What happens when you’re overdue

The last few weeks of pregnancy can feel the longest. Here’s what to expect if the due date has come and gone, and you’re officially late.

Photo: Roberto Caruso

The last few weeks of pregnancy can feel like the longest, especially if you’re past your 40-week due date. You’re impatient to meet your baby, everyone keeps making super helpful “ready to pop” comments, and you’re so…over…being…pregnant. But here’s the thing: Due dates aren’t set in stone. And a pregnancy is considered full term any time between 39 and 42 weeks. (Note: It used to be 37 weeks. The American Congress of Obstetricians and Gynecologists changed its definition of a full-term baby from 37 weeks to 39 in 2013, but Canadian guidelines are less clear-cut than those in the US.) First-time moms, though, are more likely to be overdue, carrying their babies into the 41st and 42nd weeks.

“If you go into late pregnancy with that mindset, you’re less likely to be frustrated by still being pregnant after your due date passes,” says Heather Hill, a certified birth doula in Edmonton. She counsels patients to expect their baby two weeks before or after the date specified by their doctor or midwife. Even dating ultrasounds, the most accurate means of pinpointing a due date (when done in the first trimester), have a five-day margin of error. Here’s what to consider when you’re playing the waiting game.

Frequent appointments
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Once your due date has passed, expect to see more of your doctor or midwife. Your prenatal care team will use ultrasounds to measure the amount of amniotic fluid surrounding the baby, and they may conduct a non-stress test, which means checking the baby’s movements and heart rate with a fetal monitor. Toronto midwife Jennifer Gardiner runs ultrasounds every two or three days after her patients reach 41 weeks. Topping her list of concerns is the possibility that the baby has had its first bowel movement in utero, meaning it has passed meconium—sticky, dark feces—into the amniotic fluid and is now at risk of ingesting it. The health of the placenta, which can deteriorate or fail (cutting off nutrients to the baby), is also monitored.

Kick-starting labour
The best natural labour inducer is a stretch-and-sweep, also referred to as stripping the membranes. It’s a common procedure often done during internal examinations after the 37th week of pregnancy. Your midwife or doctor will insert a finger or two into the opening of your cervix while separating the fine membranes that attach to the amniotic sac surrounding your baby. It’s uncomfortable but shouldn’t be painful. The stretch-and-sweep may trigger the release of prostaglandin, the hormone that stimulates the uterus to begin contractions. “It is uncanny how many patients will come in within the next 24 hours in labour,” says Douglas Black, chief of obstetrics at the Ottawa Hospital.

Other remedies for kick-starting labour that some women swear by include acupuncture, drinking castor oil (check with your doc before trying this one), eating spicy food, having an induction massage with a massage therapist, going on walks and, of course, sex. Many OB/GYNs, says Black, will prescribe “some bedroom action—who knows what’s going to happen.”

All about induction
Gardiner’s practice offers women inductions between 41 and 42 weeks of pregnancy. Black says he will usually wait until his patients are at 41 weeks and three days. Doctors rarely allow a woman to go past 42 weeks, as it could endanger the baby’s health.

If you were hoping for a home birth, an induction will cause you to edit the plan and deliver in hospital, because an induction makes your delivery higher-risk. If you have a midwife, you will sometimes be transferred to an OB/GYN, though your midwife will still be involved in your care.

A number of different methods may be used to induce labour. If your cervix hasn’t ripened, those prostaglandin hormones are typically inserted into the vagina in the form of a synthetic tablet, tape or gel, which cues the cervix to shorten, soften and thin out for labour.

If your cervix has started to prepare but your waters have not broken on their own, artificially rupturing the membranes may also speed up labour and bring on contractions. In this case, your practitioner will manually puncture the amniotic sac, usually with a device that looks like a long crochet hook. This procedure is usually not painful and should cause a gush of fluid.

If you’ve already had the vaginal hormones, as well as the stripping and rupturing of the membranes, without regular contractions, the next step would likely be medication, which is administered intravenously. During this kind of induction, a drug called Pitocin (the synthetic version of oxytocin, a hormone produced in the brain during natural labour) causes the uterus to start contracting.

Labour is unpredictable, so the best way to prepare is to talk to your doctor or midwife about any concerns and try to embrace the unexpected.

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