Pregnant after 40 weeks
The normal period to give birth is from 37 to 42 weeks, so between 3 weeks before - and 2 weeks after the due date. 50% of pregnancies last longer than 40 weeks and so it is very common for someone to become overdue. If someone is pregnant for more than 42 weeks, we call that 'serotinity'. Serotinity occurs in only 5% of women.
OVERDUE PREGNANCY
If you are 41 weeks (or more) pregnant, the midwives at PUUR will use the following step-by-step plan:
STRIPPING
From 41 weeks (1 week overdue) pregnancy, the midwife can try to strip you in order to help the delivery. Stripping can be repeated every few days if necessary.
INDUCE OR WAIT
At around 41 weeks you can make the choice to wait or to opt for induction.
What if the stripping didn't start your contractions, but you would like to be induced soon? Then you can decide together with the midwife to break the membranes at home. This is possible from 40 weeks and 6 days of pregnancy. And only if there are no complications, there is sufficient dilation and the baby's head has descended properly. If there is not enough dilation, it is first made by placing a small balloon in your cervix. This will be done by the gynecologist, after which you will return home. The next morning the midwife will come to your home, remove the balloon, and break the membranes if possible.
After the membranes have ruptured, there is approximately 12 to 24 hours to give birth spontaneously, at home or in an outpatient clinic of your choice.
After 24 hours of ruptured membranes, you are slightly more likely to get an infection in the uterus. This is being closely monitored. After 24 hours of ruptured membranes, you will have to go to the hospital, and you will give birth under the supervision of a gynecologist or someone from the medical team.
Has the water broken at home and your baby has been seen to have defecates in the amniotic fluid? Then you will be immediately sent to the hospital, and you will give birth under the responsibility of the gynecologist.
Not much research has been done on rupture of membranes at home, but it has been done for a number of years. It is known from a Dutch study that:
- 85 out of 100 women had contractions within 12 hours
- 44 out of 100 women gave birth without medical intervention
- 30 out of 100 women gave birth at home
- 50 out of 100 women still received extra hormones for good contractions
No increased risk of antibiotic use during labour, infection in the baby or hospitalization of the baby was found.
WAIT
If you do not opt for an induction around 41 weeks (1 week overdue), you will receive an ultrasound to assess the amount of amniotic fluid. If there is sufficient amniotic fluid, this is a good sign of the baby's condition, and a natural delivery can be waited out if you wish. Decreased amniotic fluid means that the placental function (function of the placenta) deteriorates, and it may be better to induce labor and deliver the baby.
HOSPITAL CHECK
Around 41+3 or 41+4 weeks (10/11 days overdue) we will make an appointment for you with the gynecologist for an extra check-up/consultation in the hospital. During this check-up, a CTG (heart film) of the baby is made to assess its condition. The gynecologist will also discuss with you the latest date on which the birth will be initiated. It may be necessary for the gynecologist to do an internal examination for you.
If all checks are in order and mother and child are in good condition, it is medically justified to wait for a natural delivery. You will then remain under the care of the midwife. Waiting is sometimes difficult, but don't worry; the vast majority of babies are born by themselves in due course! It is important to keep a close eye on the baby's movements during this period. If your child moves less, or if you have any doubts about this, please contact the midwife on duty (via the emergency number of your team).
BREAKING OF THE MEMBRANES
If you are already slightly dilated, the obstetrician can try to break your waters at 41+5 or 41+6 (12/13 days late). Breaking of the membranes causes contractions to start in 85% of women. You can then give birth without medical intervention, naturally and under the supervision of the obstetrician. If the delivery does not start despite the broken membranes, the gynecologist will induce the contractions the next day with an IV.
INDUCTION
If your labor still does not start on its own, it is possible to induce labor. The contractions are artificially induced by means of an infusion with the hormone oxytocin. An induction is planned in advance, usually at 42+0 weeks. This has often already been discussed during the previous consultation with the gynecologist. You may remain under the care of your midwife until the induction. You will then receive a medical indication and the care will be transferred to the gynecologist, and you will give birth under his/her supervision.
