Post Term Babies/Deliveries

Gompers, BSN, RN · Apr 19, 2006

Our docs don't let anyone go past the 42 week mark. It's basically all downhill from there and they don't want to risk it.

Altalorraine · Apr 19, 2006

At your facilites, do you see most docs inducing for post term? How long do the docs usually let women go? I do trust my doc, he is just fantastic and I feel he truly does want what is best for me and the baby. I am just curious to have the opinion of those that work in the field...I know the chances of mec. deliveries goes up with post term babies (I have had lots of discussions with my respiratory therapy coworkers about this) and I have heard that after 42 weeks the placenta can begin to break down. I just want to do what is best for me and the baby...
Any thoughts/opinions are appreciated!

I was 11 days past 40 weeks with my firstborn and did finally go into labor spontaneously. My baby was fine, but he had "old meconium"; the midwife said, "Yup, he's overcooked!"

Where I work the docs rarely let someone go past 41 weeks, though the midwives are willing to let people get close to 42. According to research I have done, there is evidence that meconium aspiration syndrome has decreased since it has become standard to induce at around 41 weeks. The risk of death in a post-term infant (past 42 weeks) rises dramatically, probably due to placental deterioration. However, I have also read that what is truly a post-term pregnancy varies among ethnic groups (I believe the study showed that scandinavian women tended to naturally have longer pregnancies).

According to the rules of the board I can't recommend anything for you to do (though it sounds like you have the same ideas I did), but you can discuss membrane stripping with your doc.

Altalorraine

Jolie, BSN · Apr 19, 2006

The placenta is the only organ in the human body that is not intended or designed to last a lifetime. Placental functioning begins to decline at the end of pregnancy. I would recommend discussing with your doctor assessments of placental functioning and fetal well-being such as NST, bio-physical profile, U/S to assess the placenta for calcification, etc. so that you can both agree on a plan for allowing the pregnancy to continue vs. induction.

The incidence of meconium staining does increase with advancing gestational age. The key is delivering at a facility that is properly equiped to manage it if it should occur. Make sure that there are at least 2 NRP-trained personnel avilable at every delivery, including at least 1 person skilled in neonatal intubation. Morbidity and mortality due to meconium aspiration have plummeted since NRP training became widespread.

Best of luck to you!

SmilingBluEyes · Apr 19, 2006

The NSTs are great for determining fetal wellbeing and placental functioning at this point. And the huge majority of women start labor spontaneously and without incident by 42 weeks' gestation. Try to hang in there...

Other than that, nothing we suggest here is foolproof or guaranteed. You really need to have a discussion with your health provider about what should be done should you remain pregnant much longer.

I wish you and your family a joyful and safe birth experience. Let us know how it goes.

zambezi, BSN, RN · Apr 19, 2006

Thanks for the fast responses. Like I said the first NST was looked good and the second will be tomorrow. We are giving her 11 days post term (I am 8 post term currently) to show up on her own and if she doesn't we will induce on Monday...Like I said, I prefer not to induce but will if she doesn't show up. I am delivering at the biggest hospital around here with an NICU- hopefully I won't need that though! Thanks again for the responses!

RNnL&D · Apr 21, 2006

At your facilites, do you see most docs inducing for post term? How long do the docs usually let women go?

Yes, at some point. Depends on the docs. Some start right at 40+1, which is not post dates, IMO, but that's what they call it. Others usually wait until 41 weeks, although I have seen a 41+5 and a 42 week induction. The 42 weeker was definitely "done", but he did fine. She actually had a failed induction the week before and was sent home. The little bugger just really didn't want to come out yet :lol2:

zambezi, BSN, RN · Apr 21, 2006

So I set up an "appointment" for the induction for monday the 24th- I will actually be 13 days post term at that point...All of my NSTs have looked good...I hope she comes on her own before then but I think she is just too happy where she is! I still don't really want to induce but I also don't want the baby to hang out too long either...I had made no other progress at my last appointment though, I have been 50% effaced and a fingertip dilated since 38 weeks...here's to hoping she decides to come in the next two days on her own!

RNnL&D · Apr 21, 2006

Wouldn't be surprised if it happened that way. I've seen more than one induction come in the night before, in labor. :lol2:

Good luck, and congrats on your upcoming addition.

imenid37 · Apr 21, 2006

Best of luck to you. I hope your labour begins this weekend. Personally, I wouldn't want an induction either. I had one and never again, but at my age, I am not looking to be preggers again either. If I were 42 weeks, then I would allow myself to be induced. The placenta may not be functioning optimally at that point and there is some increased risk. Baby could be bIG, but might even be losing a little weight at that point. Keep your NST appt. and keep your fingers crossed that labour will begin on it's own. Have a happy birth-day!

zambezi, BSN, RN · Apr 28, 2006

Just wanted to say hi! Thanks for all of your previous responses. Despite not wanting to induce, she decided that she did not want to come on her own. The birth didn't go as I planned (at all really) but I am happy with it. I did go in on the 24 th for the induction. We started with cytotec- when I came in I was having "contractions" (still non painful)- about every 5-7 minutes. I had a second dose of cytotec 4 hours after the first...when it came time for the third dose, my contractions (which were still tolerable) where too close together so they decided just to let me rest for the night. Doctor ordered ms and phenergan to help me sleep (which I ended up taking- so much for my non medicated delivery!) Around 200 that night I had to breathe through all my contractions and started shaking and throwing up with most of them- it was awful...I haven't been so sick in a long time! The plan had been to start pit in the morning around 0600...I took a shower (with painful contractions and throwing up the whole time, it was awful) and hurt so bad that I just stayed in bed. They didn't start the pit at that time (don't really remember why)...my doc came in a checked me and I was effaced but not very dilated (about 2 cms)...they broke my water and it did have mec. in it...Anyway contractions obviously got worse, I did my best trying to breathe through them- I wanted to get up and move but would get sick (literally) at the thought of it, plus I couldn't stop shaking and I don't think that my legs would have held be up...so I opted for the epidural (which I also had wanted to avoid)...in the end, it was the best decision that I made though...it took anesthesia awhile to get there (that and I had to wait to even get to 4 cms)...placement was fast and fairly easy and after a couple of contractions, I felt much better...my doc came and checked on me a few hours later and I was finally complete! The only bad thing about the epidural was that I didn't feel the urge to push very well even though I could still feel my legs and maueuver around in bed. I could feel the contractions too but the coordination of pushing was difficult (even though I felt like I had enough "mucscle" to push). Anyway, I took a nap for a hour or two waiting for the urge to push and then my contractions came on strong again where I could feel them...I pushed for about 2.5 hours...it was soooooooo long and hard. Her head was able to been seen in the birth canal for most of that time, she still just didn't want to come out. I didn't really want an episiotomy either (and my doc wanted to avoid one too) but after pushing so long and not being able to get her out, he gave me a small cut- and I tore too (ended up with a 3rd degree tear- ouch!)... Anyway she was born after a long labor...7 lbs and 15 oz. Apgars were 8 and 9 but sats were a bit on the low side due to mec...after some deep suctioning and positive pressure ventilation she was okay and I got to hold her fairly quickly after delivery. Not exactly the birth I imgained but I came out with a beautifu healthy baby and that is all that matters! I forgot to ask about how the placenta looked due to being post term...She was born 14 days after her due date on the 25th of April. We named her Kassidy Anne- she is so pretty!

OBnurse3 · Apr 28, 2006

Congratulations and welcome to the big world Miss Kassidy Anne!!:balloons::balloons: Best wishes for a long and happy life!!!