Backed Into a [Home Birth] Corner: the fiction of “due dates”

Most families who choose home birth for their baby’s birth make that choice after a traumatic experience during a hospital birth, which typically involves anything from loss of autonomy and control to abusive and coercive treatment from “care” providers. The majority of those mothers leave birth feeling as if they were backed into a corner with zero options aside from what hospital staff were “recommending”. All during a time when they need to feel strong and confident and supported….a time when most women feel especially vulnerable and raw.

I am a member of many different birth groups on Facebook….doula groups, birth advocate groups, birth photographer groups, birth worker groups, birth professional groups, and birth support groups for pregnant women. I hear over and over from women all across the U.S. writing anxiously about “needing” to go into labor before the “magical” 42 weeks when their midwife – whom they’ve paid in full at that point – is “unable” to attend their labor and baby’s birth due to state licensing restrictions. This is problematic on so many levels.

First, human gestation varies widely. Ethnicity, age, health, diet, weather, geography, lifestyle, stress, sleep, etc are just a small sampling of the amount of variables that go into how long a woman will carry a baby before labor begins. For obstetrics to continue to place women on “pregnancy timelines” and apply restrictions based on those timelines is not only absurd, but harmful to both mothers and babies. Inducing labor – as well as the drugs associated with inductions – are one of the leading causes of our rising cesarean rate which directly contributes to our rising maternal mortality rate which directly contributes to the rate of women with trauma after their baby’s birth.

Secondly, the concept of the “40 week” length of gestation is falsely calculated. It is based on a loose theory from a botanist named Harmanni Boerhaave. In 1744, he came up with a method to calculate a “due date” he pulled from evidence in the Bible that human gestation was approximately 10 lunar months. Following that, in 1812, a German obstetrician named Franz Naegele publicized this formula that we are still using today where we base a “due date” on the date of a last menstrual period minus three months from that date followed by adding one year and seven days. The problem is, this calculation is based on an average gestation length of 280 days when in reality a true lunar month is actually 295 days. That’s 15 days longer..! Statistically, when we do not interfere with labor, 50-80% of women carry babies well past “40 weeks”. Additionally, Naegele’s Rule assumes every woman has a 28-day menstrual cycle which is completely false. Cycles can vary from 26-33 days on average. More variations include the day of ovulation….not every woman ovulates on day 14 of her cycle, which is the assumption made using Naegele’s Rule. And while some “care” providers calculate “due dates” based on sonograms in early pregnancy, the margin of error for gestational age via ultrasound is about 7 days, or a week!

So, now we have this idea that these women who have chosen to birth at home are only “allowed” 42 weeks to produce a baby before the state restricts their own paid-out-of-pocket midwife from attending/supporting their labor and baby’s birth. However, if we are basing gestational length on 280 days and a 28-day cycle, we are coming up with a significantly false “due date”. When most women have reached 42 weeks, they may just only be coming to the time when their baby is ready to live outside the womb. Yet, modern obstetrics does not know this and will induce this mother and baby into a labor and birth that they are both not ready for.

TIME Magazine reported in 2010 that “The use of labor induction in the U.S. has risen from less than 10% of deliveries to more than 22%, between 1990 and 2006, according to data from the Centers for Disease Control and Prevention, and research suggests that induced labor results in C-sections more often than natural labor. A study published in the July issue of the journal Obstetrics & Gynecology found that among more than 7,800 women giving birth for the first time, those whose labor was induced were twice as likely to have a C-section delivery as those who experienced spontaneous labor.” 2010 and yet we are still doing this….almost a decade later. Our cesarean rate is still rising as is our maternal mortality rate. Even the rate of healthy, “full-term”, average weight babies being admitted to NICUs across the country has risen.

I read just this morning again of a mother who was planning a home birth after a traumatic hospital birth. She has reached “42 weeks” according to this falsely calculated formula and her midwife is no longer able to “legally” attend her birth which is disheartening for both mother and midwife. So what are they doing? Trying every natural labor induction method there is, of course. The problem with that is it’s still inducing a labor for a baby who is not ready to be born yet. When we do that, we still carry risks and cause complications that otherwise wouldn’t exist. And now the likelihood of transfer to a hospital is higher. And, in most cases, hospital staff are not warm and welcoming to, or even respectful of, women who transfer to a hospital during labor while trying to plan a home birth.

So, what are her options?

  1. wait for labor to start and stay home without the support of a midwife for labor and birth
  2. try to naturally induce and risk the likelihood of transfer for caused complications
  3. wait for labor to start and then head to the hospital for the exact birthing experience and environment that has left her with PTSD from her last baby’s birth…. one that she is attempting to avoid altogether

Hmmm….what would you choose?

Because zero of those options are the choice this mother wants to make.

She is backed into a corner….again.

All due to the fact that we are falsely calculating “due dates” with no regard to mammalian birth or the variability in gestation length for women in general.

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