I'm a homebirth midwife and have worked in a major metropolis for the past 17 years. While most of the mamas I work with begin pregnancy with very definite anti-induction philosophies, once they pass their EDD (estimated due date) by a few days, anxiety kicks in. The pressure to deliver is ubiquitous and can come from parents with fear-based misinformation, the media or friends who all had hospital births and were induced between 39 and 40 weeks.
One of the things I’ve learned about the women I work with is that there is a schism between what they want to believe about pregnancy and birth and what their fears dictate they do in spite of those beliefs. Once a mama has a baby in her belly that she can not only feel but actually visualize moving, theory takes a back seat to concerns for baby's safety. Given that anxiety is antithetical to labor, how can we best help our mamas reach a place where labor can unfold normally?
When I meet with a new client, I begin with debunking the myth of the EDD, which I like to remind mamas does not mean “exact due date.” In fact, a retrospective study done at Harvard in 1990 shows that Naegele’s rule, upon which the pregnancy wheel is based, is not quite accurate. The study found that instead of 266 days of pregnancy, primiparas were on average gestating for 274 days (Mittendorf et al. 1990). So I get my clients to start thinking in terms of an EDS—an estimated due season. This stands in direct opposition to the hospital-based obstetric practices which are changing EDDs with every ultrasound, leading women to have three or four different EDDs throughout pregnancy. With the pressure to induce based upon ever-changing EDDs, it's a wonder anyone manages to go into labor naturally!
Before going further, I think it's also important to acknowledge that there is an irreducible risk of fetal demise estimated at 4/1000 pregnancies. This risk increases as pregnancy continues beyond 41+ weeks. Having attended a mama who made the informed decision to continue her pregnancy unimpeded past 42 weeks and then woke up one morning with no baby spirit, I can attest that her grief almost destroyed her and that she regrets her decision and made very different ones for her next two babies, choosing obstetric care and induction before 40 weeks. The other midwives in my community report similar responses from their client families who have experienced a comparable outcome.
Understanding these complexities means also accepting that for many women, doing something to encourage the body toward labor will alleviate some of the anxiety and allow the hormones of labor to flow. I offer a gentle homeopathic labor prep combination at 40 weeks. I also make individualized flower essence preparations to address emotional issues. Most of my clients have their babies between 41 and 41+5 weeks. If there are no signs of labor by 41+5, mamas take a tincture containing uterine stimulants and oxytocin synergists for a couple of days culminating with a dose of castor oil before bed. This usually leads to an active labor pattern by 3:00 am and a baby born shortly after the dawn.
Given the hostile birth climate in which most urban midwives function, we must remember not to neglect provisions for proper informed choice. Our laws may dictate that we must do this or must not do that, but our clients have the right to say yea or nay when it comes to their own body, birth and baby. Providing women with information from multiple perspectives (from most conservative to most radical) and documenting those choices protects the midwife, the mama and choice itself. It is vitally important that we as birthkeepers not impose our theories/beliefs on the families we serve, but instead encourage each one to honestly examine the reality of their fears in the context of their community and make decisions that take all of these factors into consideration.
I'm busy working on my blog posts. Watch this space!