I was pregnant for 10 months

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Jack, my third child, arrived last month, 20 days late. My first two babies were 15 days late. But a day shy of week 43? That is virtually record-breaking – and, some would say, slightly mad ...

Historically, tales of weirdly overdue babies are not unprecedented. The actor Jackie Chan claims his mother carried him for 12 months before he was born by caesarean section, weighing 12lb. There is also a story of a woman in a prisoner of war camp who allegedly waited until the camp was liberated to give birth – at 12 months' gestation.

... I held out as long as I could, but in the end Jack was induced. I wish it could have been otherwise. The day before he was born, the hospital consultant had made it clear that she didn't agree with me remaining pregnant for a day longer. Despite the fact that there were no signs that there was anything wrong, there was a risk of stillbirth, she said. "How does that apply to this pregnancy in particular?" I asked, as all my tests were clear. "You're very overdue," came the answer. I could have waited another day or two maybe. But I wasn't happy acting against the hospital's wishes.

The induced labour was not a terrible experience – Jack was born with no complications in 50 minutes – but it was not ideal. I had wanted him to come out when he wanted to. Not when a doctor ordered him to. It turned out that he was large, but not abnormally so (8lb 12oz; his sister was larger at 9lb). And he had no signs of being post-dates: no wrinkly skin, and the amniotic fluid was clear ...

So why is 40 weeks seen as the norm when only 5% of babies arrive on their due date – and when it is 41 weeks in France? Could we be inducing babies who don't need to be induced – exposing both them and their mothers to unnecessary risk?

The US midwifery guru Ina May Gaskin thinks so. She believes that every baby will come in its own time, and she is currently campaigning for 43 weeks – rather than 42 – as the definition of "late". The dates in themselves, says Gaskin, do not indicate the need for induction. There are clear signs if there is something wrong and the baby needs to come out: reduced foetal movement, for example, a deceleration in growth, or reduced amniotic fluid – all of which could be picked up by the mother or a midwife.

In recent years the ultrasound dating scan at 12 weeks has been seen as the best measure of due date in the UK. Statistics suggest it is marginally more accurate than the traditional LMP ... date ...

The trouble is that very few women fit the "average" – hence the huge variation in the dates when babies are born. Seventy per cent arrive after their due date. And yet it has become a fixed point by which we measure everything in pregnancy. Meanwhile, induction rates in England are rising ...

Hannah Latham ... was 18 days overdue when she gave birth to Noah, now six weeks old. "I do wish they could give you a 'due window' of three weeks instead of a due date," she says. "It becomes very stressful. You have all these people hassling you, saying, 'Isn't he here yet?' Because, of course, you tell everybody your due date. Which in future I wouldn't do." Latham consented to an induction in the end because an ultrasound scan showed that the amniotic fluid was starting to run low.

"Until then there was no good reason to induce. But they pressure you from when you are a week overdue. They say to you, 'Are you aware that you are putting your baby at risk?' I said, according to what statistics? They said, 'We don't know.'"

This is the problem with overdue babies: there is very little evidence because so few women allow their pregnancies to go past 42 weeks. As US midwife Gail Hart points out, the most-cited statistic about post-dates babies (that their risk of stillbirth "doubles after 42 weeks") comes from a 1958 study – a time when mortality rates were 10 times what they are now. Also, as Hart argues, induction is hardly risk-free: it carries higher rates of caesarean section, uterine rupture, foetal distress and maternal haemorrhage.

These risks were what put me off induction. Home birth was also a factor, as it is for many: if you agree to induction, it has to happen in hospital. This usually means you end up being monitored, wired up to a machine to measure the baby's heart rate, and you will have to deliver flat on your back. Having given birth twice, I know that I cope best if I am free to rampage around the room. Because my midwife knew me very well ... she helped me to stand and move around, while still being monitored ...

... Joanne King's second baby was born at 43 weeks plus three days. She writes: "I explained [to the consultant] that I thought the risk of being induced versus carrying on with the pregnancy – when the baby and I were well – was not one worth taking. She agreed with me."

... The latest baby Jokinen delivered was 44 weeks gestation. "As a midwife you know if a baby is truly post-mature by the state of the skin. It's drier and flakier. They look like someone who has been in the water too long." But according to one American study [cited by Gail Hart in Midwifery Today], more than 90% of supposedly "late" babies born at 43 weeks in fact show no signs of post-maturity.

Gaskin argues that in the US there is a new medical complication, "iatrogenic" ("doctor-caused") prematurity – "inductions where babies turn out to be premature and then spend a week or more in the neonatal intensive care unit". She says in four decades of experience and thousands of pregnancies, she has seen only one woman who needed to be induced. "We've had experience with many Amish families in which 43-week pregnancies seem to be the norm."

To most hospitals, Gaskin adds, a lack of symptoms – and the patient's history – is irrelevant: "This habit of making absolute rules that are applied to cases that used to be open to individual treatment has contributed to the dumbing down of maternity care."

This is true in the UK too. I couldn't understand why my doctor was not interested in all the heart monitoring (every two days after 42 weeks) – and all perfect – or in the ultrasound scan. Nor was there any interest in my birth history (two late babies and fast births, which I thought made me a poor candidate for induction). All that mattered were the statistics – from 1958 ...

Many aspects of birth care are not studied because we have clinical practice guidelines / best practice guidelines in place (which may be based on good research, not-so-good research, expert opinion, or "it's just what we do here"). The effect of these clinical practice guidelines is to establish a standard of care that can reasonably be expected. That being the case, it would then be unethical to randomise the care of women to an experimental arm of a study trial that might cause harm. Hence, we do lack research around management of post term pregnancies (those that continue beyond 42 weeks). It may be the case, as is pointed out in a RANZCOG publication that some women do not benefit from induction at any gestation, such as women who have previously had a baby and whose pregnancy is free of complications.

Another aspect that is not studied, and which might not be ethical to study, is that of continuous fetal monitoring in labour for women with risk-associated labours. It is standard practice, according to NICE guidelines, hospital policies, RANZCOG Guidelines and so on, to continuously monitor labours which fall into certain categories (over 42 weeks, less than 37 weeks, induction, high blood pressure, gestational diabetes on insulin, VBAC, prolonged rupture of the membranes, pre-eclampsia, augmentation of labour, "prolonged" labour, breech, twins or meconium-staining of the amniotic fluid). The alternative to this, as offered in the NSW Health policy, is for intermittent CTGs in labour: having the CTG on for a certain period of time and then removing it for a period of time before re-applying it. Now that CTGs have become the accepted standard of care of women who are labouring with identified risk factors, it would be considered unethical to randomise women to either continous monitoring, or the other alternative which would be intermittent auscultation (where the midwife listens in with a water-proof doppler) every 10-15 mins. My personal opinion is that one-to-one midwifery care in labour (that is, a dedicated midwife who does not leave the labouring woman) combined with regular (10 - 15 minutely) doppler auscultation is as effective and safe as a CTG. If any concern was raised with this doppler monitoring, a CTG would be applied. Of course, my idea is not evidence-based as there is no evidence for this standard of care, and nor will there ever be a study on this as the accepted standard has already been set.

Melissa Maimann, Essential Birth Consulting 0400 418 448