We are so time conscious in our society. Life in the fast lane frequently requires scheduling out major events. Childbirth is one of the important life events that cannot and should not be scheduled. I wonder if midwives and other health care providers are taking the time to explain why. More specifically, how many women understand how the estimated due date (EDD) is calculated and what constitutes a full-term pregnancy?
Last month, we looked at a study in Obstetrics and Gynecology that analyzed women’s perceptions of full-term birth. And in December, we made note of the rising incidence of premature birth in the United States. I’d like to expand on one aspect of the study authors’ conclusion:
“…with the trend of an increased patient role in medical decision-making, ensuring that women understand the implications of the timing of delivery may be an important component of interventions to reduce the number of elective or semi-elective late preterm and early term deliveries.”Do women and their families really understand the possible consequences of a preterm delivery? Perhaps we need to spend more time explaining how the EDD is calculated and why it is important to avoid delivery before 39 weeks.
Midwives need to take time to explain that the 40 weeks used to calculate EDD is 9 months because there are 4½ weeks in most months. We need to explain that for the EDD to be most accurate, a woman must be certain of her last normal menstrual period and have a regular 28-day cycle. Even then, EDD is an estimate. Women are not machines and don’t always have the same cycle. The EDD can often be unreliable, which may unwittingly lead to early induction of what looks like a full-term pregnancy on paper—more reason to avoid unnecessary induction.
Since many women and obstetricians are “scheduling delivery’” before 40 weeks, the picture can get pretty fuzzy for women. Early delivery may appear safe since it happens so often. There are many important issues to discuss on the initial prenatal visit, but I wonder if we breeze over the issue of what constitutes preterm delivery and how the EDD is calculated. We need to give this topic the careful explanation that it deserves. It could turn out to be a key intervention that helps decrease the incidence of late preterm and early term delivery.