In Due Time, Not a Due Date

Yesterday, one of my patients shared with me this: “A bad attitude is like a flat tire. You can’t go anywhere until you change it.” I’ve been contemplating that quote over the past day and it has rendered a convicted perspective I have about a very common issue that I’ve been hearing about quite frequently – The Due Date. I wondered if there could be any validity to the notion that a more positive attitude can will us into a more safe and natural delivery? If so, what is the price of our patience when it comes to our babies being born?

I think it’s safe to say that one of the most anxious persons you will ever meet is a mother in her last weeks of pregnancy. I believe that a proportion of this anxiety is brought upon by practitioners placing a due date over a woman’s head, much like a sentence, with the implication that very bad things will happen unless the baby comes on or before that time. This forceful notion sets upon the mom an incredible amount of angst, which typically leads to negative feelings and attitudes towards the birth of their child and unfortunately contributes to the astronomical climb we’ve seen in women being induced and wrangled into unplanned and emergency cesarean sections.

Personally, I think due dates are a bogus attempt at shamelessly trying to convince women we are too stupid and ignorant to know when we are going to deliver our young.  Women are not microwaves. Pregnancy doesn’t come with a timer that dings or beeps when our babies have finished cooking. The onset of a healthy labor is an intrinsic and delicately balanced event that is based upon only a few major components of which the following are the most important: the baby being ready and the body being ready. Note that I did NOT list, “when your doctor thinks the baby is ready” or, “when the ultrasound says the baby is too big”. The price of our patience is weighty and here’s how science backs up the conundrum of The Due Date:

Conventionally, due dates have been based off of Naegele’s rule. His “rule” was set into motion sometime in the 19th century by a German obstetrics text that utilized his concept of determining birth and has since carried over into current day practice. As a standard, this method of determining a due date for a mother is calculated by finding the date of her last menstrual period, subtracting three months and adding seven days. Sounds like the directions on the back of a prepackaged meal, right? Just add a little, subtract, cook a little longer and viola, baby is ready! What is perplexing about the standard utilization of this method is that is has statistically been shown to be incredibly inaccurate for properly predicting the actual due date in spontaneous labors.  In a study of 17,450 spontaneous singleton births published by Ultrasound in Obstetrics and Gynecology, the percent of women who delivered on the predicted date using Naegele’s rule was 4.1%. I’ve got better chances of meeting Michael Jackson, reincarnated, in the grocery checkout line, folks.

I’ve been hearing A LOT of women talk about how angry or frustrated they are when their due date has been moved by their provider. What irks me to no end is this: we’ve got a plethora of already-anxious pregnant women, panting and having conniptions from the sidelines about the birth of their child and to make matters worse, we add to the mix a provider who with all their infinite knowledge and technology, claims that they can predict when a woman will go into labor spontaneously. And to add to the mounting stress of the poor mother, when her due date comes and goes, everyone goes absolutely ballistic. Induction! Cesarean section! Get that baby out of the womb because it’s too damn big to fit through the opening God designed it to come through! We are messing up a process that is supposed to be a right and privilege and gets ruined or turned into a fiasco all because we base the introduction of our children on a centuries old theory that has statistically been shown to have an accuracy rate of less than 5%. People have far more concern with what technology is predicting could go wrong than genuinely contemplating the miracle that is the human body and it’s wisdom. Now, let’s not get hasty and assume that induction and due dates don’t serve a purpose or have a place in modern day obstetrics. They do, but at what cost?

The rate of labor induction in the US has more than doubled since 1990, and in some cases, nearly tripled according to the CDC. In 1990, the CDC reported that the national induction rate in women who were induced at a gestational age between 37-39 weeks was 7.9; in 2008, the rate skyrocketed to 22.1. As far as women who are term or post-term (40-41 weeks gestation), the rate in 1990 versus 2008, according to the CDC, was 10.7 and 28.1, respectively.  Today nearly one out of every four pregnancies is induced. The trend of inducing labor is one of the countless interventions in the field of obstetrics that has consistently risen in our country. Many doctors will tout that their ability to intervene is the difference between life and death and that without them and their endless tools and brilliance, we would be no better off than third world countries. FACT: The Infant Mortality Rate of The United State was ranked as 55 among the world’s nations by The World Factbook (a publication made through the US government) according to data available thus far in the year 2014. The nations that ranked higher include: Serbia, New Caledonia, Isle of Man, Andorra and Macau. I couldn’t find these places on a map if my life depended on it but these nations are safely delivering and keeping their children alive at better rates than we are in the great county of America. Doesn’t it, for even a second, have you contemplate whether or not technological advances are working for us – or against us?

In 2005, ACOG released their data on a study that determined that inducing first-time mothers was directly associated with an increased risk for C-section: The rate was 12 percent for spontaneous labor, 23.4 percent for medically indicated inductions and 23.8 percent for elective inductions. Studies found in both the Cochrane Database and Canadian Medical Association Journal have shown that babies born to mothers induced with Pitocin were at higher risk for acidosis, lower APGAR scores, increased need for NICU stays, fetal heart abnormalities, early meconium release, neonatal jaundice, retinal hemorrhage, permanent central nervous system damage, respiratory distress and even fetal death.  A systematic review and meta-analysis conducted by Obstetrics and Gynecology reported that there was no statistical significant benefit to babies who were induced at forty-one weeks in terms of perinatal mortality rate, NICU admission, meconium aspiration, meconium below the vocal cords or abnormal APGAR scores.

In case you’re missing the point, we’re not getting worse at going into labor nor are doctors getting any better at determining the spontaneity of birth. The statistics are showing a clear increase in how frequently inductions are being performed but under no circumstance does that mean we as women are inherently growing into an inability to bear children. There are very serious conditions that necessitate an induction and thankfully they exist. However, we are working toward a trend that is enabling a large demographic to trust machines and lose faith in THE EXTRAORDINARY MACHINE.

Does anyone, besides me, feel that women should stop being led to believe that they can’t go into labor without the help of their obstetrician or midwife? We are talking about a day-THE DAY- that should be shrouded in miraculous spontaneity. I believe that we need to move away from the attitudes that our unborn children are pre-packaged material with an expiration date. I imagine that if we had a more positive attitude about the actual process of birth rather than the management of its onset, we would and could drastically change the face of how we are birthing our young in our country and the world. That’s a bold statement but I stand behind it without reservation. The facts about where we are headed and how fast in regards to birth are extreme. Many of us are buying one-way tickets to “the safest birth possible”, and they’re being sold to us by doctors who are punching holes in a process that is inherently natural and safe. If you are a woman, treading water over the uncertainty of when your child will make their debut, let me say to you this: Patience and a confident attitude is a weighty currency when it comes to labor. You can buy yourself a hell of a lot in the world of birth with those two things. You have every right, possibility and honor to create for yourself an event that mirrors a beautiful welcoming for your child. Remember, every good and great thing in due time.