The "Don't" Date

     I’m going to step slightly outside pediatrics for one article and focus of the “due date”. I recently experienced a scenario that I saw many times in practice. A daughter of a friend of mine was having her first child and was induced on her due date, even thought she had manifested no signs of labor. The induction involved stripping the membranes, administration of pitocin and rupturing the membranes.  After a day of artificial, drug-induced, ineffective labor, she was exhausted and underwent a C-section. Because of the risk of infection, the baby had to be delivered within 24 hours of membrane rupture.

     The due date – estimated date of delivery – is a estimate at best. It is figured from adding 280 days to the first day of the last menstrual period or from counting back three months from the last menstrual period and then adding 7 days. Either way it assumes that the woman has a strict 28-day cycle and conceived on the 14^th day of her cycle – neither of which is true for most women. Add to that the fact that a term infant is anywhere from 38 to 42 weeks of gestation and you can see how inaccurate the due date can be.

     The problem comes when either the mother or the doctor takes the due date too seriously. It is especially easy for the mom to do this. The social question that everyone who meets a pregnant woman asks is: “When are you due?” the first 1,000 times a mom answers this question, she says, ”sometime in fall”. The next 1,000 times she says, “in mid-September”. But, the next 1,000 times she says, “September 20^th!” The due date gets larger and larger in her mind and gradually a made-up estimation starts to become a real date. I’ve heard mothers say things like “I’m three days overdue” when it is simply three days past the due date.

     I’ve never been pregnant but I appreciate how difficult it is for moms in that last month. They can’t fine a comfortable position for sleeping, eating, sitting or living in general. They hurt when they walk and they are basically miserable – especially if it happens to be August. So, when that due date comes, it’s time to have that baby – they’ve been counting on it for months! The problem is that Nature doesn’t know the due date and the baby may normally come weeks before or weeks after. And first–time moms can be even further off schedule.

     If the body hasn’t gone into natural labor and isn’t ready to deliver, induction methods are often ineffective and result in an exhausted mom who “has been pushing for 24 hours”, a frustrated hospital staff and a worried physician who then too often resorts to a C-section. Statistics say that induction doesn’t result in any increase in C-sections, but it isn’t right to compare C-section rates from this country and say they don’t increase when our rates are the highest in the world.

     It is important for mom’s caregiver to monitor the baby’s growth, but now ultrasound technique has become so good that it is the best way to both determine the baby’s gestational age and monitor development.

     If a mother has gone beyond her due date, but both she and the baby are doing well, it makes sense to monitor the pregnancy more closely and to do watchful waiting. But the due date should be a “don’t date” when it comes to trying to hurry the natural start of labor.