Overdue babies

It is very common for pregnant women to go beyond their due date. In fact, only about 5 per cent of women actually give birth on the exact date they are due. Most babies arrive between 37 weeks and 41 weeks of pregnancy, but usually within a week either side of their expected due date. Twins and triplets tend to arrive early.

Coping with being overdue

From early in your pregnancy it is best to keep in mind that due dates are only a guide. However, once you hit the 40-week mark, it is natural to start getting anxious. You might be getting particularly uncomfortable or just be excited about meeting your baby.

Here are some strategies to help:

• Keep busy. Plan something for each day so you are not just sitting at home waiting for something to happen. Get out of the house but don’t wander too far! Always take your mobile phone with you.
• Prepare meals for freezing. Once the baby comes, you will be glad for those times when you can just grab something from the freezer and reheat it rather than having to shop and cook.
• Let friends and family know that you will make contact when something happens. They are excited too, but daily calls can get frustrating when you are already frustrated yourself.
• Get some extra rest. Nap during the day if you are finding it difficult to sleep at night. Even sitting comfortably will help build your stores of energy for labour.
• Give your GP (doctor) or midwife a call if you are worried.

The dangers of going past your due date

Most doctors and midwives are happy for you to go a few days over your due date as long as everything seems to be okay. Many will let pregnant women go up to two weeks over.

After 42 weeks, however, the baby’s health might be at risk. A very small number of babies die unexpectedly if they are still in the womb beyond 42 weeks of pregnancy.

It is unclear why the risks of a death of the baby rise as the weeks go by. It may have something to do with the placenta not working as well as it did. If this is the case, the supply of oxygen and nutrients to your baby may be reduced.

Options for when you are overdue

When you go for your 41-week appointment, your midwife or doctor may:

• double-check your due date by confirming when you had your last period
• re-check your dating scan, if you had one
• carry out a blood pressure check and test your urine for protein
• feel your stomach to check the position and size of your baby
• examine your vagina to see if your cervix feels ready for labour.

Your doctor or midwife will discuss your options with you. If your midwife or doctor is happy that everything is okay, you can:

• keep waiting for your labour to happen naturally while your healthcare professionals continue to monitor your baby every 3 to 4 days – this could involve your healthcare professional listening to your baby’s heartbeat or conducting an ultrasound to check your baby's movements and to look at the levels of amniotic fluid in your womb
• choose to have your labour induced.

However, your midwife or doctor might suggest inducing labour (or performing a caesarean section) if they are concerned about:

• your health
• the health of your baby
• the risk that the placenta can no longer sustain your baby’s life
• your waters having broken but with no contractions occurring.

Inducing your baby

‘Induction’ means taking steps to encourage labour to begin. In Australia, about a quarter of pregnant women are induced. Your midwife or doctor (usually an obstetrician - a doctor that has specialised in pregnancy and childbirth, or a GP with obstetric qualifications), will often offer an induction after 41 weeks but the timing will depend on your health and your doctor’s (or hospital’s) policy.

Some policies allow inductions between 7 and 10 days after your due date. Others allow it to go up to 2 weeks. Policies vary because there is no scientific evidence about the ideal time to induce labour.

Medical procedures for inducing labour

If you and your midwife or doctor have decided to induce your labour, the process will begin with the doctor or midwife examining your cervix to see if it is ready for labour. This vaginal examination may be a little uncomfortable, but will only take a few minutes.

Based on the examination, your doctor or midwife will use one of the following ways to induce your labour:

• Sweeping of the membranes – gently separating the membranes from the opening of your uterus with their fingers to try to ‘trigger labour’. This procedure can be uncomfortable and can sometimes cause a small amount of bleeding.
• Artificial rupture of membranes (breaking your waters) – using a small instrument to make a hole in the sac of amniotic fluid around your baby. Your cervix will need to be open a couple of centimetres before the waters can be broken. This can be uncomfortable, especially if your cervix is not open very far. Breaking the waters may be enough to start labour on its own, but sometimes medication such as oxytocin is also required.
• Applying prostaglandin gel – placing this gel (or a pessary) in the back of your vagina to help soften your cervix and prompt it to open. This may be enough to bring on labour, or you may also need your waters broken, or oxytocin to bring on contractions.
• Oxytocin drip – putting you on a drip of the man-made version of the hormone, oxytocin, which brings on contractions. This is given through a drip in your arm, and is often used in combination with the other methods listed. Oxytocin can only be administered when the waters have broken, and is used to start contractions or increase contractions.
• Cervical ripening balloon catheter – inserting a balloon attached to a tube into your cervix, and filling the balloon with saline to put pressure on your cervix. This remains in place for 15 hours, or until it falls out. Over this time it should cause your cervix to soften and open. This may be enough to bring on labour, or you may also need your waters broken, or oxytocin to bring on contractions.

Where to get help

• Your GP (doctor)
• Midwife
• Obstetrician
• Maternal and Child Health Line (24 hours, 7 days) Tel. 13 22 29