My baby is overdue – what now?

The research suggests that there is a small additional risk (1 in 1000) of stillbirth or neonatal death after 41 weeks of pregnancy. At 43 weeks, this risk rises to 1 in 5-7 for 1000 births.

Techniques for monitoring your baby cannot give 100 per cent assurance that he or she is not at risk.

There is an increased risk of caesarean section in women with prolonged pregnancies.

1. Have your labour induced

Your midwife or doctor can make arrangements for you to be admitted into your hospital or birthing unit at a mutually convenient time to have your labour induced. A variety of methods can be used to induce your labour, either on their own or in combination. These include:

• Prostaglandins, a medication which can induce labour by encouraging the cervix to soften and shorten. Prostaglandins can be given in the form of a gel or tablet inserted vaginally. You may require 2 or 3 doses of prostaglandin 6-8 hours apart.
• A catheter (small silicone tube) may be inserted into your cervix. The catheter will put pressure on the cervix encouraging it to soften and shorten.
• Your membranes (waters) may be artificially ruptured. This is also referred to as ‘breaking the waters’. This procedure requires a vaginal examination to insert a small instrument to break the membranes. This will help stimulate contractions. It can only be performed if your cervix is open.
• Syntocinon (a drug which causes the uterus to contract) is administered through a drip and encourages the uterus to contract. Once contractions begin the drip is adjusted so that contractions occur regularly until your baby is born. This method can only be used once your waters have broken.

Benefits

• Induction provides a timely birth to reduce the risk of stillbirth.
• You will be able to plan for the event – arrange childcare, transport and other essentials.

Disadvantages

• You will be required to birth in hospital.
• Your baby will require continuous monitoring during the labour.
• There is a risk of over-stimulation of your uterus, which may affect your baby.
• It is possible that the induction will not work. This may lead to the need for a caesarean.
• Induced labours are associated with a higher rate of medical intervention, such as epidurals.

2. Await spontaneous labour

If your pregnancy has been healthy but prolonged and you do not wish to have your labour induced, it is recommended that you have increased antenatal monitoring. This involves:

• monitoring of your baby using a cardiotocography (CTG), a machine that measures your baby’s heart rate patterns electronically over a period of time. This is usually undertaken twice weekly.
• an ultrasound scan to assess the wellbeing of your baby. This will include measuring the amount of fluid around your baby.
• weekly antenatal checks with your midwife or doctor.
• self-monitoring of your baby’s movements and reporting any changes/concerns.

These tests monitor you and your baby’s well-being only at that point in time and so are unable to provide absolute reassurance. If the tests detect a potential complication for you or your baby, induction of labor will be recommended.

Benefits

• Your labour will start spontaneously and naturally.
• You will have no side effects related to labor inducing drugs.
• You may continue with your birth plan as long as you remain well and in consultation with your midwife and doctor.

Disadvantages

• Increased risk of stillbirth.
• Increased risk of meconium aspiration (this is a serious condition in which a newborn breathes a mixture of meconium and amniotic fluid into the lungs).
• Increased risk of caesarean section and perinatal complications to include asphyxia (lack of oxygen), fractured bones, nerve damage or infection.

Breast and nipple stimulation

Breast and nipple stimulation is known to result in the production of the hormone oxytocin which causes the uterus to contract. There is evidence to suggest this may be an effective method of natural induction although the required timing and frequency is unknown.

Sexual intercourse

The role of sex in stimulating labour is not well understood. It has been suggested that semen is high in prostaglandins and the action of intercourse may stimulate uterine contractions. As with nipple stimulation, oxytocin is also produced during the female orgasm. However, there is no evidence to support this as a method for natural induction.

Membrane sweeping

This is a vaginal examination performed by your midwife or doctor that involves placing a finger inside the cervix and making circular sweeping movements to separate the membranes from the cervix. This has been shown to increase the chances of labour starting naturally within 48 hours and reduces the need for induction.

Additional membrane sweeping may be beneficial if the first attempt is not successful. This can be performed from 40 weeks gestation. The procedure can be uncomfortable and a very small amount of bleeding is common afterwards. There is also a potential risk of your waters breaking during the procedure and as with all vaginal examinations there is a slight risk of infection.

Complementary therapies

It has been suggested that some complementary therapies such as acupuncture, homeopathy or herbal supplements may assist in stimulating labour. There is insufficient evidence to determine the effects of these therapies as induction agents. If you wish to consider these options it is essential you see a specialist in this field as some types of complementary therapies are not recommended in pregnancy and have been found to be unsafe.

You will be offered induction of labour from 41 weeks of pregnancy. If you choose not to be induced, your decision will be respected. You should discuss this with both your doctor and midwife so that together an appropriate plan of care can be made. This plan will include increased antenatal assessments.

If your pregnancy continues past 41 weeks and 3 days, your midwife will recommend you attend hospital for a biophysical profile. This consists of monitoring of your baby’s heart beat and an ultrasound scan. The aim is to assess how well your placenta is functioning. The outcome may impact on the decision to be induced or not.