Postmature birth

About 85% of babies are born post-mature. ^[1] In order for an infant to be considered postmature, they must be born after 42 week gestation.^[2] Post-term, postmaturity, prolonged pregnancy, and post-dates pregnancy all refer to postmature birth. Post-mature births do not have any harmful effects on the mother, but the fetus, however, can begin to suffer from malnutrition. After the 42nd week of of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. If the fetus passes fecal matter, which is not typical until after birth, and the child breathes it in, then the baby could become sick with pneumonia. Doctors have the choice to induce labor once the pregnancy reaches two weeks beyond the normal 40 week gestation period. ^[3]

[edit] Causes

The causes of post-term births is unknown. But post-mature births are more likely when the mother has experienced a previous post-mature birth. Due dates are easily miscalculated when the mother is unsure of her last menstrual period. When there is a miscalculation, the baby could be delivered before or after the expected due date.^[4] Most post-mature pregnancies are because the mother is not certain of her last period, so in reality the baby is not technically post-mature.^[5]

[edit] Symptoms

Different babies will show different symptoms of postmaturity. The most commons symptoms are: dry skin, overgrown nails, creases on the baby's palms and soles of their feet, minimal fat, a lot of hair on their head, and either a brown, green, or yellow discoloration of their skin. Doctors diagnose post-mature birth based on the baby's physical appearance and the length of the mother's pregnancy.^[6]

[edit] Complications

Once a pregnancy has surpassed the 40 week gestation period, doctors closely monitor the mother for signs of placental deterioration. Towards the end of pregnancy calcium is deposited on the walls of blood vessels and proteins are deposited on the surface of the placenta, which changes the placenta. This limits the blood flow through the placenta and ultimately leads to placental insufficiency and the baby is no longer properly nourished. Induced labor is strongly encouraged if this happens.

Post-term babies may be larger than a "normal" baby, thus increasing the length of labor. The labor is increased because the baby's head is too big to pass through the mother's pelvis. This is called cephalopelvic disporportion. Caesarean sections are encouraged if this happens.

When post-mature babies are larger than average forceps or vacuum delivery may be used to resolve the difficulties at the delivery time. Difficulty in delivering the shoulders, shoulder dystocia, becomes an increased risk. ^[7]

[edit] Methods of Monitoring Post-mature Babies

Once a baby is diagnosed post-mature, it needs to be monitored to make sure its health is being maintained.

Feotal Movement Recording
Regular movements of the baby is the best sign indicating it's still in good health. The mother should keep a "kick-chart" to record the movements of her baby. Less than 10 movemnts in 12 hours is not a good sign and a doctor should be contacted. If there is a reduction in the number of movements it could indicate placental deterioration.
Electronic Feotal Monitoring
Electronic feotal monitoring uses a cardiotocograph to check the baby's heartbeat and is typically monitored over a 30-minute period. If the heartbeat proves to be normal the doctor will not usually suggest induced labor.
Ultrasound Scan
An ultrasound scan evaluates the amount of amniotic fluid around your baby. If the placenta is deteriorating, then the amount of fluid will be low and induced labor is highly recommended.
Biophysical Profile
A biophysical profile checks for the baby's heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid surrounding the baby.
Doppler Flow Study
Doppler flow study is a type of ultrasound that measures the amount of blood flowing in and out of the placenta. ^[8]

[edit] Inducing Labor

What It Is and Why It's Done
Inducing labor is artifically starting the labor process by using medication and other techniques. Labor is usually only induced if there is potential harm on the mother or child.^[9] There are several reasons why a doctor might suggest labor induction; the mother's water breaks and contractions have not started, the child is post-mature, the mother has diabetes or high blood pressure, or there is not enough amniotic fluid around the baby.^[10] Labor induction is not always the best choice because it has its own negative risks. Sometimes mothers will request to be induced for reasons that are not medical. This is called an elective induction. Doctors avoid inducing labor unless it's completely necessary.^[11]
How It's Done
There are four common methods of starting contractions. The four most common are stripping the membrances, breaking the mother's water, giving the hormone prostaglandin, and giving the hormone oxytocin. Stripping the membranes doesn't work for all women, but most. A doctor inserts his finger into the mother's cervix and moves it around to separate the membrane connecting the amniotic sac, what houses the baby, from the walls of the uterus. Once this membrane is stripped the horomone prostaglandin is released into the mother's body and starts the contractions. ^[12] Most of the time doing this only once will not immediately start labor. It may have to be done several times before the stimulant horomone is released and contractions start. ^[13] The next method is breaking the mother's water, which is also referred to as an amniotomy. The doctor uses a plastic hook to break the membrane and rupture the amniotic sac. In a few hours labor usually begins. Giving the horomone prostagladin ripens the cervix, in other words softens it, thins it out, or dialates it. The drug Cervidil is administed by mouth in tablet form or in gel form as an insert. This is most often done in the hospital overnight. The horomone oxytocin is usually given in the drug form of Pitocin. It runs through an IV throughout the labor process. This horomone stimulates contractions. Oxytocin is also used to "restart" labor when it's lagging.^[14]
What It Feels Like
Stripping the Membranes- Stripping the membranes only takes a few minutes and causes a few intense cramps. A lot of women think it feels like you're peeing on yourself.
Breaking Your Water- Having your water broken feels like a slight tug and then a warm flow of liquid. It's an uncomfortable feeling.
Prostaglandin- Inserting the hormone prostaglandin involves heavy cramping.
Oxytocin- When the horomone oxytocin is used contractions occur more frequently than a natural occuring birth, thus causing more pain.^[15]

The Risks
Inducing labor doesn't instantly start the birthing process. In fact, sometimes days will go by before labor initiates. If this happens, then a Cesarean section will be performed. If labor hasn't started a long time after the membranes have been ruptured, the risk of infection increases dramatically. Therefore, if rupturing the amniotic sac doesn't induce labor, the doctor will try a new method. The use of prostaglandin and oxytocin can cause abnormal contractions. In this case, the doctor will lower the dosage of oxytocin or prostaglandin. The risk of tearing the uterus increases when these medications are used. Oxytocin can also cause low blood sugar or low blood sodium levels, which can cause seizures. When a mother isn't sure of her last menstrual period it can cause problems once the expected date approaches. If labor is induced on a mother that miscalculated her last period, the baby could actually be born too early. Women that have first trimester bleeding or irregular periods are most affected by this. When a baby is thought to be post-term but is actually born too early it is called late pre-term. Late pre-term babies may have jaundince, trouble with feeding or breathing, or difficulty maintaining a normal body temperature.

Although there are several ways you can naturally induce labor yourself, the best thing to do is leave it to the medical professionals because this is the safest way.^[16]

[edit] Notes

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