Due Date for VBAC: Not an Expiration Date
By Danell Swim
April 27, 2008
Being a woman with a prior cesarean, I’ve become extremely supportive of women who choose a vaginal birth after a cesarean (VBAC) like I did. It seems that my support is often falling on deaf ears, as time and again, women are coerced into repeat cesareans for ridiculous reasons. The latest of which, is women who are pregnant after the due date.
I just read of another woman who is “attempting a VBAC” with her doctor. She’s desperately hoping that she’ll go into labor before her Estimated Due Date (EDD), because if she goes even a day past, the caesarean will be scheduled immediately.
This is happening all too often, as doctors seem to believe that an EDD is actually an expiration date. To back up this ideology, they use ridiculous claims to coerce women to go along with these scheduled c-sections. They say that the stillbirth rate increases after 40 weeks, that the number of successful VBACs is lowered, and that the baby will get too big which will make a vaginal delivery too dangerous. There is no evidence to back up these claims, yet doctors continue to practice according to myth and rumor rather than clear medical information.
Despite evidence to the contrary, doctors are still insisting that women only be allowed to attempt a VBAC if labor occurs before the EDD. And, they sell this policy as an actual attempt is made to give the woman an opportunity to have a VBAC in this manner. But how likely is it that a pregnant woman will go into labor before her due date? For that, we have to look at the information regarding EDDs.
About your Due Date
The first piece to understanding your estimated due date (EDD) is the origins. No doubt when the due date calculators online, plus your doctor’s office and any wheel chart all calculated your due date, you assumed some scientific equation that averages out all births? You’d be wrong.
How would you feel knowing that the man who invented the 40 week pregnancy due date, was born… oh, about 230 years ago. Other notable events in the year of 1778 were: Captain Cook’s discovery of the Hawaiian Islands, England’s declaration of war on France (again), the Revolutionary war raging on, and Franz Karl Naegele’s birth in Germany.
It is called Naegel’s Rule:
The rule estimates the Expected Date of Delivery (EDD) from the first day of the woman’s Last Menstrual Period (LMP) by adding a year, subtracting three months and adding seven days to that date. This approximates to the average normal human pregnancy which lasts 40 weeks (280 days) from the LMP, or 38 weeks (266 days) from the date of fertilisation. Example, if LMP was 8 May 2007, then +1 year = 8 May 2008, -3 months = 8 February 2008, +7 days = 15 February 2008; whereas precisely 280 days would be 12 February 2008.
It is remarkable that in such an archaic time of obstetric knowledge, someone was able to come up with a method of dating gestation that is still used today. The only problem with that is that it’s terribly inaccurate, yet doctors continue to use it as gospel.
A study was published in 1990 that examined the average length of pregnancy for white women. Essentially, they found that if you take the date of the LMP + 1 year - 3 months + 15 days (if the woman has not had a prior vaginal birth). If the woman has had a vaginal birth, you add 10 days instead.
So if I were to have my LMP on May 8th 2007, I’d jump ahead to May 8th 2008, then subtract 3 months to February 8th 2008. If I’d already had one baby vaginally, my EDD would be February 18th 2008. If I’d not had any prior vaginal births, my EDD would be February 23rd. That’s a far cry from February 15th, as Naegel’s Rule states.
| Due Date Theories | Previous Vaginal Birth | No Previous Vaginal Birth |
| 280 Day Rule | February 12th | February 12th |
| Naegel’s Rule | February 15th | February 15th |
| Avg White Women | February 18th | February 23rd |
Information is limited as to other ethnicities, but one study in England found that Black and Asian women had a gestation approximately 1 week less than white women. In addition, they found that “preterm” black and Asian infants were less likely to exhibit signs of being preterm, which gives more evidence that those babies are more developed than white babies. In layman’s terms: they’re fully cooked.
However, previous deliveries, ethnicity and familial traits are never taken into account when estimating a due date. Which is what makes it so unfair that doctors are treating these estimates as scientific evidence.
What this means for VBAC Moms
Let’s assume that Jane Doe is planning her VBAC. Her doctor supports her, but says that she has to go into labor before her due date. Let’s suppose that Jane is white, and hasn’t had any children vaginally before. Her doctor uses that handy dandy chart to predict her due date as May 7th. But, odds are that she won’t go into labor until May 15th.
Poor Jane, has a doctor that was just humoring her with promises of a VBAC. When in reality, he could have predicted all along that she’d end up with another c-section. After all, these are the doctors, they’re the ones that are supposed to be reading the studies and keeping up to date on things as trivial as average gestation.
The VBAC rate is plummeting in this country to less than 9%. Part of this is due to the malpractice fears, and the (soon to be revised) American College of Obstetricians and Gynecologists recommendations, but it’s also due to so many doctors refusing to treat VBAC women as anything but a ticking time-bomb. And, they know that with threats of shoulder dystocia, uterine rupture and placenta accreta, they can scare these women into repeat cesareans if they don’t meet the impossible deadline of their false estimated due date.
Unfortunately for women who desire a VBAC, there’s little you can do but to keep looking for another care provider. Keep looking until you find one that truly understands how the normal human body functions, and is most concerned with giving the patient the birth that they want and need.
Doctors just don’t seem to understand this. And that’s why they keep amusing themselves by allowing women to attempt a VBAC under these circumstances. It’s disturbing how many of them are insisting that VBAC patients deliver before 40 weeks, and it’s ridiculous that women are allowing them to make those decisions for them.
Because let’s face it: having a VBAC isn’t about proving anything, or becoming a “real woman” as so many would like to believe. Having a VBAC is about making the choice to have a healthier birth, a healthier mom and baby, and a healthier reproductive future. It’s about being able to hold your baby without pain.
That’s worth finding another doctor (or midwife).
References:
Overdue? (more info for calculating your due date)
The length of uncomplicated human gestation.
Does gestation vary by ethnic group?
Comments
12 Responses to “Due Date for VBAC: Not an Expiration Date”
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I have a question I have already had two c- sections and I was wondering if it was possible to have a vbac after 2. my doctor didnt even ask just said we will schedule your c-section. after my first one I tried for vbac but the baby was breech but now I would really like to have a vbac
You can still have a VBA2C (vaginal birth after 2 cesareans), but it can be harder to find a care provider willing to take you on. They are out there, you just have to look a little harder to find them. I know several women who’ve had VBA2C (and even VBA3C and VBA4C), and it’s a very viable option. I hope you’re able to get your VBAC! It’s a wonderful experience.
1. If I ever decide to have another child, I’m totally going with a midwive, and a VBAC.
2. Um… just don’t show up to your c-section!
Thank you so much for this! My doc wanted me to have my c-section two days BEFORE my due date. I did have her vaginally six days AFTER my due date, but only because I fought for it!
Every birth is different and you cant say how one way is better over the other . Of course vaginal birth is better. Because thats what we were taught. BUT I have two kids both vaginal . What happened during my first delivery made me wish Id had a c-section. I chose to go 5 days past due date. I had no pain killers. I refused to be cut. All natural. But what happened afterward was more painful than a root canal without a shot. You cannot predict what will happen during childbirth. If your childs umbelical cord is around its neck are you going to demand a natural birth still? Dont jump to conclusions or be to hasty, moms. I have learned that the medical field in this little town is limited so you just want to trust your doctor and whatever they tell you you want to believe. Even if its late at night and they want to go home because they have a 930 tee off. Its not a good feeling to hear your doctor say “Oh sh*&^%” after delivery so go with gut instincts but also have back up care in case something goes wrong. I have alot more to say on this subject but I will stop now. These are all facts dug up from somewhere and I really dont care about someones facts that are only really opinions when I have my own.
yes you can say one is better than the other - that is what medical research is for…..in a birth without complication c-sections carry more risks than a vaginal birth, period! and about the pain - if a mom isn’t ready for the pain and sacrifice that comes with childbirth, then she is not ready to be a mom - i would take any amount of pain to protect my child from health risks - and medical intervention carry a lot of hefty risks - according to ACOG only about 4% of birthing women medically need a c-section - yet our national rates are climbing past 40% right now. no i do not think it is ok for my doctor to give me one because he doesn’t want to wait around or he’s got something scheduled - that is not in the best interest of baby or mom and is placing them in harms way for a convenience! i’m outraged! and people spend more time researching their car and home purchases than , who will assist in their babys deliver, how and why….1 doctor is not enough to count anything as fact - this decision is a huge one and concern your children’s safety and health - how can anyone not want to look into the research before putting drugs in baby’s unborn body or cutting it out with all of the adverse side affects that go with it….and fyi - a nuchal cord is nothing to give a c-section for - even a doctor will tell you that - what are they going to do…deliver the baby’s head, see the cord and run you in for a c-section with the babys head sticking out of your vagina - um no - they are going to unwrap the cord and move on - just like a midwfie or homebirth does - except doctors tend to make more drama out of it than is necessary…and what on earth are these “facts dug up from somewhere” …..that doctors should be able to schedule c-sections out of convenience? please, if these are “facts” cite the sources for me - and if you would like me to do the same, i will give you all of the medical studies i have seen about the adverse affects of unecessary c-sections - no problem, but i have a feeling you’re going to have a hard time finding a study saying that a doctor’s tee time is worth a c-section - and especially without any risks to baby and mom! GL
Rose, I like what you said about going with your gut. I’m a big advocate for following your instincts. It is true that you can never fully predict what will happen during labor just like you can’t predict anything in life with 100% accuracy. However, there is a lot you can do to up the chances of having a fully normal birth without complications. When complictions arise, you can be prepared for them. However, there is no need to treat yourself as if you have complication before you have one.
Going 5 days past your due date is not a complication. Having the cord around the neck is not a complication. Nuchal cords are variations of normal. Repeated studies have shown that there are no differences in outcomes when a nuchal cord is know about before hand via ultrasound and even ACOG recommends that nothing be managed differently in births were it is known that the cord is around the neck. So to answer your question, yes I would most definitely still have a natural birth if my baby’s cord was around his neck.
In fact, my last baby was born with the cord wrapped around his neck twice and it was a fully natural birth. My son would have likely been born by c-section had the birth not been natrual because he was very large and had a large head. I needed to be on my knees so that my pelvis could open up an additional 30% in order to get him out. I wouldn’t have been able to do that had my legs been numb. I’m glad I did not expose him or myself to the added risks associated with major surgery. Instead we had a beautiful peaceful labor and birth and I experienced very little pain even thought it was natural.
The hospital I gave birth in (like most hospitals around the country) did not manage my son’s nuchal cord properly. They cut it on the perineum therefore cutting off his lfe support before he could breath on his own since he had not been born yet. This is not evidence based yet it is commonplace in hospitals. Knowing that, we feel so much more comfortable with having a home birth with our next child as our baby (as well as myself) will be at less risk.
LOL! Valerie calm down. I was just speaking my mind like it says to do here. As far as pain goes. I have an extremely high tolerance for pain. There are lots of reasons women should not have children and dealing with pain is pretty low on my list. Try having your uterus pulled out inside out and having your Dr. shove it back inside you with his hand up your vagina to his elbow. FYI I know what the procedure is for the umbelical cord I was just making a point. Facts dug up fromsomewhere? You answered your own question there. Medical studies from where? Books? They might be helpful but like I said every birth is different and every womans body is different. Youre entitled to your opinion as I am mine. Didn’t mean to make you angry. Sorry.
Can you cite the 1990 study that studied the average white woman’s due date. I would like to get a copy and give it to my health care provider. thanks,
The debate is not about whether a vaginal birth shows that a woman is “stronger” or a “better mother” (being overdue has no effect on the umbilical cord, BTW, only on the placenta. Malpositioning has the biggest effect). The debate is about the “one size fits all” policies that OB’s and hospitals adhere to to cover themselves. An OB who insists that a woman have a VBAC on or before her EDD is simply not VBAC-supportive, regardless of whether a woman has had a previous vag. birth, and should be a red flag to women trying for a VBAC. It’s important that women educate themselves and shop around for care providers who will truly support them. Nothing will change until the consumer (women) demand change and insurance companies are taken to task on their fiscally-driven policies.
yes,init’sownway
Thanks for this information. A previous appt with a Nurse Practitioner did mention that if I went past my EDD that a C-section was going to be scheduled. My OB is very supportive of a VBAC - in fact, he thinks I’m a great candidate. He has not talked about having a C-section if I go past my due date. I think I will go with his expertise vs. the NP’s.