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Your Due Date and Inductions

FROM the first moment a woman realizes she’s pregnant she wonders, “When am I due?” In fact, this may be the most anticipated piece of information that her care provider will tell her during her first prenatal visit. Additionally, it is probably the most frequently asked question she will hear in the coming months. As her pregnancy progresses, it may also become the most anticipated date of her life!

Fortunately, there is scientific research to provide an estimated due date. This is typically done by calculating approximately forty weeks from the woman’s last menstrual cycle. Additionally, measurements taken during an ultrasound scan are used to estimate the gestational age of the baby. There are also other, less scientific methods, for guessing the due date. These can include calculations based on the mother’s first notice of fetal movement, among others.

History of Due Dates

Interestingly, the most commonly used method is based on the research of a German doctor in the 1800s. His findings are what the forty week gestational period is based on. But it’s important to note that this assumes a twenty-eight day menstrual cycle. It becomes increasingly inaccurate if your cycles do not fit into his assumption of a normal twenty-eight day cycle. In fact, a Harvard public health study indicated an average gestation of forty-one weeks plus one day. This study suggests that the date given by your care provider is likely to be eight days early!

Ultrasound Dating

Ultrasounds give us the ability to measure the baby’s growth. The ultrasound software then estimates the due date by comparing these measurements against a normal range for size. It’s important to note, however, that every baby grows at a different pace. In fact, it is logical to consider that shorter parents might just have smaller babies than taller ones. Because of this, ultrasound dating is considered less accurate the further along the pregnancy is. In fact, early ultrasounds have a margin of error of approximately plus or minus six days and late term ultrasounds have a margin of plus or minus two weeks!

Probability of Due Date Delivery

Most care providers will acknowledge that the due date is only an educated guess and consider two weeks on either side of the date to be within normal range. Realistically, your chance of spontaneous birth occurring on your due date is only about 4%; whereas the probability of delivering within thirteen days either side of your due date is roughly 70%. That still leaves an over 25% chance that you will deliver more than two weeks before or after your due date.

Importance of Due Dates

It’s important that expectant couples take note of the word “estimated” when considering their due date. A due date really is nothing more than an educated guess as to approximately when your baby might be born. Notice all of those ambiguous words?

This is especially important information for couples who are encouraged to consider a scheduled induction of labor. Because I am not a doctor, I can never advise you with regards to your particular medical situation. Therefore, I would never tell you what you should do. But I do want parents to be informed of the very normal range of gestation so as not to be rushed into a decision that carries increased risks to the health and safety of both mother and child.

Scheduled Induction

It is of major concern to me when I speak to expectant mothers, time and time again, who are being encouraged or advised to schedule an induction. Typically the suggestion for induction starts at about thirty-eight weeks gestation (two weeks before the estimated due date). The suggestion for induction will usually get stronger and more demanding as her estimated due date approaches. If she reaches, or passes, her estimated due date, the suggestion for an induction may become more of an order or a threat, than a suggestion.

I personally must question the agenda when the medical provider starts discussing medical management of the birth date, especially prior to the estimated due date. If the pregnancy is healthy and uncomplicated, my concern turns to the doctor’s trust in the natural process.

Unfortunately, if the doctor in question does not trust birth, he or she will be inclined to medically manage as much of the process as possible. In my humble opinion, this is a sign that he/she has a fear of birth to the point that they feel a need to dominate and control every aspect of the event.

Trust Birth

As an advocate for natural birth, I would not want to put my trust and body in the hands of such a provider. Personally, I trust Allah’s design of our bodies and accept the fact that birth is unpredictable and much of it uncontrollable. I also recognize the many inherent safeguards that our Creator has built into the pregnancy and birth process. Having said that, I also understand the value of childbirth education. Learning about these safeguards allows us to prepare for birth in order to work with our bodies to maximize them.

Respect for Doctors

In all fairness to doctors, I must express my respect for their training in pregnancy and labor abnormality. They are the experts and our safety net when complications do arise.

Additionally, true postmaturity is an illness and means more than simply past estimated due date. In fact, it is a real risk for babies as the placenta ages and is not able to adequately nourish the baby. However, only seven percent of babies go beyond forty-two week gestation. Even of those that do, true postmaturity is extremely rare.

As for the perception of their need to manage or control the birth process we should consider three factors:

1. Medical training teaches about complications and interventions to reduce risks and save lives. Often times, doctors prefer induction because they can’t guarantee that something bad might not happen if they wait.

2. Since they are trained to intervene, many doctors never actually observe or participate in completely natural, non-medical births. Because of this, they may find it hard to trust the natural process.

3. Most women lack understanding of the natural birth process. Therefore they are unaware of the many safeguards Allah (SWT) has provided for us in birth. Without this knowledge they do not prepare their bodies physically, nutritionally, mentally, and emotionally to work with these safeguards and ensure each one is available at peak performance. As a result, many cases seen by doctors are of high risk, unfit mothers who are not at optimal preparation for natural birthing.
Induction Risks

It’s utterly important that expectant parents realize that there are medical risks to induction. So long as the mother is healthy and doing well and there are no medical signs of fetal illness, I believe patiently waiting is far safer than medical induction, Allahu alim.

Induction of labor literally means a medical attempt at forcing the early termination of the pregnancy. I use the word “attempt” because there are no guarantees of success and the risk of Cesarean section delivery is therefore greatly increased (as much as fifty to two-hundred-fifty percent). Below is only a small list of the myriad of risks to labor induction on both mother and baby:

Abnormally strong, frequent contractions

More painful contractions for mother

Fetal distress for baby (may be reason for Cesarean)

Increased risk of infection to both mother and baby

Umbilical cord preceding baby during birth, as labor may be forced before baby engages into the pelvis (can cause fetal death)

Uterine rupture caused by over stimulation of the muscles (especially if the mother has previously had a Cesarean delivery)

Possibility of allergic reactions to medications used for mother and baby

Domino effect of increasingly invasive medical procedures, including Cesarean

Informed Consent

Obviously, there are cases where delivery is safer than continuing the pregnancy, for mother or baby or both. However, it’s important that parents have full disclosure of the reasons for suggesting the induction as well as the real risks and benefits so that they can asses what’s best for them.

Ultimately, it is the parent’s right and obligation to weigh the risks. They are the ones responsible and must come to their own decisions regarding their care and acceptance of medical interventions. After all it’s the parents, not the doctor, who live with the consequences of the risks of induction verses the risks of continuing the pregnancy until spontaneous labor begins.

Preparation for Due Date

As we wait for our due dates there are many preparations to consider. Personally, I feel the mother’s physical, mental, and emotional preparation for labor, birth, and motherhood are of top priority. Additionally, I am an advocate for fathers at birth; but only if he is willing to lovingly support his wife and takes the time to get educated.

Childbirth education and lots of reading about birth, labor options, and breastfeeding top my list of things to do. However, there are also the more tangible, and probably more fun preparations to consider as well. These may include:

Preparing the baby’s room

Stocking the baby’s wardrobe

Selecting baby’s furniture

Purchasing baby accessories

Installing the car seat

Choosing a name, etc.

Conclusion

One thing is for sure, assuming we live through the pregnancy, birth will come, one way or another, insha’Allah. One other certainty is that there is usually plenty of time between the discovery of the pregnancy and the estimated due date to get educated and make the necessary preparations for labor, birth, and parenthood, alhamdulelah.

God knows what any female bears [in her womb], and by how much the wombs may fall short [in gestation], and by how much they may increase [the average period]: for with Him everything is [created] in accordance with its scope and purpose. [Qur’an 13:8]

I also find it a fitting reminder for Ramadan. We need to work hard to be prepared for our estimated due date. Yet the actual date a baby will be born is known to no one, except Allah (SWT). How similar is this to our need to work hard to be prepared for our ultimate date with Allah (SWT)? After all, this date is also known to no one, except HIM. The difference is that we may not live to see our baby’s birth date, but we shall surely be present when the trumpets are blown and each of us will surely see Judgment Day!

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