Saturday, October 15, 2011

The double edged sword of the due date:

It is common knowledge in "birthy" circles that the Estimated Due Date (EDD) given to women by midwives and obstetricians in most everywhere is somewhat of a fallacy. Yes, the average time a woman will spend pregnant is 40 weeks. BUT, that is just an average. The normal range for a term pregnancy is 37 to 42 weeks (and based on some people's arguments the range could be as wide as 36 to 43; but for the sake of this post we'll stick with 37-42 as average since it is the accepted norm). Which means that if your EDD is, let's say January 1st, you could have a normal length pregnancy without being either "early" or "late" anywhere from December 11th to January 15th. Quite a difference than focusing on that one day, right?

The thing is, there's been a trend that I've noticed in a lot of natural birthing communities to ignore the first 3 weeks of that range. It is seen almost as a badge of honor to beat the EDD, to go past it. Women are using that 42 week mark as their due date, it's seen as beating the system or being more of a woman to be considered "overdue" by the medical community at large. Especially if you buck the pressure to induce, something that is very very understandably hard to do for both first time moms and mothers with little ones at home who may only have help available for a very short window of time.

And, there is NOTHING wrong with that. I comment women who carry their babies for 40+ weeks without being pressured into a non-medical induction or succumbing to society's pressure to just get that baby out. Scheduling birth is a big trend in our country (I would encourage ACOG to look at elective, non-medical induction, whether suggested by women or their providers, as a bigger 'cause celebre' than homebirth is!), and it's one that many are pressured into by all sides. Even knowing we were planning a homebirth, I started getting phone calls wanting to know when the baby was coming at what we thoughts was 38 weeks with my last pregnancy. And I wasn't even "due" yet! Turns out I was more realistically at 36 weeks; an entire month before when I would have been considered due to have the baby.

BUT, what about those of us on the other side of the spectrum? My children have all been "early." My 3 daughters were born at 36 weeks exactly (according to my OB's wheel; by ovulation she was actually 35w4d), 37w1d, and 37w6d. The first I admit had circumstances that likely contributed to her being born before 37 weeks. I had an infection that left untreated can lead to early labor. And my doctor ignored me when I told him that I wasn't able to keep the antibiotics down long enough to be effective. I did wind up in preterm labor three weeks later (at 33w5d) and spent a weekend in the hospital with magnesium sulfate to stop labor. I was taken off of light bedrest a few days before my daughter was born. If I remember correctly, a different antibiotic was never prescribed after the preterm labor, and I am unsure at this point (almost 6.5 years later) if it was because no infection was present or because it was an oversight in medical care. So, that could very well been a contributing factor in her birth.

The other two, however, came "early" with no prompting from me. I had prodromal labor for at least two weeks before each of their births. With my middle daughter this consisted of hours of braxton-hicks contractions that kept me awake but were clearly braxton-hicks. With my youngest, it meant about 2 and a half weeks of hours long periods of labor contractions that had a definite pattern, involved using breathing and coping techniques. Then? They'd just stop or space out to an obviously not labor pattern. Now, as I'm approaching the beginning of my "due month (late October to early December in my case)" I find I'm having the long periods of braxton-hicks like contractions again. While I have no scientific reasoning, I am guessing on a baby within 4 weeks because of patterns that are showing up as they have with other pregnancies.

Even waiting 4 weeks, which would be my longest pregnancy, I would still be birthing before 40 weeks. And that is FINE with me. I don't like comparing women to appliances, so I don't like when people say I "cook" babies fast or anything like that. I am not cooking an infant, I'm gestating. ;) But, I do err on the side of shorter pregnancies. And, because I am okay with that, because I don't feel bad about not going to 40 weeks or beyond, I've gotten some flack. People saying I "want" a preemie or care more about my comfort than I do my baby's health. And to them I say a two word phrase that I won't repeat here because I made myself a promise not to curse on this blog.

Do I WANT a 40+ week pregnancy? Absolutely not. Let's go with my last, and longest, pregnancy. 37 weeks 6 days. By the end of that pregnancy I could not roll over in bed or get dressed without assistance due to SPD. I was super emotional and full of outbursts of anger from hormones. I felt like I wasn't in control of my mind or my emotions anymore. Doing things with an caring for my older girls was plain HARD and they endured a lot more TV, missed trips to the zoo, and PB&Js than they should have had to deal with. I was dealing with prodromal labor that largely happened overnight, and then had children to deal with all day. Five more weeks of that and I may have lost my mind.

The night before I had my daughter I was cursing and yelling and swearing that I was GOING to be induced that week (at the time we were going with an earlier EDD, but because of my daughter's size, the amount of vernix and some issues with my cycle, I believe an earlier dating ultrasound that had her EDD two weeks later was the more accurate of the two) because I could not be pregnant another second. I was crying at EVERYTHING, and scaring not only myself, but my husband and the big girls. It wasn't a pretty picture. However, even believing I was AT my 40 week mark, I knew I would stay pregnant another 2 or so weeks if that's what the baby needed.

And now, now I would gladly again stay pregnant for 42 weeks. Do I want to? Again, no. This baby's movements are large. My stomach moves more than Shakira's hips! I wake up at night in pain from those movements. The SPD, while more manageable with chiropractic care, is wearing me thin. I have a fractured tailbone and hyperemesis to deal with this time, too. It's been a largely horrible pregnancy. As long as baby is healthy and ready, they can be born as soon as it's safe for them to do so for my preference. But if they need to stick around until the end of the due month, that's okay with me, too. I may complain a LOT about it, but it would be of a venting nature.

Because I don't want a preemie. I've never WANTED a preemie. I was one. I spent most of my first year in and out of a NICU. I wouldn't wish the reality and uncertain health of a preemie on any parent or any baby. I want to slap people when they say I want a preemie; and that is not the pregnancy hormones talking. And while my comfort is important to me, especially right now when there are so many factors attack it, of course my child's health is more important. Worrying about the baby's health versus my comfort is what led me to the natural childbirth movement in the first place.

I guess the point of this post is that the EDD is just that. Estimated. It is the average. And while I commend the women who happily plan for and even relish in 42 weeks of pregnancy, I have to say remember there is another side to the EDD sword. Those of us who make up the early end of that due month curve. And just because we don't carry our baby's in the womb as long and aren't upset about that doesn't mean we should be looked down on. In a community like the natural birth one, full of people that the mainstream world rarely sees as "normal", it'd be nice to have it remembered that for there to be an average there have to be a range both above and below that average. And in this case, unlike our report cards in school, there's nothing better about being above average rather than below average.

DISCLAIMER: This is based on when the BABY chooses their own birthdate and does not apply to inductions before 40 weeks. Obviously there are inductions that are medically indicated before a baby's EDD, and if that is what a woman and her provider deem necessary given their circumstances, I support that. BUT this post isn't about this. When a baby naturally lets the mother's body know to start labor before 40 weeks, there are rarely issues. It's when labor is artificially started that your risks of having complications associated with "early" babies can happen, even within that 37-42 week window.

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