These archives contain posts from the UK Midwives and Consumers email list, a discussion group for people interested in midwifery in the UK. All are welcome to join the group. Posts in these archives express the views of the individual authors, and not those of the Association of Radical Midwives.
I can't seem to find where they actually got these statistics from, yet i have heard them many times. Any ideas?
Thanks,
FN
Virginia Howes wrote an excellent article in Practising Midwife a while back,
I think it was called lambs to the slaughter re induction and "prolonged"
pregnancy. The Mentinigou (sp?) reference is also a good one. I do wonder how
the powers that be *know* that 6 out of 3000 babies will die if "allowed"
to go to 43 weeks if women are automatically induced at the usual Term + 10.
The IMA database study will be useful in terms of outcomes of longer pregnancies
and a bit more up to date than the data that our medical colleagues rely on
(some of the research dates back to the 1950`s)!
LA
In the MIDIRS Informed Choice leaflet there are lots of stats to do with stillbirth
rates. One of the figures quoted is indeed slightly over 6:3000 at 43 weeks
gestation (Hilder et al, British Journal Obs & Gynae, 1998). I have emailed
you the URL, as not sure (again) about copyright issues.
SR
One woman I know (we were in the same antenatal group when I was expecting my youngest) was told by an obstetrician that at 38 weeks it was 100% that your baby would survive - when she told me I thought what a load of crap, nothing is 100%, in fact had a really weird feeling and thought that at least one of 'our' babies wouldn't make it (but was assuming it would probably be the one who had been given no chance of surviving earlier in the pregnancy and was going to have open heart surgery at a few days old) - and when her daughter was stillborn (at 40 weeks ish) I did wonder what that doctor thought then, I really pray he NEVER says something like that again
CC
The ob. I saw when pg went one better - he told me (with an air of regret that this probably wasn't going to happen) that if all women could have a cs at 38 weeks, there would be 'no more problems'. Hmmmmmm.....
AS
Sara Wickham is doing some work on this at the moment for her PhD She has sent
me this reply in response to your question.
The RCOG (2001) and NICE (2001) guidelines cite a retrospective analysis by
Hilder et al (1998) in supporting their assertion that perinatal mortality is
lowered by induction after 41 weeks. This study suggested that the risk of pregnancy
loss increases from 0.35/3000 (continuing pregnancies) at 37 weeks to 2.12/3000
at 42 weeks and 5.8/3000 at 43 weeks. (The authors of the RCOG guidelines rounded
these numbers up to 1/3000, 3/3000 and 6/3000 respectively). However, there
are a number of potential sources of bias in this study.
There are a number of methodological and statistical problems inherent in this
study, including that (but not limited to) the definition of "pregnancy
loss" includes infant mortality as well as stillbirth. Hilder et al justify
this on the basis that "post-term delivery has been associated with an
increased risk of infant loss for up to two years" (169). However, while
a correlation may be found between post-term birth and infant mortality, including
the total infant mortality rate in an analysis such as this will include babies
who have died for reasons quite unrelated to the gestation at which they were
born.
Hilder L, Costeloe K, Thilaganathan B (1998) Prolonged pregnancy: evaluating
gestation-specific risks of fetal and infant mortality. British Journal of Obstetrics
and Gynaecology, 105(2): 169-173
Regards
LD
I may not have thought this through properly so will appreciate being corrected. Are there any figures on how many babies lives have been saved by the policy of routine IOL for prolonged pregnancy? What I mean is this practice has been around for a while now, so has it affected the perinatal mortality stats? If it reduced deaths by any amount wouldn't they decrease? In other words, if the object of this practice is to save lives, can the practitioners of it prove they have?
S
We've never been taught how to calculate length of pregnancy other than by using the standard obstetric wheel AND I have never come across a woman who hasn't stated that her menstrual cycle was anything other than 28 days. If I met a woman who told me that her cycle was regularly 34 days, would I literally just add 6 days on to her EDD?
Thanks, KM (2nd yr student midwife)
Well, that's a *lot* better than ignoring it - but really it depends on when she ovulated. She may or may not know exactly ( well, to within 24 hours) when she ovulated - and ovulation might have been earlier or later than usual for her this cycle anyway, no matter how regular her periods usually are ( and I've got the DS3 to prove it LOL). Also, not every woman ovulates 14 days before their period starts - could be 10 days, could be as long as 16 days, but an individual woman's Luteal Phase doesn't usually vary by more than 24 hours either way. Having said that, of course, babies come when they are cooked as a rule, as we well know - but those few (or more) days can make a lot of difference in the amount of pressure a woman is put under to accept induction should she have the temerity to go beyond '40' weeks..... I know you probably have a gazillion books to read already, but I really cannot recommend highly enough Toni Weschler's "Taking Charge of Your Fertility". I'd suggest any woman read it - but *particularly* one who is going to end up dating pregnancies :-) I thought, as a nurse, I was fairly well-informed about the female cycle until I read it - oh how little I knew LOL. I have no daughters, but have every intention of eventually giving a copy to my nieces.'
BW
Once - a long time ago and when I obviously was at a low ebb in my social life - I decided to work out how my cycle differed over the year and from year to year. As I am an inveterate hoarder, it was very easy to dig out my old diaries. It was interesting to note (to me, at any rate) how my cycle changed throughout the year. In the summer, when the days are longer / nights are shorter, my cycle was close to 28 days. In winter, when the nights are longer, it was closer to 36 / 37. This held true year after year - so that although you could argue in any year the cycle was 'irregular', overall I seemed to be working to a bigger plan.
These days, my cycle is closer to 42 days (or it would be if I weren't duffed) - and the midwife had tremendous problems trying to calculate the EDD, even though I knew when I had ovulated and suggested she just take 14 days from that date and use that as a nominal first day of LMP.
And I've grumped massively before about doctors completely ignoring my information about ovulation and acting like I couldn't possibly have any insight into the matter...
KR
oh it's enough to drive you bonkers, isn't it? Imagine my surprise when I found an ob who agreed with me when I told her I was certain I'd ovulated around cycle day 28 (unusually long cycle for me, that month). I almost fell off my chair LOL. This made a huge difference at the end. Gabriel pitched up at 40+5, with no pressure on me to accept induction. Had anyone been calling it 40+19, I think the pressure may well have been immense. I would probably have a) quietly altered my dates at the beginning when no-one was looking and/or b) told my harassers at the end to take a running jump, but not every pg woman would, and I'd still have been upset that my last weeks of pregnancy were being marred by nagging.
BW
In my experience, GPs have been ok, have noted the date of ovulation as well
as LMP and calculated EDD on the former. It's in hospitals that I've been given
short shrift. After my second miscarriage, the SHO was very sarcastic about
'our' inability to date the pregnancy, saying 'So we have no idea how far along
you are...' (Well - speak for yourself, love - I'm perfectly clear on the matter.)
She found it impossible to believe that I could know - particularly having not
used ovulation tests. I was very determined with this pregnancy to make sure
that an EDD was calculated on my ovulation date, in order to forestall arguments
later.
Personally, even when not trying to conceive, I've found it quite easy to judge (roughly) that time of the month when the sap is rising and a glint comes into my eye...
KR
One of the best pieces of advice I ever received is that if you know when you ovulated, there is simply no legitimate use for the information about when your LMP was, so just don't tell anyone. I just offered my ovulation date, and said "so, 14 days before that was ..." if pressed. (I think the only person who pressed was a receptionist at an ultrasound clinic, because she had to put something in a box on a form.)
S
Ah, but I tried that. Neither the consultant nor the midwife during my most recent visits wanted to know. Veritably pooh-poohed, I was. Of course, I should just have lied about my LMP...
KR
The only person I told my true LMP this time was my IM. Learnt my lesson last time when even with 4 scans agreeing with my chart date I still had a consultant paed claim Seoras was 43w + (not 40w 3d) :(
MM
take off 3 months and add 7 days from LMP for a 28 day cycle. add or remove
extra days as per cycle length.
is that right?
FN
Well, yes, *but*...
If she knows when she ovulated, that is a much better way to establish
gestation than the use of the LMP method. Even with a "textbook"
28-day cycle, it is not necessarily the case that a woman ovulated on
day 14. With a regular 28-day cycle, ovulation could take place
anytime from about day 11 to day 20 - and of course there's no certain
way to establish (unless she was charting) that the cycle during which
a woman conceived was also a 28-day cycle - even if she has regular
cycles, this one could be different.
So if you have a woman who says her cycle is regularly 34 days, you do add six days on. But this cycle might have been 27 days or 47 days, so it's all still an assumption. And even if her cycle was going to be 34 days if she hadn't conceived she might well have conceived several days before or after day 20 (14 days before her next period would have been due).
Adding on (or taking off) the extra days is more accurate than not doing it, but it's still a guess. And it's also important to remember that the EDD is *estimated*, and that it is perfectly normal and healthy for a woman to give birth at anytime between 37 and 42 weeks, and even beyond those boundaries. I speak as someone who *was* charting, knows *exactly* when she ovulated for all of her children, and gave birth at 41+4 (induction), 42+4, 42+1 and 41+6 (all spontaneous labours, all perfectly healthy, not overcooked babies).
DW
Obviously I'm not an obstetrician or in any way educated in the subject of embryology. However, I've had three scans thus far in this pregnancy and putting the measured crown - rump length into the dating tool on a website my husband found (www.gestation.net - devised by the Perinatal Institute in Birmingham) has given a dead accurate due date everytime, in line with my ovulation date. The ultrasounds themselves have been out by about 3 or 4 days.
In the light of such current technology, isn't concentrating on LMP just a bit medieval...??
KR
I knew my ovulation date and I never have a 28 day cycle (who does?!), and luckily my midwife took that into account when calculating my EDD. We both concluded that my EDD would have been Feb. 23, and I was really pleased with that - I had visions of induction being threatened on me too early if my son didn't arrive by some date using an archaic calculation method.
Having said that, I did indeed end up being induced the day before my EDD (due to pre-eclampsia) and my son was not ready to be born! The cervical gel didn't work (his head was never more than 2/5 engaged and I never had any effacement or dilation), and I ended up having an emergency c-section. I think he was quite comfy in there and would have happily remained in my womb for at least another week or more.
So all this to say, EDDs tend to be a bit arbitrary in the end anyway! ;-)
LD
Ultrasound done after about 12 weeks is very unreliable for dating pregancies; it has a window of error of two weeks in either direction. For most women, LMP is more accurate than ultrasound.
DW
Strange then isn't it that our Trust will only use the US dating scan and will not take into account a woman's LMP at all! They reckon this is supposed to cut down on IOL for post dates!
AR
I think this is because health-care providers primary motivation is not really logic or science. High-tech machinery has a charisma which women's bodies don't and induction of labour allows a degree of certainty which spontaneous labour doesn't and therefore allays anxiety. The fact that it may lead to more physical and psychological trauma for the women is evidence that women's well-being is not highest on the list of priorities.
MT
I had read the opposite - that ultrasound is more reliable than LMP. Just wondering where you got this info from - is there some useful research somewhere that supports it?
My EDD has been calculated from ultrasound because I didn't know when my LMP was. However I do know the earliest possible date the baby could've been conceived and yet my EDD has been set at 5 days earlier than should be possible from that date. So anything to support my fight against induction would be good.
JW
There's quite a lot of research that indicates that ultrasound is not a particularly useful tool for dating pregnancies. A very quick glance at the AIMS website finds a reference to Olsen O, and Clausen J, "Routine ultrasound dating has not been shown to be more accurate than the calendar method", Br J Ob Gyn, 1997; 104: 1221-1222 - there's certainly more.
JW> My EDD has been calculated from ultrasound because I didn't know JW> when my LMP was. However I do know the earliest possible date the JW> baby could've been conceived and yet my EDD has been set at 5 days JW> earlier than should be possible from that date. So anything to JW> support my fight against induction would be good.
I should have thought that this itself is pretty good evidence that ultrasound is unreliable for dating! But you don't have to "fight" against induction, simply say "no thank you" :~)
DW
Right. I knew they were more accurate done earlier on. Mine were all done before this. But the last one (11 weeks, I think) had an error of +/- 5 days. Two weeks seems like a big leap.
KR
No time to search out research right now but I think it depends *crucially* on when the ultrasound is done. Had a conversation with a very nice ultrasonographer about this. I had an ultrasound at 7w4d by my dates. She said that the estimated gestation would be + or - one week, but that in most cases it'd be much closer than that at that stage. FWIW, their estimate was 7w5d. I presume it's a normal curve or something like that, so how much error they tell you there is is just a question of just how unusual they want the exceptions to be, but I have the impression that ultrasound dating being out by as much as a week at that stage is very unusual - giving that wide a margin of error is probably playing it safe. Going on my LMP would have led to an error of more than one week :-)
Saving posts, I think one nice thing about the "so, 14 days before that is..." formulation is that if you're careful and a little lucky, you don't actually have to explicitly lie about your LMP. You're not telling them when your LMP was, you're telling them when 14 days before your ovulation was. If they choose to mishear or misinterpret... ;-)
S
This has started off a really interesting debate for me... I'm gonna get looking for a copy of Toni Weschler's book this pm... It does seem pretty straightforward ish and I get what people are saying about ovulation dates.
What I'd like to know now is, as a midwife do I have the authority to 'overrule' an US result and change an EDD where a woman is confident of the length of her cycle/knows when she ovulated? Has anyone any experience of doing this?
I imagine that some people will have a strong response to this (i.e. not only do I have the authority but I also have an obligation) but remember that I am training in a large teaching hospital where US and doctors are viewed as god - I have never seen a midwife change an EDD contrary to the US. Thanks, Kirsteen x
p.s. At the hospital where I work we only change an EDD (worked out on LMP) if the US disagrees with the EDD by 10 days or more... does anyone know why 10 days? Is this evidence based or did someone pluck a number out of thin air?
KM
What are you a midwife or a mouse? It is up to you as a professional Midwife employed to be just that, what you do. You should of course be able to justify what you do. But also consider who appointed the doctors and US as God??
In sisterhood Mary
k> This has started off a really interesting debate for me... I'm gonna get looking for a copy of Toni Weschler's book this pm... It does seem pretty straightforward ish and I get what people are saying about ovulation dates.
Definitely read the Weschler book :~)
k> What I'd like to know now is, as a midwife do I have the authority to 'overrule' an US result and change an EDD where a woman is confident of the length of her cycle/knows when she ovulated? Has anyone any experience of doing this?
I can't see why you shouldn't do it. You are a woman's primary provider of maternity care, and surely it is up to you to use your knowledge and experience to ascertain the edd as accurately as possible :~)
k> I imagine that some people will have a strong response to this (i.e. not only do I have the authority but I also have an obligation) but remember that I am training in a large teaching hospital where US and doctors are viewed as god - I have never seen a midwife change an EDD contrary to the US. Thanks, Kirsteen x
Why not be the first? There is nothing more accurate than knowledge of the date ovulation, so anyone who tried to argue that your altered date was less accurate certainly couldn't back up their argument.
k> p.s. At the hospital where I work we only change an EDD (worked out on LMP) if the US disagrees with the EDD by 10 days or more... does anyone know why 10 days? Is this evidence based or did someone pluck a number out of thin air?
I've never seen anything that would support this policy, but I expect it's based on the theory that if the u/s disagrees substantially with the LMP, the woman must be wrong about her LMP. Of course there's no official definition of "substantially", and the assumption that women are lying about their LMP (and yes, I know it happens, but to *assume* that??!) is offensive imo.
DW
Yes, for a proportion of women they will give the right result as they work on average measurements - so they will give an accurate estimate for the middle group of women (say 60% - depending on the degree of accuracy you are trying to obtain), whilst there will be groups either side where the estimate is too short or too long (say 20% in each).
On the basis these approximations these two groups may their the dates changed,
often despite the fact that they know what their real dates are. When making
the estimate we don't know whether someone is in the middle accurate group or
on of the outer were the estimate is incorrect. That's Statistics for you. No
improvement in scanning equipment will change this!
DCD
Do NOT fight against induction. Inform your caregivers that you will not be having your labour induced unless there is a compelling reason and can you have that reason in writing. and you will regard any discussion as harrassment. BUT DO NOT fight or be drawn into discussions YOU do not wish to have, Just quietly leave.
Regards MC
What is the point about all this debate about calculating EDBs.. Babies come at the end of their gestation period which is about 37-42 weeks. Prior to US and when many women did not keep accurate period dates or have any idea when they might have conceived, ( though some could tell us exactly the date of conception) we would "date" pregnancies by the size of the uterus and the date of quickening which in a 1st pregnancy was about 20 weeks and in subsequent pregnancy about 17 weeks. . This enabled us to tell the woman her baby would arrive around end of May or beginning of August or thereabouts And if it didn't correspond we wondered if we had twins! It worked!
In sisterhood MC.
I hear you, but as soon as we have any notion of the bounds of normal gestation, even with a 5 week window, it becomes important to have the ends of the window in the right places.
I'm glad I did insist on having my EDB based on my ovulation date not my LMP. My baby arrived at 42 weeks exactly, by my dates. Had I let them use LMP, he would have arrived at I forget exactly what, but well over 43 weeks anyway.
I know some babies really do come that late normally, but even you, Mary, say that it's not usual - if I had thought that my baby was that cooked, I would have felt and been under pressure to accept close monitoring or worse. Because everyone had the "right" dates for my 37-42 week window, though, I didn't have that pressure (well, not much).
S
Absolutely MC, my Grandmother often says that my Mum was a month late. Now I don't know whether my Gran had got her dates wrong or whether she indeed went to 44 (ish) weeks *but* nobody threatened her with induction or c/s and my mother was born when she was ready to come, in the middle of the Blitz! My Grandmother's mother had twins at home in 1916 and I'd love to know whether she knew beforehand that they were twins but unfortunately she isn't around to ask ;-)
CB
A friend of mine (she must be about 45 as she's a little older than me) was an undiagnosed identical twin - her mum had no idea that she was having twins until she arrived. I *think* she was in hospital though. As twins go, were undiagnosed ones pretty unusual then?
BW
I do hear what Mary and others are saying about 'what is the point of debating this issue of calculating EDB' and I completely accept it... BUT I am working within a large hospital that performs alot of IOL's for 'post-dates' according to US scans and I for one have not been taught about calculating pregnancy length according to quickening or any other form of 'ing, apart from scan - 'ing and obstetric wheel -'ing :0)
KM
Just read MCs, 'are you a midwife or a mouse?' comment and felt compelled to reply. In a way, I believe that you are SOOO right in your response MC, we do need to be strong and we do need to stand up and be advocates for the women we care for. I firmly believe that people only wield the power that they are allowed to. I probably didn't make it clear in my post that I'm a student midwife (I'm not offering this as an excuse!!) and as such I am still in the process of forming myself into an Uber-ultra-super-strong-midwife BUT do not always have the best role models...therefore it is good to debate these things with others who may have some new knowledge and refreshing ideas... thanks for the comments though, will start to visualise myself as the (non mouse-like!) uber-midwife each night before I go to bed :0)),
KM x
Believe me KM I have done my stint as a mouse, and squirm when I remember just what a wet wimp I was, and how many perineii were mutilated by me on doctors orders before I stopped and remembered I was A MIDWIFE
In sisterhood MC
My mother had a ten month pregnancy according to her dates. The baby was born at home and weighed in at 11 1/2 pounds. My mum wasn't surprised at the length of pregnancy or the size, as all her babies has followed a similar pattern, and she knew that babies come when they're ready. I, like her, carried my babies longer than 40wks despite a 28 day regular cycle.
with joy, JH.
And there is a whole 'nother thing to add to the mix as well. This is based on the BMI of the woman at the point she became pregnant.
Basically you add 1/2 a day for each point she is over 25, and a further whole day (1) for each point over 30.
Found this in an article on Danny ?? 'site (linked from homebirth.org.uk) and it has been spookily accurate for me and several friends... (those of us who elected to be left alone :-)
It seems to work in reverse as well re: underweight women (take 1/2 day off for each point 20 and under, given that those with a BMI of less than 15 rather ovulate anyway).
For myself - I have always gone to the 'booking' visit with my dates worked out and stated 'my edd is this to this, I ovulated here, with a cycle of x days, so that gives you a starting date of y for the wheel, which we'll call my LMP; not that it was :-)' But maybe I'm just a bolshy soandso... (who, it will be admitted, has never bothered to 'book' in before 18 weeks, 1st time because I didn't know I was preg to that point; and the next two times because I wasn't going to face weeks of being whatever'd and pushed for scans etc. I didn't want :-)
HA
I've always just blithely stated my EDB. The midwives put the next day because that was what the scan said. It is interesting to note that the consultant made a great play of crossing that date out and putting in mine.
I can't remember who it was whose baby got kicked out for pre-eclampsia on 'due' date but didn't look cooked. Mine was too and he looked a little overcooked. I've asked before if we really have any evidence for any of our various signs of over or under - be that by scan, ovulation records, LMP palpation, quickening (wouldn't like to be going off an assumption of 20 weeks Mary when mine make themselves felt much earlier than that), amount of body fat, vernix, peeling skin?
JV
My mother was an undiagnosed twin born in 1913. The midwife (not formally qualified) said after she was born: hold on there is another one in there and my mum's brother was born ten minutes later. Just as well they didn't do active management of the third stage in those days. I'm not surprised the midwife didn't diagnose it because I think she probably wasn't employed until my grandmother was in labour but I think it was a bit strange that my Grandmother didn't notice anything different -- it was her seventh pregnancy. I'm assuming it feels different to have two babies inside. But my poor grandmother was probably too ground down with looking after her other kids to notice.
Yours, MT (retired midwife)
I don't want to come across as the medicalised medical student but I don't
think we should be entirely slagging off the technology.
I strongly agree that if women know when they ovulated that this probably gives
a better idea of EDD but obviously you would use other evidence as well since
even the best of us make mistakes!
I do think EDDs are useful though. I don't know the studies but is it not right
that thre is an increased stillbirth rate over 42 weeks? Is it not useful to
know when a woman is outside 42 weeks so that things like placental function
can be assessed? I don't think this information should be used to pressurise
women the minute they hit 42 weeks but I think it still can be useful.
But then I'm not even remotely experienced so feel free to shoot me down if
I'm talking out of my bum!
AR (2nd year Med Student and daughter of IM - for those who don't know me already)
ar> I don't want to come across as the medicalised medical student but I don't think we should be entirely slagging off the technology.
If there was any evidence that the use of the technology improved outcomes, I'd agree with you. But there isn't any such evidence. There are individual cases - but statistically, the use of u/s for dating, for diagnosing IUGR etc - has only resulted in more intervention, not better outcomes.
ar> I strongly agree that if women know when they ovulated that this probably gives a better idea of EDD but obviously you would use other evidence as well since even the best of us make mistakes!
Do you mean that when a woman knows when she ovulated, you would still routinely use other evidence? Why? Women are disempowered by this attitude. I find it quite offensive that my own knowledge of my own body is considered untrustworthy and that I'm supposed to accept the opinion of someone who doesn't live in my body and technology that works on averages rather than considering the individual. How can women be expected to trust their bodies if the professionals clearly don't? If you can find a single method of dating a pregnancy that is more accurate than the woman's own report of when she ovulated, I'd like to hear about it.
ar> I do think EDDs are useful though. I don't know the studies but is it not right that thre is an increased stillbirth rate over 42 weeks?
There is an increase, but the risk of fetal death is still very low - certainly not high enough to justify the level of scaremongering that goes on, and it's very difficult to determine which of those fetal deaths are genuinely due to post-dates pregnancy. It is likely that in some cases that there were other circumstances which caused both the fetal death and the lengthy pregnancy (ie they both resulted from one cause, but neither caused the other), and it is likely that some of those stillborn babies might have died regardless of whether they were inside or outside the uterus.
ar> Is it not useful to know when a woman is outside 42 weeks so that things like placental function can be assessed? I don't think this information should be used to pressurise women the minute they hit 42 weeks but I think it still can be useful.
Well I think that you've hit an important nail on the head there - the information *should not* be used to put women under pressure, but it *is*. It's incredibly rare that a woman gets to 42 weeks without someone shroud-waving. If the information were not going to be misused in this way, it might be useful - but that's not how things are :~|
DW
The general gist of it was first that I wasn't talking about scans - more that
some people seemed to be suggesting that knowing people's dates has no use and
i thought this wasn't true, though I do believe knowledge should be used with
caution.
My other point was in defence of wanting to use other evidence of dates. My
basic principle would be use ovulation to predict EDD but it still isn't the
word of God. If a woman was measuring 4 weeks out, surely it's possible she
made a mistake? No one is going to know the woman's body as well as she does
but surely it's foolish to entirely ignore all other evidence because you have
the best piece already. I would obviously put the woman's knowledge at a priority
but was basically saying i would keep an open mind.
God that was long winded! Sorry!
Love AR
I agree I might not be a professional MW or anything (well, Mum I guess) but I know what I went through and after talking to women in my BFing support group I know what they went through..... Obs and MWs refusing to listen to them about when they ovulated etc and these women might have had successful births, might not but one thing was really evident, how angry they are (even after 10+yrs) at not being listened to or respected when it came to them, their body and what they knew of their pregnancy so far.
I hate mentioning my story (so many times lol) but will again... My cycle is on average 6-8 wks, the GPs didn't listen, nor the MWs, nor the the Obs. At first I was just so excited to be pregnant it didn't matter. But at the end I buckled (which I am angry about and deeply regret but most of all I am angry at them because if they had just listened to me, given me a chance and my baby things need not have been so bad).
All 5 scans I had showed a baby that was 2 weeks smaller than they expected. Instead of them deciding that instead of Kaya being x number of weeks she might be 2 wks younger they decided that she was of the gestation they originally thought but small. I could scream I am still so angry.
I knew in my heart and body that I was right but it didn't stop me feeling bad because maybe I wasn't eating enough, maybe I was being a bad Mum and hell, if I was a bad Mum then how bad would I be when she was born. I was told to eat more and more and I did (and put on 7 stone). I was scared, fed up, fat etc and all confidence in myself was knocked out of me. When it came to the induction I kept refusing until they made me feel so bad, I should have asked for an extra scan to check the placenta but I was worn out, upset (since the induction had been mentioned I had just cried, day in day out cos it felt so wrong).
When K was born they were all surprised at a)how vernixy she was, b)how little hair she had, c)how small she was and d) how much amniotic fluid there was. They decided I was right.
If my story was a rare one I would be all for dating scans, but its not. Its all way too common. How many bad births, inductions could be avoided if only we mums were listened to????
I will go get a dating scan this time around, but only cos I want to make sure the baby is healthy (the baby is a massive surprise so haven't taken folic acid etc bit worried). I will be avoiding my GP and OB and I know my MW already so we shall be discussing everything in full and we shall go through my last pregnancy and birth.
Dating scans/scans could be useful but the way they are used at the moment I don't think they are. They are used to bully women and thats not right............
Don't mean to sound so angry etc, just am.... K
Women should not be pressurised full stop. Sadly they are and in what I've seen so far, this pressure begins before they even reach 42 weeks :o( I personally feel that US does have a place, but this is not it.
V
>>What is the point about all this debate about calculating EDBs<<
and I couldn't agree more. We are trying to use a formulaic approach for something
that cannot be formulated. Obstetrics is a very imprecise science and the introduction
of technology IMHO only clouds the issue further. I think that we really need
to be asking where is the evidence that suggests that women are at greater risk
after a certain period of gestation. Because if you really pull the research
that supports this apart then, like so much of the obstetric data, it really
does not stand up well to scrutiny. The choice of term date is also so arbitrary.
We heard only recently on this list that some midwives are carrying out sweep
and stretch at 38 weeks. Why?
On a further sad note S wrote:-
>> I think one nice thing about the "so, 14 days
before that is..." formulation is that if you're careful and
a little lucky, you don't actually have to explicitly lie about
your LMP. You're not telling them when your LMP was, you're
telling them when 14 days before your ovulation was. If
they choose to mishear or misinterpret...<<
Midwives have been 'practising good by stealth' for many years, fabricating
dilatation rate etc and it sems that women are also lookingfor ways to get what
in their hearts they know to be right for them, without confrontation. It makes
me weep.
LD
Twins could only be diagnosed on palpation and but surprisingly few were undiagnosed maybe we were better at palpoation?? When active 3rd stage management became the norm there was a lot of concern that synto might be given in the presence of an undiagosed 2nd twin -and it did happen.
Regards Mary
If women were offered ultrasound and allowed to make an inform decision about whether they felt they wished to have one or not, that would be a good starting point.
I suspect my 9 year old is very unusual in not having been scanned at all.
Debbie
LW updated April 3, 2005