Lobbying grows for the 10-month baby

by TRALEE PEARCE

Just how long does it take to make a human baby? Nine months is the going answer, but a small lobby of women believes that it’s more like 10 months and beyond.

Guardian columnist Viv Groskop gave the debate some gravitas with her Oct. 1 story of giving birth to her third child 20 days after his due date. “My first two babies were 15 days late,” she wrote. “But a day shy of week 43? That is virtually record-breaking – and, some would say, slightly mad.”

Generally, a baby is considered full-term when it reaches a gestational age of 37 weeks. A “post-term” baby is one that been gestating up to or beyond 42 weeks.

Ms. Groskop acted against her doctor’s orders for as long as she could before being induced. She says her son showed none of the classic signs of being a post-term baby: wrinkly or dry skin, long fingernails and high birth weight. “I wasn’t sure he was really late at all,” she wrote, adding that only about 5 per cent of babies arrive on their due date.

Many women welcome a medical nudge toward the delivery room, but Ms. Groskop is part of a vocal backlash against the “just-get-it-out” approach to overdue babies. For one thing, many women reject the increasingly standard practice of relying on early ultrasounds to date pregnancies rather than dating them from a woman’s last menstrual period.

The argument that the current definition of “post-term” is passé also dovetails with the natural-childbirth movement, especially because its advocates already resist routine inductions to bring on labour. They cite various complications, including the possibility of a cesarean section if the induction stalls.

“Many women feel that when we start messing with [induction], we’re not giving our bodies and our babies a chance to do what they feel like they need to do,” says Sam Leeson, a Toronto childbirth educator and doula.

Ms. Leeson says a majority of the supposedly post-term babies she sees in her practice emerge looking like merely full-term babies. “Often you think, ‘This baby would have been perfectly happy and probably would have benefited from staying inside a little longer.’ ”

Ina May Gaskin, often called the “mother of modern midwifery,” also gives the lobby extra weight. Ms. Gaskin, who runs a birthing centre in Tennessee called The Farm and has an obstetrical manoeuvre named after her (it dislodges an infant’s shoulder during birth without drugs or surgery), is lobbying for 43 weeks to be the new normal.

A Facebook site has popped up in praise of the “10-month mama.” Member Cindy Wallach happily crossed the 42-week mark this week, but “you’d think I was dangling my baby over a pit of hungry tigers the way people are reacting.”

Ms. Wallach, who lives in Annapolis, Md., reports that all her tests are looking good. She and her brother were also 10-month babies, she adds. “I only wish my care providers had as much faith in the process as I do.”

The most recent guidelines of the Society of Obstetricians and Gynecologists of Canada recommend “membrane sweeping,” a process that is believed to stimulate labour as early as 38 weeks. They also suggest that women who are 41 to 42 weeks pregnant should be offered an induction, which involves such measures as prostaglandin gel applied to the cervix and/or oxytocin administered intravenously.

The 2008 guidelines are based on a review of scientific literature that found evidence inductions decrease the risk of stillborn babies or babies who die in childbirth (without increasing the chances of a cesarean section).

There are other risks associated with giving birth to a post-term baby: The baby-nourishing organ, the placenta, can deteriorate and not provide well for the baby; it can be difficult to deliver a baby who has grown too big; and the longer a baby gestates, the greater the chance that he or she will defecate into the amniotic fluid, which can lead to infection if aspirated.

But with careful monitoring of the baby and mother’s health, mothers-to-be can negotiate their way to the post-term birth they desire.

The longest-gestating baby that Rebecca Serroul, a Kitchener, Ont., doula and childbirth educator, has helped to bring into the world was at 43 weeks and three days. Her client was certain that the ultrasound-determined due date was wrong, because she knew exactly when she had conceived. “She really felt they were about a week and a half off, so she was willing to go two more days than that before she was willing to be induced,” Ms. Serroul says.

In the end, the client was watched closely by doctors instead of the midwife she had chosen (in Canada, midwives transfer care to obstetricians for deliveries past 41.5 weeks). She went into labour naturally and gave birth to a healthy 10-pound baby. “It was a beautiful birth, in which she had a lot of control,” Ms. Serroul says. 

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