We are already well past Thanksgiving. The streets are crowded with Christmas tree vendors, the sound of the Salvation Army bells echo in subway entrances, and holiday lights are glittering in the night sky. This is the beginning of holiday festivities, vacations and planned get-togethers with family and friends. This is also the season for holiday-induced labor inductions.
Not long ago, NPR posted a chart titled, “Which Birth Dates Are Most Common.” Upon examining the chart, I laughed quietly to myself when I noticed that there were almost no births between December 23 and December 26th. However, there was a sharp increase in births the week leading up to Christmas, and then after December 27th, with the most births happening on December 30th.
Why is this? Many care providers do not want to be wandering the hospital halls awaiting a delivery during these days. For this reason, a mother may start to feel pressure from her care provider to move things along, and her doctor may even suggest early labor induction or a push if she is a day or so past the due date.
One of our students heard at her last visit that her doctor was concerned that her baby was measuring big, and wanted to start talking about labor induction if the measurements continued in this trend. Subsequently, her due date is December 28th. She explained that up to this point, every measurement had been normal and her baby being “too big” was never discussed.
Of course, some mothers may also want to avoid the skeleton holiday hospital staff and an unexpected disrupted holiday dinner and request an induction. If these discussions and pressures are coming up, it is helpful to know what is considered “medically valid reasons to induce.”
According to Lamaze International, “induced labor can pose health risks for you and your baby. It’s important to be familiar with the valid reasons for induction, how to spot one that’s medically unnecessary and to know how and when to push for safer care.(2) You may need to begin labor artificially if:
- You’re showing few signs of labor by 42 confirmed weeks of pregnancy.
- You have a medical disease that is not responding to treatment.
- You have certain medical conditions such as high blood pressure and too much protein in the urine (a condition known as preeclampsia).
- Your labor isn’t starting on its own after your water breaks, and you have a Group B Strep positive culture.
- You have a uterine infection.
- Your baby’s growth has been slow for his or her age.
On the flip side, there are reasons that are NOT medically valid.
Suspected macrosomia aka “too big” baby
Fetal macrosomia is defined as either birth weight of 4000-4500 g (8 lbs 13 oz – 9 lbs 15 oz) or greater than 90% for gestational age based on gender and ethnicity. Macrosomia affects 1-10% of all pregnancies. This condition can not be 100% confirmed until after delivery when the baby can be weighed.(3) Significant error has been seen while estimating fetal weight by ultrasound – up to 10%. Depending only on the fetal ultrasound for the estimation of fetal weight can lead to unnecessary obstetrical intervention. It is thus necessary to correlate the ultrasound findings with clinical examination.(4)
American due dates are often determined by “Naegele’s rule” which locates the first day of the woman’s last menstrual period (LMP) adds one year, subtracts three months, and adds seven days to that date. The result is approximately 280 days (40 weeks) from the LMP. This is based on the assumption of women having a 28 day cycle and ovulating on day 14, which is why due dates are estimated, and that only 4-5% of babies are born on their due dates. A few days past one’s due date is NOT considered post term.
Recently, The American Congress of Obstetricians and Gynecologists (ACOG) has redefined the meaning of “term pregnancy” which offers a little more leeway into categorizing “post term babies”.
The following represent the four new definitions of ‘term’ deliveries:
- Early Term: Between 37 weeks, 0 days and 38 weeks, 6 days
- Full Term: Between 39 weeks, 0 days and 40 weeks, 6 days
- Late Term: Between 41 weeks, 0 days and 41, weeks 6 days
- Post Term: Between 42 weeks, 0 days and beyond
Remember, for those who may be feeling pressure to induce earlier than 39 weeks, ACOG now recommends elective induced labor should not occur before 39 weeks of gestation. This is in response to current research evidence showing decreased fetal outcomes in induced labors, and doubled risks of cesarean section.(5)
If these discussions are arising, I encourage you to speak with your care provider and simply ask, “Is mother OK? Is baby OK? Can we have more time?” This will help highlight if there truly is a medical concern and induction needs to be discussed. If you do have a holiday baby, your child may love that growing up. Personally, I am a Halloween baby and LOVE having a combo Halloween/birthday party!
Happy holidays and happy birthing!
Debra Flashenberg, CD(DONA), LCCE, E-RYT 500 is the director of the Prenatal Yoga Center. After several years as a yoga student, she decided to continue her education and became certified as a Bikram Yoga instructor. In 2006, Debra received her certification as a Lamaze® Certified Childbirth Educator. In September of 2007, Debra completed a Midwife Assistant Program with Ina May Gaskin, Pamela Hunt and many of the other Farm Midwives at The Farm Midwifery Center in Tennessee. Drawing on her experience as a prenatal yoga teacher, labor support doula and childbirth educator, Debra looks to establish safe and effective classes for pregnancy and beyond.
The views and opinions expressed on this blog are purely the blog contributor’s. Any product claim, statistic, quote or other representation about a product or service should be verified with the manufacturer or provider. Writers may have conflicts of interest, and their opinions are their own.