’s mind is relaxed she is less likely to be in a state of stress, hypothetically preventing labor from occurring naturally.
5. Walk 3 miles a day, minimum. There is a reason there are so many stories from our great great grandmothers working in the fields and just squatting down and birthing a baby. Physical, upright, dynamic activity strengthens, stretches and tones the muscles, helps baby drop down and engage, putting pressure on the cervix and makes for a theoretically easier and more timely birth.
6. Know your tests. Once you pass the 40 week mark, if you are under an obstetrician’s care, a hospital-based midwife’s care or some out of hospital based midwifes care, you may be asked to get regular non-stress tests on baby to ensure they are doing well. If you are labeled “high risk” for any reason there will be even more stress on you to get non-stress tests. Even more accurate that an NST, is a biophysical profile. If there is any question of the baby’s health and induction is being pressed, request a BPP. This test measures 5 factors of health that help you see the big picture. The most common reason I hear for induction is “low fluid”. The thing is, if you were to be induced, most likely they would AROM you any way at a certain point to “get things moving”. Plenty of labors start off with a natural rupture of membranes and release of fluid and healthy babies tolerate contractions just fine with low fluid inside during labor. Low fluid is diagnosed via ultrasound in most cases, which is commonly incorrect. A midwife will palpate your belly and will be used to the feeling of how much fluid is around baby, and will notice if there is a detectable dip in the amount that would warrant concern. It is normal for fluid levels to decrease slightly before the onset of labor! Seek a second (and third) opinion. Increase your fluid intake if this is a concern and eat lots of high-water fruits and vegetables along with electrolytes to stay very well hydrated.
7. Have sex. Once you hit 37 weeks, you are considered at term, and its time to start ripening up. Ripening means that the cervix gets softer, thins out, and starts to dilate, and baby beings to drop… like a ripe fruit. Sex releases oxytocin, which is released during labor. Orgasms can get oxytocin flowing and you might notice an increase in the intensity and frequency of your toning contractions aka Braxton Hicks. Sex with ejaculation if you are in a hetero relationship releases prostaglandins which help to ripen the cervix. Having sex also loosens up the hips and increases circulation in the whole body, reducing stress and relaxed mamas tend to go into labor in a timely fashion.
8. Get acupuncture. Starting at 37 weeks, see your acupuncturist for ripening treatments. If you don’t like needles you can have your practitioner use the electrostimulator instead, with seed stickers that can stay on the points after your session so you can stimulate the points yourself.
9. Get an induction massage. A good induction massage will pay attention to the acupressure points in your upper shoulders, feet, ankles and sacrum as well as help relax and release muscle tension in the piriformis, obturator and hip flexors. Application of massage oil with clary sage and jasmine can also help get contractions going.
10. Practice spinning babies exercises starting at 24 weeks. The three sisters, rebozo sifting, forward leaning inversion and side lying release are all wonderful and safe exercises to do on a daily basis as you are preparing your labor. These exercises help release ligaments and muscles that hold your uterus and skeleton and patterns that do not encourage ideal alignment. Often a labor may be stalled from initiating because baby is still working on turning and dropping down into an ideal position to start labor. This is where inducing can really mess things up- if baby hasn’t dropped yet and is in a posterior position at the beginning of labor and pitocin is started, the waters are artificially released and mama is made to lie down with an IV and is on drugs because of the strong effect of pitocin, that baby doesn’t have a very good change of turning and dropping down into a more preferable and smaller diameter anterior position. Babies certainly do come out posterior or “sunny side up”, but any mama who has had this type of presentation or labor (sometimes they turn mid-way through labor) will attest to the insanely excruciating pain that back labor is! Posterior babies skulls press on your spine as they move down, as opposed to the face and belly of an anteriorly positioned baby.
11. Surrender. Surrender is trusting and accepting. If baby is fine and mama is fine, there is no need to rush nature. Of course if there is a legitimate medical concern and baby must come out, baby must come out, I just implore you to consider all your alternatives, all your choices, seek second and third opinions, and always follow your own intuition.