What if labor doesn't start at 40-41 weeks?

With the onset of 40 weeks of pregnancy, a woman literally "sits on a suitcase" - she is ready to go to the hospital at any moment, because things have already been collected, documents have been checked. All relatives are in impatient anticipation. But the expected date of birth is passing, and the baby is in no hurry to be born.

Is this normal?

The estimated date of birth (PDD) exists in obstetric practice in order to approximate the timing of the completion of gestation. It is a calculation based on the date of your last period. According to the established practice, obstetricians take away three months from her and add a week - thus the approximate date when the baby should be born is obtained.

Therefore, it is assumed, which is not 100% accurate. Ovulation in a woman could be delayed, come later, and then the baby may well be born a week, or even two later... In addition, too many maternal and child factors must coincide to start labor.

Regular labor activity begins when the organisms of the expectant mother and baby are fully ready for this process. The hormonal background should be favorable, the uterus should be prepared, the cervix should be softened, the child should be mature enough for a safe birth. This is such a complex, multi-stage and individual process that it is impossible to evaluate and calculate it with any obstetric formulas and mathematical calculations.

According to existing medical statistics regarding the timing of the onset of spontaneous reflex labor, exactly only 5% of women give birth on the day of PDD... This means that only about every twentieth pregnant woman can give birth at exactly 40 weeks of pregnancy, and this is not so much. Most of the physiological births occur in the week preceding it - 39-40 weeks... About 35% of babies are born at 40-41 weeks, about 10% - after 41 weeks.

Therefore, delivery in the week following the PDD is not considered unusual or abnormal. Pregnancy at 40-41 weeks is not considered post-term - doctors do not see anything alarming in the fact that 40 weeks have passed, and labor has not yet begun. It's just not yet time. They start talking about prolongation if the pregnancy lasts more than 42 weeks..

It should be noted that it is more likely to bring the baby to 40-42 weeks if the first birth is coming. In the second pregnancy and subsequent babies, they are usually born before the PDD. Also, women with multiple pregnancies and polyhydramnios are unlikely to reach 41 weeks.

If the time has come to give birth, and labor does not begin in any way, the main thing is not to worry and not panic, so as not to harm the child and yourself. What is happening is a variant of the norm, there are no deviations in this phenomenon.

Harbingers and their absence

Most women who are at 41 weeks pregnant are frightened by the situation when there are no precursors of childbirth. From the point of view of physiology, such a situation is completely impossible. The body of a pregnant woman is actively preparing for this period, just sometimes this preparation goes unnoticed, especially if the woman does not have a high degree of sensitivity.

Pregnant women are not always attentive to the signals of the body, and sometimes they simply do not imagine what they should be, so they conclude that the signs and symptoms of imminent birth simply do not occur.

Indeed, some women have such a low sensitivity of the nervous system that specific markers of well-being before childbirth can be perceived by them somewhat smoothed out, almost imperceptibly. In addition, it is possible that there really are reasons for the absence of external manifestations of a great internal preparation of the body for childbirth.

The main precursors and reasons why they may not be observed are described below.

Abdominal prolapse

The abdomen changes its shape and location somewhat, the height of the uterine fundus decreases due to the fact that the baby at a certain moment of its development, anticipating the imminent birth, moves to the lower part of the uterus, props the internal pharynx with its head. This pressure has a stimulating effect on the cervix - it begins to shorten and flatten faster, open slightly.

After lowering the abdomen, a woman may feel some relief - there is no more pressure on the diaphragm, some internal organs are released, as a result of which it becomes much easier and easier to breathe, and heartburn decreases. However, this increases the pressure on the bladder. - there is a frequent need to empty it. A woman begins to go to the toilet for "little need" very often.

In most cases, in primiparous, the belly sinks 3-4 weeks before giving birth, in those giving birth again - a week, or even a few days. It is not excluded that the baby during repeated childbirth will take the "low start" position only with the onset of labor contractions.

At 40-41 weeks, most women have such a sign, but there are exceptions. For instance, with the pelvic position of the fetus or its oblique location in the uterine cavity, prolapse does not occurbecause the presenting part is not the head. The abdomen does not change the shape and height of standing in women carrying twins, in women with polyhydramnios, as well as with certain structural features of the pelvis.

Weight loss

Two weeks before giving birth, women usually notice that they have begun to weigh 2-3 kg less. Many associate this with excitement, experiences on the eve of the birth process, and some are sure that the matter is in a violation of appetite and less food intake.

In fact it is weight loss is a real harbinger, which indicates that there is less intercellular fluid in the body. Its stores go away as progesterone levels decrease. The lower the level of this hormone, the faster labor will begin. Also, weight goes away due to a decrease in the amount of amniotic fluid.

Body weight may not decrease in women with obesity, with low fetal weight, according to ultrasound, with endocrine disorders.

Mucous plug

The exit from the cervical canal of the cervix of a mucous clot of a milky or yellowish color (sometimes streaked with blood) is a sure sign of an imminent birth. The neck expands, softens. The mucus, which served as a barrier against germs and viruses, cannot be retained inside and leaves the thin cervical canal. Normally, discharge occurs either completely or in parts two weeks before delivery during the first pregnancy and a few days before repeated delivery (jelly-like clots will be present in the discharge).

It should be borne in mind that the plug can come off unnoticed, for example, when bathing in the bathroom or during sex. Also, the plug can continue to be held in case of insufficient maturation of the cervix.

It is possible that it will not come out until the very moment of active contractions, and then it will go outside along with the amniotic fluid. For this reason the absence of characteristic discharge should not be considered the absence of a sign of approaching labor as such.

Cervical maturity

Doctors will pay special attention to this sign at 40-41 weeks. The neck is considered mature, the length of which at this time is about one centimeter or less. It should be soft along its entire length, its location should be central.

If a deviation of the neck to the right, left, back or to the front is found, or it softens unevenly or remains rigid, and also in the case when its length exceeds 1.5 centimeters, then at this time the medication preparation of the neck will be shown uterus for childbirth.

Other symptoms

Harbingers, which consist in a decrease in the activity of the baby, in insomnia, diarrhea and other rather subjective signs, cannot directly indicate the approach of childbirth, so their absence should not worry a pregnant woman.

Feelings such as pulling the belt, tingling inside, back aches, which women mention on thematic forums on the Internet, also cannot be considered direct signs of imminent childbirth... They are more associated with fatigue, heaviness, because 41 weeks is a very impressive period, during which it is very difficult for a pregnant woman to walk.

It should be noted that not always the distinguishable presence of precursors means imminent birth. It also happens that, without any intelligible precursors, a woman begins to give birth, and everything goes quite well.

Reasons for delayed birth

Of course, a woman who has been carrying her baby for over 40 weeks is most worried about why this is happening. After all, there are many examples before my eyes - women give birth up to 40 weeks, and here there are not even precursors.

There can be quite a few reasons.

Own biorhythm of the female body... As a rule, later labor begins in women who have a longer menstrual cycle (more than 30 days).
Lack of physical activity... Women who move little in the later stages, try to lie or sit at rest more often face a delay in the onset of labor. The fact is that adequate movement helps not only prepare the muscles for childbirth, but also has a positive effect on the preparation of the cervix for the beginning of the reflex labor process.
Large or giant fruit... A large child is called a child whose weight, according to a preliminary estimate of ultrasound, exceeds 4 kg by 40 weeks. Children are considered giant if they weigh about 5 kg at the same gestational age.
Psychological factor... It is he who should be given special importance. Sometimes it happens that a woman, without realizing this clearly, postpones the moment of childbirth with her own fear of childbirth, unwillingness to experience pain, and sometimes unwillingness to give birth.

Childbirth can be delayed if the pregnancy is unwanted, the woman is in a difficult psychological situation, for example, she is experiencing significant financial problems or divorces her husband.

At the physical level, during the described experiences, a muscle "blockade" occurs - the woman is squeezed, tense. As a result, the cervix is in no hurry to open. Stress hormones partially block sex hormones and oxytocin production.

Condition of mom and baby

Future mothers, whose labor did not begin as planned, are also worried about the condition of the child, because everyone has heard about the dangers of post-pregnancy. But, as we have already found out, 40 and 41 weeks of gestation are not considered overmaturity, therefore the risks for the baby are not as great as it might seem, if, of course, the pregnancy proceeded without complications, and the condition of the baby is stable.

While the mother anxiously peers at the calendar and listens to herself in search of symptoms of an imminent birth, the baby in the womb continues to gain weight. At 40-41 weeks, he weighs more than 3.5 kg, and some more than 4 kg. The growth of children at this time usually exceeds 52 cm.

All organs and systems are developed and work. A sufficient amount of surfactant, a special substance produced by the alveoli, has accumulated in the lungs. After the baby takes its first breath, it is the surfactant that will prevent the alveolar bubbles from sticking together on exhalation. This will enable the baby to breathe freely on its own from the first minutes after birth.

If this will reassure mom, then below are some pediatric data.

Children born as a result of prolonged pregnancy until the 41st week have stronger immunity and are less likely to get sick. The placenta has grown old and does not fully fulfill its barrier functions, therefore the baby in the last days in the womb receives more maternal antibodies than children who are born before 40 weeks.
After birth, children who have gained a good mass and a sufficient amount of subcutaneous adipose tissue have better adaptation processes and less often pathological situations of the early neonatal period develop.

The child felt cramped. At 41 weeks, perturbations are minimal - they are limited only by necessity. For this reason, you should not be afraid that the baby has become less active. If there are no signs of hypoxia (and this will be checked by doctors at such a solid gestational age), then the baby is quite comfortable and wonderful, which cannot be said about his mother.

Women are exhausted by 41 weeks: it hurts, aches, pulls almost constantly and in almost any part of the body. The most common pain in the pubic articulation. And it is at this time that hemorrhoids are very often exacerbated.

There is less water, so any movement of the baby is perceived and felt almost painful. Sleeping on your side becomes nauseous and unpleasant, and you cannot sleep in a different position - hence the sleep disturbance.

The hassle and training contractions add - they intensify in those who have experienced them throughout the third trimester, and may first appear in people who have not previously felt them.

Doctors' actions

Since pregnancy at 41 weeks is not considered post-term, you should not wait for active action from the doctors. They wait, watch, monitor the condition of the mother and fetus.

If during this period they offer drug stimulation and do not explain why it is so urgently needed, then there is a reason to think about changing the attending physician or maternity hospital.

Induction of labor only on the basis that PDD passed a few days ago is not considered reasonable and expedient - this is reflected in the clinical guidelines of the Russian Ministry of Health and the World Health Organization. Induction must be mandatory.

Childbirth will be called in the maternity hospital at this time if the initial stages of the disorder according to CTG data are found in the child. Also, stimulation is likely with the discharge or gradual leakage of amniotic fluid.

Many indications according to which a pregnant woman cannot be left alone, to wait for an independent birth, require prompt delivery - a cesarean section (a large or giant fetus with a small pelvis, pronounced polyhydramnios and other factors).

The decision on whether it is necessary to stimulate labor, how the labor will take place - independently or in the operating room with the help of surgeons, if there are no complications - is made closer to 42 weeks of gestation. Only women who have pathologies that complicate the onset of labor need to go to the hospital at 40-41 weeks. This is usually warned by an obstetrician-gynecologist in a antenatal clinic.

If the decision is made to stimulate labor at 41 weeks, then the classic scheme is usually used for them:

amniotomy (puncture of the fetal bladder);
the introduction of "Oxytocin" and antispasmodics to relax the cervix after 3 hours, if independent contractions after puncture of the fetal bladder did not occur.

To stimulate labor in the hospital, kelp sticks can be used, which are inserted into the cervical canal for its mechanical expansion. To prepare the cervix, hormonal gels are used. With an immature neck, it is strictly forbidden to stimulate contractions with "Oxytocin", "Mifepristone" and other drugs.

In the vast majority of cases, there is no need for stimulation this week.

Several decades ago, there was a pernicious practice in maternity hospitals in Russia - to stimulate childbirth in almost all cases when the date of birth indicated in the card was left behind.When the rates of child and female traumatism during childbirth were calculated and analyzed, as well as the increased number of emergency caesarean sections, it was decided to abandon this practice at the state level.

Can you trigger contractions yourself?

If a child is in no hurry to be born, then he has certain reasons for that. The question of self-stimulation is rather dubious. It is clear that the woman is very tired of carrying a heavy burden, but there is very little left, so it would be more correct to wait for the contractions to begin on their own. There is still plenty of time until 42 weeks.

In matters of self-stimulation of labor activity, traditional medicine has succeeded more than others. She instructs women to drink a decoction of raspberry leaves, rose hips, to speed up childbirth. You can also have sex, if, of course, the mucous plug has not yet departed and there are no other contraindications.

Obstetricians recommend moving more, doing light gymnastics, doing simple homework as much as possible that is not associated with excessive stress.

Reviews

According to women, the most effective way to bring childbirth closer at this time is sex. After a "productive" weekend with a spouse, many go to the hospital in a day with full-fledged labor contractions.

According to the reviews of those who gave birth at exactly 41 weeks, the children showed no signs of postmaturity, hypoxia, or distress.

Usually, women perceive a prolonged pregnancy as a post-term one, therefore they are quite emotional in their reviews.