Overdue Pregnancy: Signs, Risks And Ways To Induce Labour

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Overdue pregnancy is when the labor does not begin even when you are 41 weeks pregnant. Delayed labor may cause you some worry or anxiety; however, you should know that it is common to deliver babies between the 37th and 42nd weeks of pregnancy. It may occur for many reasons, such as first pregnancy or genetic tendency. Usually, the condition does not involve any risk, but if the pregnancy reaches beyond the 42nd or 43rd week, it may cause certain complications in some cases. If you are in such a situation, consult a healthcare provider who will closely monitor your pregnancy and guide you about the future steps. Read the post to know about the causes of overdue pregnancy and what you can do to deal with it.

Why Do Babies Go Overdue?

Labor usually starts between 37 and 41 weeks of pregnancy, but in some cases, the pregnancy may get prolonged beyond 42 weeks (1). This is called overdue, post-term, or prolonged pregnancy.

There is no exact reason for a baby to go overdue, but around 5 in 100 women have an overdue pregnancy (1). Here are some possible reasons that are believed to be the cause of overdue pregnancy:

  • First pregnancy
  • History of previous overdue pregnancy (1)
  • Genetic predisposition (hereditary)
  • Miscalculated due date (2)
  • The position of the baby, like the breech position (3)
  • Maternal weight gain (4)

If you have gone overdue, then look out for the signs.

What Are The Signs Of An Overdue Pregnancy?

Here are some specific signs of an overdue pregnancy (4):

  • Meconium in amniotic fluid
  • Low amniotic fluid volume
  • Inadequately functioning placenta

Can Overdue Pregnancy Be A Problem?

If you are overdue by one week (in the 41st week), then there might not be any risk or complication to the baby or you as long as the pregnancy is going well. However, if it gets delayed by one more week (goes as far as the 42nd week or 43rd week), then there could be some risks.

Risks Of Overdue Pregnancy

You and the baby are likely to face the below risks (2):

  • Infection inside the womb (1)
  • Placenta unable to provide nutrients and oxygen to the fetus
  • Unexpected problems during pregnancy
  • Stillbirth (1 in 1,000) (5)
  • Baby being larger than the average size
  • Prolonged labor time
  • Risk of C-section
  • Shoulder dystocia (during delivery the shoulder of the baby gets stuck behind the pelvic bone) (6)
  • Meconium aspiration is caused by the staining of the amniotic fluid with meconium and is inhaled by the baby, causing breathing difficulties
  • Oligohydramnios (low amniotic fluid) can lead to a drop in the fetal heart rate or cause compression of the umbilical cord during contractions
  • Delivery complications such as infection, severe vaginal tears, postpartum bleeding (7)

Therefore, your doctor will constantly monitor you to minimize the risks.

How Will You Be Monitored During Overdue Pregnancy?

Here is how the doctor will monitor you once the due date has passed (4):

  • You will be advised to count the number of times your baby kicks. It is an easy method of assuring that your baby is doing good.
  • A non-stress test is done twice a week and the fetal heart rate is closely monitored with CTG (cardiotocography). If an abnormality is identified in the non-stress test, a contraction stress test is performed. This helps in determining any uteroplacental insufficiency, which indicates a reduced blood flow in the placenta.
  • Doppler velocimetry helps in assessing the placental function by measuring the blood flow velocity through the umbilical artery.
  • Getting a biophysical profile (BPP) done to check the baby’s movements, amniotic fluid level, muscle tone, and breathing patterns.
  • Getting an amniotic fluid index test done to determine the fluid level – sufficient levels of amniotic fluid indicate proper functioning of the placenta.

The next step is to initiate labor by different, medically-proven techniques.

When Do You Go Through Induction?

If the pregnancy gets prolonged beyond 41 weeks, the doctors usually suggest labor induction. If there is any complication with the baby and the baby needs to be delivered soon, then labor will be induced.

Even if there is no complication, the doctor will suggest labor induction once you have crossed your due date, to avoid any unnecessary complications (7).

  • About 9 out of 3,000 babies died when labor was not induced after the due date.
  • Only 1 out of 3,000 babies died when labor was induced after the due date.

Will you be given induction?

Moreover, induction will be offered based on the following critical factors (8):

  • Duration of overdue
  • Your age
  • If you smoke
  • Your weight
  • Size of the child (if the baby is big)
  • Any signs of fetal distress

Next, we look at the different labor induction methods used to initiate contraction and further the delivery process.

What Are The Methods Of Labor Induction?

Before the doctor induces labor, they will do a vaginal examination to check if your cervix is ready for labor. You will be put on some medications that will help ripen the cervix to initiate labor. One of the following methods of induction will be used (9):

  • Prostaglandins: Hormones in the form of a gel are applied to the cervix to ripen it, which can bring on labor.
  • Cervical ripening balloon catheter: The tube helps to stretch and open the cervical wall by putting pressure on the cervix. The catheter remains in place for 15 hours or until it falls.
  • Membrane sweep: Gently separating the amniotic sac membrane from the uterine wall to trigger labor.
  • Artificial rupture of membranes: A small incision made in the sac with a plastic hook can start labor.
  • Oxytocin: A synthetic hormone administered in the form of a tablet (taken orally) or suppositories (inserted into the vagina) or through an IV drip can help initiate the labor.

However, there are some risk factors associated with labor induction too. They include (10):

  • Need of an epidural to decrease the effect of labor pain. This also increases the risk of obstetric interventions such as assisted vaginal delivery using forceps or vacuum.
  • Increased chances of a C-section.
  • May have a heavy blood loss after normal method of childbirth.
  • Induction of labor might not work at first go, so need to repeat it.
  • Use of prostaglandins may cause nausea, vomiting, muscle ache, and diarrhea (11).

During labor induction, the doctor will continuously check the heartbeat of the baby and monitor your health too. If these methods seem risky, there are a few natural ways to induce labor.

Can The Labor Be Induced Naturally?

Here are few proven ways to induce labor naturally.

  • Acupuncture: Needles are inserted at specific points on the body to provide energy and stimulate specific organs that initiate labor.
  • Nipple stimulation: Gently rubbing or rolling the nipples can help release oxytocin that initiates labor.
  • Sex: Having sex can lead to an orgasm that will release oxytocin to initiate contraction.
  • Walking: It can help the baby exert pressure on the cervix, initiating the release of oxytocin that starts the contractions.

Always speak to the doctor before trying any of these techniques.

You can also do a few things to deal with the situation. We look at them next.

How To Survive An Overdue Pregnancy?

Here are some tips you can follow to survive an overdue pregnancy (9):

  • Take a lot of rest.
  • Practice relaxation techniques and meditation.
  • Keep yourself engaged in light activities that you enjoy.
  • Do not hesitate to ask for help from your friends and family members.
  • Talk to your doctor in case of any discomfort.

Some women experience overdue pregnancy due to possible causes, such as heredity or breech position of the baby. Your doctor may recognize an overdue pregnancy if you have low amniotic fluid volume or meconium in amniotic fluid. If your pregnancy goes beyond the 42nd week, it may cause complications such as womb infection, stillbirth, postpartum bleeding, etc. Therefore, if your pregnancy is overdue, consult a doctor promptly. Doctors can monitor your condition using different techniques such as non-stress tests and Doppler velocimetry. Your doctors may choose to induce labor using medication or natural methods. The best way to deal with the situation is to stay calm, stress-free, and get enough rest.

References:

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Dr. Shivani Chaturvedi

(MD)
Dr. Shivani Chaturvedi is a member of Indian Medical Association (IMA) and has received the President’s Award from the IMA, Lady Achievers Award, and the National Kamini Rao Award for an oration on safe abortion. She is a specialist in Urogynecology, Cosmetic Gynecology, and Colposcopy. She is also a Hysteroscopic surgeon. Dr. Chaturvedi writes and publishes papers in relevant academic... more

shreeja pillai

Shreeja holds a postgraduate degree in Chemistry and diploma in Drug Regulatory Affairs. Before joining MomJunction, she worked as a research analyst with a leading multinational pharmaceutical company. Her interest in the field of medical research has developed her passion for writing research-based articles. As a writer, she aims at providing informative articles on health and pharma, especially related to... more

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