Three Weeks Overdue: When to Induce?

I am now three weeks past my due date and I am swelling. I am concerned because I almost lost my previous child due to the detachment of my placenta. At that time, they could not regulate my blood pressure or the baby's heart rate. We have tried sex, nipple stimulation, walking, jogging and castor oil. Do you think I should ask to be induced?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Induction of labor has risks and benefits and should never be entered into without due consideration of both.

By definition, postmaturity is reached at the last day of the 42nd week of pregnancy from the first day of the last period. This also translates to 294 days.

If you are indeed three weeks overdue, it may be that you are one week beyond postmaturity or that somehow, there has been a miscalculation of dates. Miscalculation is prevalent in modern maternity care for several reasons:
-- Care providers are often too busy -- or actually careless -- in doing a careful history of dates, normalcy of menses, timing of the cycle, possible conception dates and dates of quickening.
-- Women do not seek care soon enough in the pregnancy, when determination of uterine size (and memory about dates) is more accurate.
-- Women are discouraged from seeking early care due to busy schedules, or are being counseled to "wait until the danger of miscarriage has passed."
-- Ultrasound has largely replaced good medical assessment of history and uterine size.

If you are truly three weeks overdue, there are several complications which all care providers should consider:
-- The risk of fetal death and stillbirth is considerably higher in postmature babies.
-- The risk of macrosomia (very large baby) and dysfunctional labor is higher.
-- There is an increased risk for operative delivery (cesarean, forceps and vacuum).
-- More intervention is done for postdates pregnancies (induction, monitors, IVs and testing).
-- The risk of infection and hemorrhage goes up slightly.

The most critical factor in a postdates pregnancy is fetal and neonatal health. Meconium, which is often present in the fluid of a postdates baby, can be aspirated into the lungs. This necessitates suctioning and careful observation to prevent pneumonia.

I'm not clear what you mean by "regulating" your blood pressure and fetal heart rate. If your blood pressure is elevated, and you have significant edema, you should be assessed for pregnancy induced hypertension (PIH). A diagnosis of PIH would alone increase the risk for you and your baby and induction should seriously be considered, especially at this late gestational age.

If your baby's heart rate is not stable, that is, if it does not accelerate with fetal movement (non-stress test) or if decelerations are noted with any contractions (stress testing), induction and a trial of labor is definitely indicated. A cesarean would be indicated if characteristic decelerations are noted.

By now, you should have had several non-stress tests and a biophysical profile. A biophysical profile is a scoring system that assesses the well-being of the fetus and the appropriateness of continuing the pregnancy. A score of 10/10 is perfect. Two points each are given for a favorable non-stress test, fetal movement, fetal muscle tone, fetal "breathing" motion and amniotic fluid volume.

Although I cannot give you a recommendation one way or the other, I've described the standard of care for postdates pregnancies. After reconsideration of your dates, if you are indeed three weeks past your due date, induction or some form of cervical ripening with misoprostil or prostaglandin seems reasonable.

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