postterm pregnancy, birth at 43 weeks gestation

At Yui Clinic, we wait for natural labor as much as possible.

At Yui Clinic, we wait for natural labor as much as possible after the due date and try not to induce labor as much as possible. If a patient has any problems, such as low amniotic fluid or mother’s blood pressure rises, we recommend to induce labor. If there is a medical situation where the patient cannot wait for spontaneous labor, I may strongly persuade to induce labor. However, if there are no obvious abnormalities and the mother strongly desires to wait naturally, I consult and wait for natural labor. In such a situation, some people may give birth at 42 weeks to 43 weeks of pregnancy. The greater the number of medical interventions, the more cesarean delivery may be required. The cesarean delivery rate at 42 weeks of gestation is much higher than our emergency cesarean delivery rate of around 3%. In the eight years since the opening of Yui Clinic, there have been a total of 22 births of 42 weeks to 43 weeks pregnancy. Ten of them gave birth by emergency cesarean delivery with an emergency cesarean delivery rate of 45%. Although cesarean section rates are high, I do not believe that induction of labor at 41 or 40 weeks of gestation can lower cesarean section rates. I believe that the more medical interventions the higher the cesarean section rate. However, in the case of 42 weeks, I try to induce labor by considering the possibility that amniotic fluid may run out and placental function may deteriorate. Sometime before the 42 weeks, pregnant women had induction of labor due to problems such as maternal hypertension and insufficient amniotic fluid. In addition, some people had to be hospitalized in 42 weeks to schedule labor induction, or they were planning to be hospitalized soon, they had labor pains naturally and had a natural delivery. Anyone who (was) naturally labored had a natural birth.

This year, there were those who gave birth at the post-term pregnancy, 42 weeks of pregnancy and 43 weeks of pregnancy. I will introduce the birth progress of one person. It was the first birth for her.

The birth process

She was hospitalized on Monday, 42 weeks and 1day. There were no apparent abnormalities, but the baby was so large.  She was recommended hospitalization during 41 weeks to induce labor. Also, since the uterine cervix was not ready enough to reach, it was thought that it would take a considerable time if labor induction was not started. However, she wanted to wait for the labor spontaneously, and waited for the natural labor. But she was hospitalized on the 42nd week and 1 day due to no labor. On that day, she took medicine for induction of labor from noon. She had some uterine contractions but no effective labor. At this point, she was examined to check the cervix, and internal examination fingers are finally reached the cervix. However, the cervix had hardly retreated in the posterior and  it was barely effaced. The preparation of the cervix was very bad.
The next day, Tuesday, a balloon was placed in the cervix to help expand it and after that, she took medicine to induce labor. She felt there was a little pain, but the cervix did not open much. On Wednesday the following day, we took a day off treatment. We stayed out after consulting, thinking that she would be tired even if she had induced labor every day. The next day, on Thursday, the cervix was expanded in the morning, and she took medicine to induce labor. The cervix opened a little, but it wasn’t very effective. On Friday, the cervix was expanded with the balloon again and she had induction of labor with an IV. The cervix finally expanded to about 4 cm in the evening. There was almost no natural labor on Saturday morning, so she had induced labor by infusion. With the cervix open 4 cm, she didn’t need to have any cervical dilation procedure. In the evening, the uterus expanded about 7 cm, but the baby’s head was still high. There was no labor pain on Sunday morning, and induction of labor had started from morning. At the time of the morning, the baby’s head was still high, the cervix was opened about 6 cm, and the cervix was positioned back.  We had to consider cesarean section the following day. We suggested using a labor-inducing drug to give birth.

On Saturday night, the baby’s heart rate temporarily increased, and she was a little worried about her condition. However, she did not have her water break yet and baby’s condition on the fetal heart rate monitor seemed to be fine. The fetal tachycardia calmed down after a while. On Saturday, maternal fatigue and anxiety also appeared. She wanted to give birth spontaneously, but she was concerned that she would have to consider cesarean section. Her husband also told me that at 43 weeks of pregnancy, he was worried about mother and baby. Fortunately, there was no problem with the maternal blood pressure or the baby’s heartbeat, so I followed the course while continuing intravenous treatment for dehydration. At that point, there was no need for an emergency cesarean section. But at this time, if her family or she asked me to do a cesarean section, I think I had chosen a cesarean section.

Even on Sunday, the baby was fine and the cervix slowly expanded. I was worried that her cervix had not yet opened enough in the morning, but the birth proceeded smoothly. At noon, the cervix was fully opened and the baby’s head went down smoothly after the water broke. The baby was very big, so I was worried I would have to consider cesarean section. After the cervix was opened on Sunday afternoon, the birth proceeded smoothly.

I really thought I couldn’t read the birth process. She had been told on Sunday morning that she had weak labor and her baby’s head was high, so it might take until the next day. After giving birth she was very pleased, “I didn’t think I could hold my baby today.”
She passed the schedule one week later, and she gave birth at 43 weeks 0 days of pregnancy, but fortunately the mother and the baby were safe and it went really well.
She was safely delivered through the vagina and all the staff were pleased and relieved. I waited for a week, thinking that I should perform a cesarean section immediately if something went wrong, but this time we were really happy to have a safe birth.

There have been many cases where a Cesarean section was required in 42 weeks of pregnancy cases. I think the reason why her vaginal delivery was successful this time was because the mother and the baby had that power.
If the birth did not progress after her water broke, we would have to consider cesarean section on Sunday evening. I realized that I had to believe in the power of mom and baby and wait.

About post term pregnancy

After the due date, placental function may decline and amniotic fluid may decrease. If the amniotic fluid is not enough, the umbilical cord may be caught between the wall of the uterus and the baby’s body during contraction due to labor, and with each contraction, the baby’s heart rate may decrease and the baby may suffer. In addition, the placenta function may deteriorate and the baby may be starved of oxygen. Worrying about such things, it is common to induce labor before the 42 weeks of pregnancy.

The emergency cesarean section rate at Yui Clinic is about 3%. At Yui Clinic, we do not offer VBAC (vaginal birth after cesarean section), so the total cesarean section rate is about 10%. Elective cesarean section is performed for those who have a history of cesarean section or who do not want to have vaginal delivery for breech presentation.
I think that’s the reason why the cesarean section of Yui Clinic is lower than the general cesarean section rate,  because we wait for natural labor as much as possible. We avoid medical intervention and wait for as natural labor as possible.
I believe that waiting as much as possible while taking into account the safety of the baby and mother will produce good results. The person I introduced this time had prepared her body well with exercise, so spontaneous delivery was achieved despite medical intervention to induce labor for days. But sometimes cesarean sections are needed. Regarding the birth method, we will continue to support the desired birth for mothers that they gave birth in any way.

Here is the impression of the mother.

Birth Impression

Our sweetheart finally arrived 3 weeks after her due date! While I was disappointed that labor did not start naturally, Dr. Fumi led us through a very thoughtful and customized induction that started at 42 weeks. It was probably the best chance at a vaginal birth that was not as rushed as some of the induction options back in the States. There are too many details to share here, but on the morning of her birthday Haruko San told me I was finally at 10 cm and I cried at the news. Finally, it was such a long awaited celebration when she finally arrived that afternoon. I will never forget the level of care I received here from the entire staff over an almost 2 weeks stay! I wish every Mama could receive the love and care I received and every baby loved and cared for as much as she was here.