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How far over due date is tooo far before a baby is in danger?


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My niece was due on August 15th. She still hasn't had the baby and isn't having more than one contraction per day. She stopped going to the health department doctor for prenatal care because she didn't like him (I think this is mostly because he got on her about her lifestyle which includes, though she swears she doesn't smoke, reeking of smoke at all times). She announced she would be having a home birth with a mid-wife whom she had never seen and has now only had one pre-natal visit with.

 

Her ultrasound, one week after her due date, showed that she was absolutely full term.

 

Here is the history, her mother had a c-section with her for going nearly three weeks over due, did not go into labor on her own, was induced, labored for 36 hours but did not dilate past 6cm, and niece's heart rate plummetted. Additionally, her maternal grandmother had to have a c-section with her only child (niece's mom) because she never went into labor on her own and induction did not cause her dilate. On top of that, way back when, her maternal great-grandma ended up not going into labor either. Her grandmother's sisters were all the same way. So either EVERYONE got a raw deal from their doctors or something isn't right for them genetically, i.e. they don't produce enough hormone to go into labor/something is wrong with their cervix.

 

At any rate, I am beginning to get worried. She is 26 days past due and shows no sign of imminent labor. The midwife wants her to have an ultrasound but because she stopped going to the health department and state health insurance does not pay for midwives and home births, she says she can't afford it because she would have to pay out of pocket. She's pregnant out of wedlock so my brother and his wife say she and boyfriend will have to figure it out because they created the problem, they can deal with it....grr......

 

Thoughts, experiences....am I right to be worried that this baby may be in peril.

 

Faith

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I'm all for going as long as it takes (knowing that dates can be wrong. My aunt claims my cousin was more than a full month "late", but I think her dates were just off. ;)), but I would not be comfortable with going that far past without regular non-stress tests and biophysical profiles.

 

Risks *do go up the further past-due one goes (assuming dating is accurate), but regular monitoring usually catches any potential problems.

 

FWIW, using ultrasound for dating is completely unreliable at the end of pregnancy.

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I'm all for going as long as it takes (knowing that dates can be wrong. My aunt claims my cousin was more than a full month "late", but I think her dates were just off. ;)), but I would not be comfortable with going that far past without regular non-stress tests and biophysical profiles.

 

Risks *do go up the further past-due one goes (assuming dating is accurate), but regular monitoring usually catches any potential problems.

 

FWIW, using ultrasound for dating is completely unreliable at the end of pregnancy.

 

Forty-ish years ago, my said I'd be a Christmas baby. The doc said, nope a New Year's baby.

 

I was born on 1/15. :lol:

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I can tell you for a fact some women never start labor on their own. I never once went into labor on my own with any of my 4 kids. The longest the dr let me go was 3 weeks over (With my now 5 year old) and by time they induced me my son had shoulder dystocia (he was stuck, I had 3 nurses on the bed with my pushing on my stomach while the dr pull with a vacuum thingy), he had his first BM inside me and his first APGAR score was 1. His 2nd was 3 and at that point the all rushed out of the room with my baby still not crying and I had no clue what was going on. Somebody needs to talk some sense into her some how and get her into a hospital and get an ultra sound. I am praying- this sounds like a very scary situation. :grouphug:

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The average length of pregnancy for a Caucasian first time mom is 41w1d assuming she's not induced earlier. But a pregnancy isn't considered postdate until a mom goes past 42 weeks. The numbers are slightly different if mom is of a different ethnic background.

 

Don't put too much stock in the estimated due date. Since it is based on an assumed ovulation date, it can be way off. So unless she knows her body extremely well, and knows when she ovulated, the EDD may have been inaccurate. Possibly very inaccurate. And unfortunately, ultrasounds administered near term are not accurate at determining how far past the EDD baby has gone. If she had an ultrasound during first trimester, that due date would be the one to go by, but chances are she didn't have one that early.

 

If I was in her shoes, I'd want baby to be moving a lot and I'd want to be monitoring heart rate frequently. Her midwife should be seeing her daily to check heart rate and assess fluid level by palpation. Her midwife should be able to loan her a fetal stethoscope and show her how to use it and what to look for.

 

Even though I'm not a huge fan of hospital obstetrics, in her shoes I'd still want a non-stress test and a biophysical profile. If baby and placenta both look good, no worries. Repeat one or both tests in a couple days. If she won't go in for these tests, she should expect her midwife to drop her as a client.

 

Between diagnostic scans, if baby's movement decreases significantly, or heart rate drops or becomes too regular (ie. doesn't change if you push on baby or after drinking juice), she should get to a hospital asap.

 

At home, she can be doing the usual low-risk non-invasive things to try to get labor going. Spicy food, long walks, sex, etc.

 

Good luck to her!

Edited by jplain
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{{{hugs}}}

 

I would be scared for that niece.

 

I went to 44 weeks with my son and it almost killed both of us. The placenta was HORRIBLE and the neonatologist couldn't believe he wasn't stillbirth weeks prior.

 

She needs to be seen by a doctor and I'm not normally a pro-medical care type of person.

 

Kris

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I can tell you for a fact some women never start labor on their own. I never once went into labor on my own with any of my 4 kids. The longest the dr let me go was 3 weeks over (With my now 5 year old) and by time they induced me my son had shoulder dystocia (he was stuck, I had 3 nurses on the bed with my pushing on my stomach while the dr pull with a vacuum thingy), he had his first BM inside me and his first APGAR score was 1. His 2nd was 3 and at that point the all rushed out of the room with my baby still not crying and I had no clue what was going on. Somebody needs to talk some sense into her some how and get her into a hospital and get an ultra sound. I am praying- this sounds like a very scary situation. :grouphug:

 

This was me.... only I went to 44 weeks. Good heavens!

 

Kris

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The average length of pregnancy for a Caucasian first time mom is 41w1d assuming she's not induced earlier. But a pregnancy isn't considered postdate until a mom goes past 42 weeks. The numbers are slightly different if mom is of a different ethnic background.

 

Don't put too much stock in the estimated due date. Since it is based on an assumed ovulation date, it can be way off. So unless she knows her body extremely well, and knows when she ovulated, the EDD may have been inaccurate. Possibly very inaccurate. And unfortunately, ultrasounds administered near term are not accurate at determining how far past the EDD baby has gone. If she had an ultrasound during first trimester, that due date would be the one to go by, but chances are she didn't have one that early.

 

If I was in her shoes, I'd want baby to be moving a lot and I'd want to be monitoring heart rate frequently. Her midwife should be seeing her daily to check heart rate and assess fluid level by palpation. Her midwife should be able to loan her a stethoscope and show her how to use it periodically throughout the day.

 

Even though I'm not a huge fan of hospital obstetrics, in her shoes I'd still want a non-stress test and a biophysical profile. If baby and placenta both look good, no worries. Repeat one or both tests in a couple days. If she won't go in for these tests, she should expect her midwife to drop her as a client.

 

Between diagnostic scans, if baby's movement decreases significantly, or heart rate drops or becomes too regular (ie. doesn't change if you push on baby or after drinking juice), she should get to a hospital asap.

 

At home, she can be doing the usual low-risk non-invasive things to try to get labor going. Spicy food, long walks, sex, etc.

 

Good luck to her!

 

:iagree: I went to week 43 with my last, but my midwife was required to have me have a biophysical ultrasound at 42 weeks from a solid due date (I'd had an early ultrasound @ 7 weeks and we had a good date to work with). Baby and placenta looked great at 42 weeks, but a week later the placenta was starting to calcify a bit.

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She won't be having any diagnostic tests. By refusing to continue her prenatal care at the health department, she cannot get the state to cover the costs. She works in a daycare and the boyfriend works for a dairy farm. They just make ends meet and nothing more. The reason she did not have a choice of doctors is that we do not have a single hospital in our county that still has a maternity department nor is there one single OBGYN. Our county does not even have a midwife. For women on state health insurance, prenatal care is one day per week at the health department and a doctor (usually the one that drew the short straw and would like to be anywhere else but here) drives in from the city. The nearest OB is one hour away. The midwife is 75 minutes away so...yikes if she has a fast labor.

 

I am very concerned and especially since she knows when the baby was conceived. They had "tea" once without protection (all other times with protection and giving that they've been actively involved in tea for three years)....for boyfriend's birthday....she is probably spot on about when this child was conceived.

 

At any rate, they have no savings and her boss at the daycare wouldn't let her work last week for fears of liability if she went into labor there, was on her feet all day, etc. so she missed out on a much needed paycheck. My brother and his wife are unmoveable on the issue of helping to pay for prenatal care and the state health insurance is very specific...she opted to do something againt the code, they are not liable to provide her with any care through another doctor. Additionally, my sister-in-law thinks that every doctor in the whole world is a quack and women would never, ever need inductions, birth assistance, or c-sections if it weren't for the incompetance of doctors. She has passed this attitude on to my niece and so I am worried that even if her own instincts told her something was very wrong, she would be loathe to get help beyond what the midwife, 75 minutes away, can provide.

 

Additionally, she is bi-polar...nearly every female on her mother's side of the family is as well. She refuses to stick to therapy or meds and so no one can be certain that her decision to stop prenatal care at the health department was due to legitimate reasons or to mental state.

 

The whole situation makes me queasy.

 

Faith

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Is she still feeling the baby move? (I worry about the answer to that question.)

 

 

astrid

:iagree: I think that the answer to that question would make a pretty big difference. Additionally, if she's not getting any sort of care at the moment, she might want to drop by a drugstore and use one of their blood pressure checker machine things.

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Maybe you can scare her with the notion of how big that baby must be getting? If doing well, baby could be well over 10lbs. If doing poorly do to umbilical or placenta issues, baby could be born under premature weight conditions. Will the midwife come if she isn't doing as requested such as ultrasounds and stress tests? The baby moving is not much help. Yes, it says e worst hasn't happened, but really the goal is to not wait until the baby stops moving! Does she know how to do kick counts?

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My girls were very late, both 19 days. My first was late and induced at 15 and I ended up w/ a section. The girls were both born at home. I had very few contractions prior to labor, some BH, but nothing consistent until I was fully in labor. I am surprised her MW isn't more concerned. I think mine would be getting antsy and in fact the one w/ DD 1 was given my history, by the 3rd go 'round we sort of expected it. My MIL had her 3 children late, very late. One was almost a month late, IIRC. At the very minimum she should be doing kick counts every hour.

 

I will be thinking about your family and looking for a happy update.

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I have not had an update in 24 hours. As of Tuesday, the baby was still moving though she told her mother that it wasn't as much as the week before. Dh and I would help with the diagnostic exam costs if we could pay the practitioner directly. Sadly, our niece however, wants nothing to do with us. She is not on speaking terms with us because she has very hard feelings about the year that we had guardianship of her. She was suicidal then (age 14) and we kept her on a pretty strict 24 hour watch while she went through months of therapy. It wasn't done because we were trying to be punitive, but after an attempted overdose at her parents home, we were just trying to keep her alive! She did very well with us but after the guardianship expired, her parents wanted her back home. Legally, we didn't have any right to keep her. She is now 19.

 

So, for the first couple of years after leaving us, we were the prison guards she hated. Then after getting over that phase, she hated us because we didn't love her enough to keep her and her life is a mess because we returned her to her family. Sigh.....there wasn't any way we could win with her. And, though we voiced our extreme disapproval of her leaving our home as well as that same view from two psychologists and two pastors, they still insisted she be returned and according to our lawyer, they had a parental right to insist. She went home, was never suicidal again that we know of, but spent two years being very rebellious before finally running away after failing her senior year of high school. She's made a lot of bad choices and her parents choices didn't help.

 

At any rate, we'd pay but she won't have anything to do with us out of resentment for what we did and didn't do for her back then.

 

Sigh, I just want this baby to be okay. Poor, poor baby....I hate it when innocent human beings suffer the stupidity and selfishness of people who never grew up.

 

Faith

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I have not had an update in 24 hours. As of Tuesday, the baby was still moving though she told her mother that it wasn't as much as the week before. Dh and I would help with the diagnostic exam costs if we could pay the practitioner directly. Sadly, our niece however, wants nothing to do with us. She is not on speaking terms with us because she has very hard feelings about the year that we had guardianship of her. She was suicidal then (age 14) and we kept her on a pretty strict 24 hour watch while she went through months of therapy. It wasn't done because we were trying to be punitive, but after an attempted overdose at her parents home, we were just trying to keep her alive! She did very well with us but after the guardianship expired, her parents wanted her back home. Legally, we didn't have any right to keep her. She is now 19.

 

So, for the first couple of years after leaving us, we were the prison guards she hated. Then after getting over that phase, she hated us because we didn't love her enough to keep her and her life is a mess because we returned her to her family. Sigh.....there wasn't any way we could win with her. And, though we voiced our extreme disapproval of her leaving our home as well as that same view from two psychologists and two pastors, they still insisted she be returned and according to our lawyer, they had a parental right to insist. She went home, was never suicidal again that we know of, but spent two years being very rebellious before finally running away after failing her senior year of high school. She's made a lot of bad choices and her parents choices didn't help.

 

At any rate, we'd pay but she won't have anything to do with us out of resentment for what we did and didn't do for her back then.

 

Sigh, I just want this baby to be okay. Poor, poor baby....I hate it when innocent human beings suffer the stupidity and selfishness of people who never grew up.

 

Faith

 

Ugh, no kidding. Praying for this sweet baby. :( Please keep us updated!

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I'm praying for that baby!!!

 

I can't imagine how your niece and her parents aren't beside themselves with worry and fear about the health and safety of this baby.

 

You must feel so helpless, as it's clear that you know that your niece needs medical care ASAP, and you must be incredibly frustrated that she won't accept your help. :grouphug:

 

I hope your niece's inaction doesn't lead to a tragedy for this innocent baby.

 

I know this sounds like a heartless question, but I have to ask -- Does your niece want the baby? It almost seems like she's sabotaging all efforts to ensure the child's safety, and that worries me.

 

Please keep us updated when you can. I'll pray for the baby, and for your niece to start showing a little common sense about the situation.

 

Cat

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- If she can't afford one u/s to do a biophysical profile, how is she paying the midwife?? if that midwife is doing this birth for a greatly reduced fee or for free, she's nuts.

 

- If she can't afford the u/s, how is she going to pay for a hospital birth when she has to transfer there during labor b/c she's stalled out?? With that family history I wouldn't be surprised if she follows suit. In addition, with all of her issues (emotional, mental, physical) I would be *shocked* if she made it through a labor at home. Also, women who TRULY want a homebirth will do what it takes to make that successful (which in her case would be following her mw's direction to get an u/s).

 

- It's quite possible she is lying about her dates.

 

-

Does your niece want the baby? It almost seems like she's sabotaging all efforts to ensure the child's safety,

I wondered this as well.

 

All of that said.....

 

As hard as it is, you're just going to have to tell yourself, "Not my baby. Not my birth." Worrying about it will not change the outcome.

 

This is her body, her baby, and her birth. As much as it is hard to watch from the outside, she is the one who has to live with her decisions. It was her choice to stop prenatal care. She knows how to get the care she needs to have the best chance at getting baby here safely.

 

And fwiw, the mw who has taken over her care is asking for trouble.

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Sil just called....niece's water broke at 2:00 a.m. She's made it 5cm in 15 hours but now contractions have stopped. Hasn't had a single one in 30 minutes and isn't effacing very well. The Midwife is nervous but niece refuses to even consider going to the hospital. Apparently the midwife has done just about everything she knows to do to get this labor moving. At any rate, if the baby's heartrate stays strong I would imagine that the MW will stick with this until 24 hours has elapsed. At that point, if my niece is still not wanting transport, I am not certain what can be done or if the MW will call it quits or if she even can legally.

 

Sigh.....praying that those contractions resume and they get that baby out now.

 

Faith

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I don't know about midwifery in other areas, but in my state a MW must be a certified nurse midwife. Once she assumes care of a patient, she is responsible and held liable for the outcome. If a reasonable professional with appropriate training would provide a certain level of care, that is the standard by which the situation is judged. A post-dates patient with stalled labor just bought herself an emergent c-section. Especially with the familial history. If the MW doesn't transfer care soon, she could be liable for the resultant injury/death.

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If the midwife is any good, she will call an ambulance, but obviously she can't make the fool get in the ambulance.

 

If the midwife can't do anything to make the labor progress, then she can't work magic to change that fact. I guess the poor woman would stick around in hopes of the situation changing and being of some use, but then again, she might not feel she can stomach that.

 

I don't know that DHS can do anything either.

:grouphug:

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I don't know about midwifery in other areas, but in my state a MW must be a certified nurse midwife. Once she assumes care of a patient, she is responsible and held liable for the outcome. If a reasonable professional with appropriate training would provide a certain level of care, that is the standard by which the situation is judged. A post-dates patient with stalled labor just bought herself an emergent c-section. Especially with the familial history. If the MW doesn't transfer care soon, she could be liable for the resultant injury/death.

 

NONE of that means the patient has to consent to it though.

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If the MW doesn't transfer care soon, she could be liable for the resultant injury/death.

This is one reason I said what I did in my post about this midwife taking on her care. Because she hasn't had a chance to develop a relationship with this Mama to build the trust that is vital to a homebirth. Which means if the mw says they need to transfer, the trust isn't there and the client isn't going to listen. Add onto that the fact that this girl obviously isn't trusting of the medical system, if you tell her she needs to transport, she's not going. As a result, because the midwife has been her primary care giver, SHE is the one who will take the blame if anything happens to the Mama or baby. Like I said...this mw is just asking for trouble with this situation.

 

The fact that you say the mw is nervous is a HUGE red flag.

 

Praying that all ends well for all parties involved.

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I don't know about midwifery in other areas, but in my state a MW must be a certified nurse midwife. Once she assumes care of a patient, she is responsible and held liable for the outcome. If a reasonable professional with appropriate training would provide a certain level of care, that is the standard by which the situation is judged. A post-dates patient with stalled labor just bought herself an emergent c-section. Especially with the familial history. If the MW doesn't transfer care soon, she could be liable for the resultant injury/death.

 

NONE of that means the patient has to consent to it though.

 

 

Thats just it, the midwife can do what she knows she legally and morally (for the baby) has to do, but nobody can force an adult to do anything- unless they physically sedate her and do this by force which I am guessing is very illegal.

 

:grouphug: I had goosebumps when reading Faiths update post, I am praying! God can do marvelous things! Please keep us updated~!

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If the midwife is any good, she will call an ambulance, but obviously she can't make the fool get in the ambulance.

 

If the midwife can't do anything to make the labor progress, then she can't work magic to change that fact. I guess the poor woman would stick around in hopes of the situation changing and being of some use, but then again, she might not feel she can stomach that.

 

I don't know that DHS can do anything either.

:grouphug:

 

Either way, this MW is on the hook. If she doesn't cover her hiney 90 different ways, she's hung out to dry. Documentation, documentation, documentation!

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