Expected Due Date

This has been the thorn in the side to many families and doulas. How do we determine if we will take a client – we ask their due date (among other questions)?

One of the first things a mother will receive when headed into the doctor’s office for the first time is her “due date”. And one common problem family’s face towards the end of pregnancy, are the never ending phone calls about their “due date”, asking why they haven’t had their baby yet. As if to say there was something wrong with this mother because she has failed to deliver on or before the "due date".

Then becomes the further obstacle, the physician wanting to induce because mom has gone past her “due date”, a date that they themselves will admit is just an estimate. The induction rate in America is almost 60%, majority of which is because mom has gone past her due date.

It’s a vicious cycle. I can’t help but to think that this added stress may be the reason many women fear labor. They have had undue stress throughout pregnancy and not left to just be and to trust in her own abilities, because many people are telling her she’s doing something wrong.

Not so long ago, when a mother was asked “when will your baby arrive?” they would say “near the fall” or” in the spring”, they would never say my baby is due on October 26. Then a pinwheel was developed based on one German Doctors’ theory.

Dr. Naegele, circa 1850, determined that the average length of human gestation was approximately 266 days from conception. He assumed that the average woman had cycles that lasted 28 days and that she ovulated on Day 14 of her cycle. However, we know that this isn't true!!

He used his data to come up with a mathematical calculation for due dates:
((LMP + 7 days) - 3 months) = Due Date
EX: ((January 1, 1996 + 7 days) - 3 months) = October 8, 1996

However, Dr. Naegele did not consider certain factors in his calculation. For example: Not every woman ovulates on Day 14. One study indicates that we need to add 12 days to the Naegele EDD for Caucasian, first time moms, and 7 days for Caucasian moms having subsequent children. African American and Asian women tend to have shorter gestations.

Nowadays, doctors use ultrasound, when available or if there is a question of menstrual history. Ultrasound can be an effective way of dating a pregnancy, but this accuracy is lost if not performed in the first half of pregnancy. Not to mention the current controversy as to whether or nor ultrasounds are actually safe for the unborn child. Natural Attachment does not offer or perform ultrasounds and advises against Vanity Ultrasounds (Keepsake Ultrasounds and ultrasounds used to determine the child’s sex).

Most folks agree that there are many ways to date a pregnancy, and that not just one factor should be used to determine the final due date. Other factors to consider are:
• Quickening (first time mom feels the baby move)
• Fetal heart tones heard through doppler, stethoscope and fetoscope
• Fundal height (Measurement of the uterus done throughout pregnancy)
• A mother's Fertility Awareness Method chart

Even a doctor’s predicted due date is nothing more than a prediction. Only 10% of women deliver on the estimated due date. Half of women hit the due date within one week, but 90% deliver within two weeks of the predicted due date. This is why some obstetricians have started predicting due “weeks” instead of dates. ~ O. Wallace

Inducing labor is intrinsically ironic. It works best when least needed and often fails when needed most. It also causes the very problems it was intended to prevent. A German obstetrician in the early 1800s simply declared that a pregnancy should last ten moon months, that is, ten months of four weeks each. However, when researchers in 1990 study followed a group of healthy, white women they discover that pregnancy in first-time mothers averaged 8 days longer, and the average was three days longer in women with prior births. ~Henci Goer

Currently ACOG “recommends” that a pregnant woman not be allowed to go past 41 weeks gestation (however cosniders a mom post-term anything after 42 weeks). That may be valid, if there are signs of the placenta breaking down, growth of baby has been compromised – but how is it determined when a woman is ACTUALLY 41-42 weeks? Currently the system in place does not take all the data into account and women are being induced at 41 weeks determined by that original “due date” that we have now learned to be flawed, which means babies are born earlier, with a higher risk of complications (thus needing prolonged stays in the hospital, lower birth weights, delayed bonding between families and their newborn). Most mother's do not know that 50% of inductions will end in a c-section (The Hazards of Induction, CIMS - www.motherfriendly.org).

To best educate our clients and ourselves we need to know how these “due dates” were developed, why they were, how they are not completely accurate and how to empower these women to trust in themselves and not solely in the expected due date. I suggest that before any women consent to an induction of any type that they take these things into account, they ask their care provider for their bishop score and that they always read The Hazards of Induction on the CIMS website. As doulas we should keep our opinion and thoughts about baby’s well being out of the conversation, stick to supporting them in whatever they decide.

If they chose to move forward with an induction we find peace in that they truly know the risks and benefits, and that they have made the best decision for them and their birth.