Pregnancy beyond the term, risks and advice of the midwife

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Childbirth over the term

The 40th week arrives, the presumed date of birth, but the baby has no desire to be born. The anxieties rise, the worry that something is wrong grows and the questions grow as to why this child just can't decide. In this article we will address these doubts, trying to clarify what a pregnancy and over-term birth, What are the risks and what to do to try to help our baby to come into the world.

Calculation of the term of a pregnancy

First of all, let's start by understanding together what it means term of pregnancy and how it is calculated. The modalities are basically two: using the date of the last menstruation or using the dating ultrasound data.

  1. The first method is simply to calculate 40 weeks from the start date of the last menstruation, which is about 9 months. The fortieth day is the day of the presumed date of birth, the term of pregnancy.
  2. The ultrasound method is based on the same principle, but the calculation is carried out based on the child's measurements. In fact, it may happen that ovulation and fertilization occurred after the canonical period of 14 days after the start of menstruation. So the baby will be a few days smaller.

What does it mean baby measurement? The actual measurement of its main parts, in particular the total length which is statistically attributed to a given week of pregnancy. Let's take an example, at 10 weeks the length of a fetus is about 33mm, so if during the ultrasound the gynecologist sees that the baby measures 33mm he will deduce that we are at 10 weeks. And in this way he will come to date the pregnancy, automatically calculating the term.

Read also: Time's up and the baby doesn't want to be born. What to do?

What is pregnancy beyond term

After forty weeks, however, we cannot immediately define the pregnancy beyond the term. This because the dating of the pregnancy is never accurate. It is possible that there are variations on conception or that, for example, a baby is longer than the average of his "peers" and therefore is larger on ultrasound measurement. For this reason we still give ourselves a few days, usually 5-6 days before understanding how to intervene and whether to intervene. From definition of scientific literature the pregnancy beyond term è the one that continues beyond the 42nd week. Up to 41 plus six days is still term, beyond it becomes protracted pregnancy or beyond term. To date, in fact, almost all hospitals do not expect that long to intervene, at 41 weeks and 2 days they are already thinking about hospitalization for the induction of childbirth. The reason? Surely the fact that the risks associated with prolonging the pregnancy are reduced. Speaking a little bit of statistical data we can say that pregnancy beyond the term affects about 3-10% of total pregnancies and that it is more frequent in women to their first child or in women who have already experienced this event in previous pregnancies.

Childbirth after the deadline, the causes

In reality there are no established causes for which it is possible to univocally establish a relationship with the I leave after the deadline. That is, there are no factors why it is said: I have this then I will give birth later. There are indirect associations, some factors can lead to childbirth beyond the term but not with absolute certainty.

  • Among these, as we have already said, are the miscalculations in dating pregnancy or familiarity, or when there has already been a history of over-the-term births in one's mother or previous children.
  • Some small studies have tried to show association with certain drugs such as NSAIDs (non-steroidal anti-inflammatory drugs). Indeed, at very high doses they can delay the release of labor hormones, but before stopping them, the reason why they are taken at high doses must be evaluated. For example, aspirin can be important to avoid thrombosis in some situations, so always contact the treating gynecologist before stopping a drug.
  • A probable association has also been noted between women who take contraceptive pills for long periods before pregnancy and childbirth beyond the term, but in this case the reason would be related to the miscalculation, i.e. delaying ovulation, conception occurs after and therefore the date of the last menstruation is no longer valid as a reference point. In this case we will rely only on ultrasound data.

The risks of an after-term birth

As we said above, the fact of not waiting 42 weeks before inducing birth is motivated by the reduction of risks for both the mother and the baby's well-being.

  • Increased anxiety

As far as the mother is concerned, the first risk factor of all is increased anxiety. This is not only from an emotional-psychological point of view. Stress and anxiety trigger a response in our body that releases a hormone, the cortisol. Cortisol has a similar structure to oxytocin (the hormone responsible for initiating and maintaining labor) and prevents the rest of the body and in particular the uterus from binding with it and starting labor. It is a kind of vicious circle, the more cortisol is in the circulation, the less oxytocin is produced and read, the less easy it is for labor to start spontaneously and therefore stress increases.

  • Caesarean section

Maternal physical risks, on the other hand, are substantially linked to those of the child. The more the baby is in the belly, the more it grows and the risk of passing the maximum weight threshold for spontaneous birth (4500gr). Beyond this weight, the risk is to have to intervene with the Caesarean section. However, even approaching 4500gr can give the mother problems such as important lacerations, very long births and consequent medical interventions to shorten them (operative parts).

  • Child mortality

The risks closely related to the child are related to his own mortality. A child born at full term has a mortality of 1 in 3000 pregnancies, if it remains beyond 42 weeks of 6 out of 3000 pregnancies, practically 5 times more. This is because the space begins to be restricted, the placenta begins to stop working and therefore to no longer bring oxygen and nutrients to the baby and finally it is possible that the baby, as a result of the lack of oxygen, makes his first poop inside the belly. and then suck it (causing the so-called meconium aspiration syndrome).

So surely there are risks but I would like to reassure the fact that the situation does not exactly precipitate at 42 weeks. The growth of the various risks is proportional to the time that passes from the term of pregnancy, for this reason we can afford to wait a few days and observe the situation, certainly not to put mother and baby at risk.

Time is up. Advice

Many of you ask me for advice on what to do if there is not the slightest sign of labor in the 40th week. As we understand the answer in this case is: nothing. That is do not be alarmed if at 40 weeks and 1 day he is not yet born, for all the reasons we mentioned earlier when we talked about calculating the term of pregnancy.

  • Certainly the first thing to do to entice the baby to be born is speak with him. I know it will seem absurd to you, but I don't mean that you have to go around the street talking to the belly. That is, you can do it but it is not necessary. Talking to him simply means stopping and thinking about him, thinking about what you would like to happen, thinking about what he / she will be like. This alone is enough for our brain to circulate precisely oxytocin, which in addition to being the hormone of labor, is the hormone of love, of the maternal and infantile bond. The higher the dose of oxytocin, the more it will be able to counteract anxiety and cause labor.
  • Absolutely no walks and exhausting physical efforts are needed as I hear some grandmothers advise, quite the opposite. Our body knows how much effort it has to do to face the birth of a new life and if it does not find the necessary strength among its reserves, it simply does not let it go. So rest as much as possible in preparation for what is to come. Rest does not mean doing nothing, it means carrying out daily activities but carving out the right time to stop and relax when you are tired.
  • There are actually gods natural, herbal or homeopathic remedies, which can be useful for the induction of labor but to be able to take them it is strictly necessary that you are followed by a person competent in this area. Natural is not synonymous with harmless, plants also have very powerful effects so in this case it is good that you contact your midwife or your trusted naturopath / homeopath.
  • Finally I would like to recommend something that makes many smile: sexual activity. It is not a popular rumor that sexual activity in the case of pregnancy beyond the term can favor the onset of labor. You will say, but with this belly? And don't we hurt the baby? Yes indeed the belly could be a little uncomfortable but you can free your imagination to try other more comfortable positions. And no, don't hurt the child who is lulled by the movement of sexual intercourse. And then, last but not least, sexual intercourse puts into circulation a series of very important hormones, first of all endorphins that make the child feel loved and desired, that protect him from pain and fear. Oxytocin is also produced during and immediately after sexual intercourse, and this, as mentioned, can help trigger contractions of labor. So go ahead.
  • As you may have guessed, there are not many things that can be done from the point of view of prevention of pregnancy beyond the term. These are simple, sometimes trivial, measures that can help unblock the situation but do not give 100% certainty that this labor starts spontaneously. For this reason, medicine takes over, if all this were not enough, don't worry, they certainly won't let you risk going much beyond the deadline. They will intervene with induction and they will ensure that you can have your baby in your arms and start your journey as mothers.
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