The Waiting Game

39 Weeks

It's my due date today... yahoo! 

In the midst of a million emails and text messages asking, "Is it here yet! Is it here yet!" I would like to confirm that only 5% of women give birth on or before their due date. Using my very basic mathematical prowess, that's only 5 out of 100 women. 

What's up with that? 

If most women don't have their babies until they're overdue (past 40 weeks) and women are more likely to be overdue than anything else, it invites an obvious question: are they really 'overdue'?

The concept of a 40-week pregnancy was popularized nearly 200 years ago by Franz Naegele, director of a maternity hospital in Germany and author of a textbook for midwives. In a method called "Naegele's Rule", he calculated the date of birth by adding 280 days to the date of last menstrual period.

 Naegele borrowed this idea of a 280-day gestation from the 18th-century Dutch physician and botanist Herman Boerhaave who created the modern teaching hospital. Boerhaave based his estimate of a 280-day gestation on evidence from the Bible that pregnancy lasts 10 lunar months.

There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average!

I'd like to add that Naegele’s Rule assumes that women are having regular periods and ovulating on day 14 of her cycle. Of course for many women, including myself, this isn't the case. 

There is also the assumption that the routine pregnancy is 280 days based on our current calendar system, yet many months contain 30 days or 31 days. And what happens in a leap year, or if you're pregnant over the shorter month of February?

So here's what I'm thinking, Naegele’s Rule seems a bit archaic and inefficient; especially if we are using this dating method to determine the necessity of medical interventions. So what do we “do” with the “due?” date? 

One of the most vital pieces of information to keep in mind when your phone starts buzzing, or you doctor starts at you with a pitocin drip, comes from the the ACOG (American College of Obstetricians and Gynecologists)itself. The ACOG does not recommend interfering with a normal pregnancy before 42 completed weeks. In fact, the ACOG says the following:


“Waiting for the birth of a child is an exciting and anxious time. Most women give birth between 38 and 42 weeks of pregnancy. But very few babies are born on their due dates. It is normal to give birth as much as 3 weeks before or 2 weeks after your due date... The average length of pregnancy is 280 days, or 40 weeks from the first day of a woman’s last menstrual period." 

Did everyone get that? Let me write it again. A postterm pregnancy or a post date mama is once she passes 42 weeks. Not 40 weeks, not 41 weeks 2 days, but 42 weeks is considered post date.

 

This information can help mama and baby avoid unnecessary trauma throughout the labor and delivery. Remember, babies can't read calendars; medical issues aside, most come on their own time and almost always without complication when left alone to be born when they are truly ready.

For more on what ACOG says about due dates, moms can read their Education Pamphlet.

So with this in mind, there are plenty of non invasive natural ways to help to encourage labour and pass the time if a mama is feeling antsy. As far as I know none of these methods have been medically researched or proven, but I've heard they worked for some moms and when you're 40 weeks pregnant and have no-so-much to do except wait for baby to bust out of your vagina... anything helps:

1. Keep Busy.** A watched pot never boils! Wax your snatch. Clean the shit out of everything. Organize the shit out of everything. Read books that have absolutely nothing to do with babies. Pick the crusty stuff off your nipples. Rub oil all over your body. Bake five different kinds of cookies. Talk on the phone like a teenager. Cry into your baby's new soft plush bunny toy for no reason in particular. When strangers ask when you're due, tell them you're not pregnant: you're just fat. 

**I may or may not have done all of these things.

2. Sex, Sperm and Orgasms. If you feel up for sex, it's a great way to help bring on labour. Sex could trigger the release of oxytocin, the hormone that causes contractions. The sperm help soften and dilate the cervix. Orgasms cause contractions by stimulating your uterus. It's fun, safe, and a game the whole family can enjoy! Just don't do 'it' once your waters have broken, OK?

3. Acupuncture. I've talked to tons of moms who said acupuncture brought on labour when they were at risk of getting medically induced. I plan to visit Acumamas here in Vancouver if I hit 42 weeks and baby hasn't arrived yet. 

4. Evening Primrose Oil (EPO). As recommended by my midwife, stick 8 500mg capsules up your nether region to help ripen the cervix. Won't induce labour, but helps soften it and get everything down there ripe and ready to roll.

5. Castor Oil. I don't know too much about taking castor oil personally, but it's supposed you give you the shits and the subsequent bowel movements induce labour. I have one acquaintance that took too much, went into labour within 24 hours, and spent the whole time spraying her medical professionals with poop. 

I think I might shit, I mean sit, this one out if that's OK with you? 

6. Eat Dates! This one has a recent study behind it:

“We set out to investigate the effect of date fruit (phoenix dactylifera) consumption on labour parameters and delivery outcomes… 69 women consumed six date fruits per day for 4 weeks prior to their estimated date of delivery, compared with 45 women who consumed none. The women who consumed date fruit:

    • Had significantly higher mean cervical dilatation upon admission compared with the non-date fruit consumers (3.52 cm vs 2.02 cm, p < 0.0005)

    • Had a significantly higher proportion of intact membranes (83% vs 60%, p = 0.007).

    • Spontaneous labour occurred in 96% of those who consumed dates, compared with 79% women in the non-date fruit consumers (p = 0.024).

    • Use of prostin/oxytocin (for inducing/augmenting labour) was significantly lower in women who consumed dates (28%), compared with the non-date fruit consumers (47%) (p = 0.036).

    • The mean latent phase of the first stage of labour was shorter in women who consumed date fruit compared with the non-date fruit consumers (510 min vs 906 min, p = 0.044).

It is concluded that the consumption of date fruit in the last 4 weeks before labour significantly reduced the need for induction and augmentation of labour, and produced a more favourable, but non-significant, delivery outcome. The results warrant a randomized controlled trial."

Get 'em in ya! 

7. Galloping. Many women claim that imitating a horse can help start labor. Make sure you wave when you see me trotting down Main Street!

(Camel-toe optional)

8. Pineapple. Best taken fresh and raw. Statistically speaking, the chemicals pineapple contains, which are said to start labour, aren't very high. So that means about 7 pineapples should put you into labour. 

Ya, good luck with that.

I'd rather gallop around in tight white pants.

YEEHAW. 

Snip It

Week 38

Nothing (and I mean nothing) evokes more vitriol and controversy on mom-to-be internet sites than the topic of circumcision– the most commonly performed surgical procedure in the world. 

It's a crazy and confusing thing. 

On one hand you have Moms (primarily from North America) citing scary statistics about penile cancer and genital infection rates in uncircumcised boys and men. On the other hand you have Moms accusing parents who circumcise their kids of child cruelty and genital mutilation. So either you mutilate and harm your child, putting him at a small risk as a baby to save the potential of a small risk in the future OR you leave your kid as-is, saving him pain in the present but risking possible complications later in life. 

Heavy stuff, whichever way you slice it...

The funny thing is that until very recently I didn't think circumcision was a big deal. Almost every guy I've ever been with (and trust me there are MANY-- just kidding Mom!) has been circumcised. In my generation around 50% had the procedure done fully covered by the Canadian medical system. Of those I know who have been circumcised, no-one has admitted suffering unduly. Of those who haven't, I have at least one older family member who had to undergo the operation at the age of five due to infection. It was unpleasant, but not life destroying.

These days around 32% of boys in Canada are circumcised. Since 1996 the official position of The Canadian Pediatric Society opposed the routine circumcision of newborns. This year, the Society (after dealing with much of the aforementioned vitriol no doubt) issued a more 'neutral' statement that captured the risks and the benefits of circumcision while respecting personal preferences, religious issues and many other things that dictate this very personal decision. The bottom line is that according to our country's medical professionals: it's OK if you don't, and it's OK if you do. It's pretty much up to you.

To complicate the issue further, the positions of the world's major medical organizations range from considering neonatal circumcision as having a modest health benefit that outweighs small risks, to viewing it as having no benefit and significant risks. No major medical organization recommends either universal circumcision for all infant males or banning the procedure altogether.

So what's a Mom to do?

The reality is that parents opt for circumcision of their baby boys for a host of reasons: religion, culture, tradition (the “I want him to look like Dad and all the other boys in class” argument). What I find interesting is that most of the indisputable benefits of circumcision (aside from an oh-so-slightly lower rate of easily treatable UTIs in the first year of life) are conferred on sexually active adults.

For example, in the U.S. circumcised men have about a 15 per cent lower lifetime risk of contracting HIV. They have a lower risk of contracting syphilis as well as genital herpes, but there is no protective effect for gonorrhea. These differences, apparently, are really only significant in sub-populations that have high rates of infection, such as men who have sex with men and/ or sex trade workers.

It has long been believed that circumcised men have lower rates of penile cancer. Again, this is common knowledge these days, to which I'd like to add a couple of lesser-known important provisos:

1) penile cancer is very rare and;
2) the risk is apparently exclusive to uncircumcised men with phimosis (a condition in which the foreskin does not fully retract).

There is no evidence that penile sensitivity, sexual satisfaction or sexual function varies between circumcised and uncircumcised men.

So taking all this into account, if circumcision really only affects men later in life, why not let adolescent boys and young men make the decision to be circumcised once they are old enough and wise enough to make an informed decision? Is the procedure really so much more traumatic once a man is older?

Apparently not. Excising the foreskin of a man is no more complicated than doing so to a newborn (this argument was made quite forcefully in the Canadian Medical Association Journal) and in fact poses less of a risk for adult males because adolescents/ adults can take better care of themselves and also communicate more effectively than newborns. The main difference of course is that an adult will remember any pain and discomfort, where as a newborn will forget.

At the end of the day I can only say for sure that I agree with The Canadian Pediatric Society on this one. In the words of this cynical mom-to-be: 

You're damned if you do and you're damned if you don't. 

Do whatever feels best for you. Trust your intuition because chances are your baby will be just fine either way. Teach him to be grateful for the gift of life, and celebrate the fact that people are different, that everyone and every body is unique. In the end that's what will make the most positive impact on your kid's life... not what the hell his penis looks like.