The Million Dollar Question: So When Exactly is my Baby Gonna Come?

It was a steamy Tennessee July, each swollen pregnant patient that entered my office would ask me the same question, “WHEN is this baby gonna come?”

Each time I would give my best sympathetic shrug, and reply, “Sorry I do not have any magic ability to predict labor.  I can give you my best guess, but it’s just that, a guess.”

This answer was usually met with a glare.  Then, I would watch the patient waddle down the hall, shoulders slumped in disappointment over my lack of prophetic ability.

I remember one patient that summer though, who never glared back.  Though her due date, of July 18^th came and went, she kept a good attitude as she waited for her baby to make his appearance.  Her husband made every visit, always kind and supportive.  By 10 days over her due date, with no sign of labor in sight, the decision was made to proceed with an induction of labor.

She and Hubby arrived at the hospital to start the induction, giddy with anticipation. Her cervix required an overnight dose of a medicine called cytotec to help get it ready for labor.  Her cervix was extra stubborn. The next morning a second dose had to be given.  Her husband stayed by her side the entire labor, and they both kept their spirits up despite the long process.  Finally after being at the hospital for nearly two days, it was time to push.

Despite her excellent effort, the pushing process went slowly as it often can with the first baby.  With each passing hour it seemed that her husband became increasingly anxious.  As she approached her third hour of pushing, it was nearly midnight. At this point the husband began to go from encouraging cheerleader to more l like a hardened drill sergeant. How odd, I remember thinking, that seems out of character for this mild mannered guy.

As the baby got closer to crowning, his ‘encouragements’ got louder and louder, I could tell the patient was getting annoyed. Again I wondered about his tactics, but in a labor room I’ve pretty much seen everything and nothing really surprises me at this point.

Then with one last push, a beautiful baby boy was born. He was healthy and hearty at 8 pounds even, entering this world at 11:57 pm on July 31^st.  Shortly after birth, the husband reaches in his pocket and pulls out the most beautiful ruby ring I’ve ever seen.

This is for you honey. It’s our baby’s birth stone. He said with tears in his eyes.

Suddenly his behavior made sense. Though her due date was smack dab in the middle of the month, they were minutes away from having a completely different birthstone!  Here he had bought this beautiful ring long before to celebrate his wife’s journey to motherhood, only to have it be minutes away from being obsolete.

Average gestational time

The average length of a pregnancy is 280 days (40 weeks) from the first day of the last menstrual period.  That said, only 3% of babies actually come on their ‘due date.’  Term is considered anywhere between 37 and 42 weeks. That 5 week window causes some angst for those type A planners out there.

Multiple hormones have been studied that increase at the time of labor, but we are unsure exactly what triggers these hormones to increase.  Most scientists feel that the placental tissue itself secretes some unknown protein that travels to the mom’s brain, causing labor to occur.  In other words:  the baby comes, when HE decides it wants to come.

Too Soon

Babies born before 37 weeks are considered preterm, but a new category of ‘late preterm’  is getting more and more attention.  Babies born  between 37 and 38 6/7 are fraught with a small but statistically significant increase in complications.  I mentioned earlier, after 37 weeks is considered term, and if spontaneous labor occurs during this time period, then it is usually not of too much concern. However, elective deliveries during late preterm has been highlighted by the March of Dimes over the past couple of years due to the increase risks such as poor feeding and lung immaturity requiring ventilation. Our hospital and most throughout the country have adopted rules that don’t allow for induction or elective cesarean section at less than 39 weeks unless there is a medical reason.

Too Late

Babies born after 42 weeks are considered postterm.  The placenta is an organ that is designed to work for 40 weeks, and in some cases can begin ‘wear out’ as women get past their due date.  A pregnancy that goes past 42 weeks has a 10 fold increased rate of stillbirth.  Once past 41 weeks, it is recommended to begin doing tests to make sure that the placenta is still healthy and baby is continuing to get enough oxygen. Induction is usually recommended if the cervix is dilated or if the pregnancy approaches 42 weeks.

Risk factors for going over your due date include:

First pregnancy

Male baby

Previous pregnancy overdue

For now, there is no magic test to estimate when the baby will come.  I can give it my best guess based on the dilation of the cervix, but that is not very scientific.  Until the technology improves, we will have to wait for the babies to come when THEY decide they are ready, and  hold off on buying any birthstone jewelry until AFTER the baby is born.

Patient stories are either used with permission or are a fictitious conglomerate of multiple patient encounters.