Mothers Who Carry Longer Than Is Accepted
-by Mary Ann Watson
I am a midwife of 20 years experience in my own
practice. The longer I practice and the older
I become, the lower interventionist I become.
This has proven over and over to be the best practice.
Even as midwives, some of us tend to be too interventive
when a mother is no longer following an accepted
guideline. That is not to say that some guidelines
should be respected. But I am finding more and
more that when that guideline encompasses an arbitrary
time limit, it is often inappropriate. This is
especially true when it becomes a rule rather
than a guideline.
The phone calls begin about a week before the
due date. "You haven't had that baby yet?
It's getting awful close. Are they thinking of
inducing you? Why not? What if you go overdue?"
We have a hospital in our area that induces on
Tuesdays. Every Tuesday. If you are due that week,
you get induced on Tuesday. That way, everyone
has delivered by Wednesday morning and no one
is in the hospital on the weekend. And did you
catch the quote on Good Morning America? When
one physician was asked why it was that most babies
in the United States are born on Tuesdays, he
replied that most hospitals induced on that day.
How in the world did this happen?
If you read Dr. Robert Bradley's book Husband-Coached
Childbirth, he points out that while most babies
are born near their estimated due date, some come
quite a bit earlier and some come quite a bit
later. The early ones, we all know, can give us
problems. Therefore, we try to be very careful
about prematurity. The late ones can also give
us problems, but much less frequently. As a matter
of fact, most of the truly postmature babies I
have seen came fairly near their due date.
Many years ago, it was accepted that three weeks
overdue was fine. Then the standard was changed
to two weeks past that estimated date. Then it
was drawn back further to one week overdue. Now
some doctors are getting antsy when one has reached
her due date and has not delivered. Of course,
that woman has had an ultrasound to determine
EXACTLY how pregnant she is. During her pregnancy,
she is even counted by weeks and days, i.e.: 32
weeks, 4 days. This is valuable in determining
prematurity, but more of a hindrance in determining
postmaturity.
My newest 'overdue mama' was 45 weeks and 2 days
pregnant when she delivered a beautiful baby boy
in record time (I didn't make it and her husband
caught the baby). He has a couple of signs of
'true postmaturity' but he is a wonderful specimen
of health and happiness. Not even a touch of jaundice.
Nursing like a champion. This mother's last child
born by cesarean section due to prematurity. While
both she and I considered this cesarean a necessity
and were glad to get it, it did not color how
she was cared for during this pregnancy. Because
mom had been determined from early on in the pregnancy
that she would not be induced, NO MATTER WHAT,
we laughed at each prenatal about what a wonderful
sense of humor God had. Be careful what you ask
for, you might get it.
While she and her husband as well as myself were
quite comfortable with how the pregnancy was progressing,
I cannot say that was the case with everyone around
her. Many were supportive. Some, however, took
it upon themselves to 'keep tabs' on her by calling
frequent with inquiries. You know the ones. "Are
you sure everything's all right?" "Suppose
you go another week?" "Did the cesarean
perhaps cause a problem and you can't go into
labor?" "Maybe you ought to go in and
see the doctor." And the doctor's office
even called. This mother had elected to have an
ultrasound that showed her due date as the same
one that she and I had decided on. So about once
a week, someone in the office would call to tell
her they were 'thinking about her'. And this is
a doctor who is friendly to women who wish to
have a home delivery. Finally she stopped answering
the phone. How sad to have to do that.
But strong woman that she is, she stuck by her
belief and went on to have that spectacular birth.
She has already shared her birth story on that
birth and I now want to share from a care provider's
standpoint what I believe and how I handle this
situation.
My most favorite quote that I hear frequently
both from doctors and mothers is, "I (She)
would have never gone into labor so induction
was necessary." How long is never? Will she
be 85 years old and still growing that baby? Sometimes
when I get nervous (and I do occasionally), I
remind myself that no matter what, eventually
she will labor. All mothers can labor. It may
take a few days or weeks extra to crank up, but
ultimately it will happen. My standard response
to the above quote is, "How long did you
wait?" Why two weeks late. Or worse, one.
Then you cannot truly say that she would never
have gone into labor because YOU DON'T KNOW. You
didn't wait.
"This baby is getting way too big."
Well, how big is that? And how big is too big?
Read Open Season by Nancy Wainer Cohen to see
how she suggests a circle template should be used.
Funny how males of the species are never 'too
big or too small'. But women are told daily that
they cannot bear their children. That is not to
say that every mother can. I, too, have women
who have delivered by cesarean because of size.
But that is often accompanied by other factors
such as breech or other malpresentation or problems
with head presentation. In over 400 deliveries,
not once have I not encouraged a mother to have
a go at labor to at least attempt to deliver.
I once heard another midwife say that 9 out of
10 women that you think can deliver vaginally,
can indeed deliver vaginally. 9 out of 10 women
that you think cannot deliver vaginally also can
deliver vaginally. It's that one woman that will
give the midwife fits, no matter what.
The placenta might die. What?! Now what is the
likelihood of that? Well, let's think about this
logically. In defense of physicians, this is a
real fear for them. Think about where they trained.
In a teaching hospital, many of the patients are
the very poorest of the poor, women who may have
problems with drug or alcohol addiction or may
have no access to clean shelter and nutritious
food. These women obviously deserve superior care,
the best that can be given them. But it is incorrect
to lump all women together and assume that each
placenta will function in the same manner. While
I cannot site 'scientific' evidence of this, my
logical mind tells me two things. A woman who
is well nourished and hydrated and is healthy
is much more likely continue with a healthy pregnancy.
It also tells me that God has picked this baby's
birthday and He has not informed anyone except
the baby what that birthday is. Our bodies work
logically.
"Are you sure the midwife knows what she's
doing?" Many people (grandparents, siblings,
cousins, etc.) are mistaken in their assumption
that the midwife is in charge of the birth. The
mother and her partner/spouse are in charge. My
job is to present options, give opinions and share
information. It is the parents responsibility
to become informed, take care of themselves and
make decisions based on good information. I don't
always agree with all of their decisions, but
it is my duty to support them once I am sure they
have truly been informed.
Now lets talk about empowerment. The catchphrase
of birth supporters everywhere and one which I
use because nothing else fits as well. I once
assisted at a birth of a woman who had had a truly
unnecessary cesarean with her first baby. The
baby, in the 7 pound range, was 'too big'. She
was extremely traumatized by this birth. She could
not look us in the eye to talk to us, spoke softly
and was very shy. Then we had baby # 2. A BIG
boy. Almost 11 pounds. Did she have to work? Absolutely.
But he came out vaginally with no problems. She
did sustain a tear, but that would have probably
been avoided had she been allowed to deliver vaginally
the first time. No she didn't have gestational
diabetes. No she wasn't too small. Now she goes
with us on public speaking engagements and entertains
everyone. She is hilarious. And she is empowered.
Because she believes her body works. In all honesty,
I can't remember if she was late, but it stands
to reason that she was.
I do know that she had several false alarms because
she didn't know what to expect. That's what happens
to women who are late and finally deliver. They
believe. Their bodies do work. Their babies do
come out.
Two of my mamas have carried seven weeks overdue.
Both of their due dates were confirmed. Both delivered
healthy babies. One of these mothers, with her
second child, had vomited six to eight times a
day every day of her pregnancy. When she got more
than 4 weeks overdue, she was seen by myself or
my partner midwife every three days. The only
thing we could offer her was an arbitrary due
date that had passed. And we kinda thought that
perhaps she needed to cook this baby a little
longer since she could hardly ever keep any food
down. Birth, less than three hours, we almost
didn't make it. Postpartum, sent husband for a
large pizza and ate the whole thing herself. Next
baby, on time, no vomiting.
The other mother was expecting her seventh child.
Came to me very late in pregnancy because she
had recently moved into my area. Was prone to
very large babies. Greater than 12 pounds. This
one, a girl, weighed 13 pounds, 4 ounces. While
she experienced a little self-doubt while pushing,
there was never a question of induction. And an
hour after delivery (without a tear), she was
up showering and SHAVING HER LEGS.
Neither of these mothers, nor any of the others
in my practice who have carried longer than two
weeks past due, would have been allowed to deliver
according to their own clock/calendar had they
been under physician care. While many of them
would have expressed strong opinions to their
physicians, in our area it is not uncommon for
some overzealous physician or nurse to threaten
to take custody of the baby if the patient is
noncompliant. What happened to us being able to
make our own medical decisions?
I know I have done some doctor bashing and I
just want to say that there are some excellent
physicians out there practicing compassionately
to the very best of their ability and for that
all of us are truly grateful. They are respectful
of both parents, the midwife (if one is employed),
the doula and the baby. I have found them to be
the exception rather than the rule. I can even
look at it from a care provider's perspective
and cut them some slack for feeling as though
they must practice 'legal medicine'. They are
absolutely terrified of being sued. But this is
not an excuse to intervene for the sake of intervention.
ESPECIALLY for arbitrary time limits.
Mary Ann
H. Watson lives in Paris, Kentucky.
She can be reached by phone at 859-987-9710, or
pager at 859-741-1247.
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