Due Date – How About Due Month?

CalendarOne of the first things that every pregnant couple needs to let go of as soon as possible is the expectation of having their baby be born on a specific day. This is just not something you can count on. When you, your provider, or an internet application attempts to calculate your due date some very big assumptions are being made.

First, that you know the exact date of your LMP – or last menstrual period. You find that date by using the first day you began bleeding on your last menstrual period. Some women will know this without question. They’ve been trying to get pregnant, or may even be using IVF or other means of getting pregnant that really require a heavy amount of tracking in order for conception to take place within a certain timeframe. But, remember the window for conception is a little bit bigger than you think! You can get pregnant any time from about 5 days before ovulation occurs right up to the actual day of ovulation. So knowing exactly when you conceived your little bundle of joy might not be as predictable as you think. And then don’t forget all the other women who, quite honestly, have no idea what their LMP is! “Umm… I think it was the 15th. Maybe?!”

The second assumption is that you have a 28-day menstrual cycle. Some of us do – but only about 10-15%. The rest have cycles that can vary anywhere from 21-35 days in length. And then even that number can vary from month to month. Life events, varying degrees of stress or illness can mean that the number of days between periods fluctuates and doesn’t always remain consistent or regular.

But what if we use ultrasound to determine the almighty due date? How accurate is that?

Well, it ends up being slightly more accurate than using the LMP calculation, but it’s not perfect, either! According to this great article from Evidence Based Birth and Rebecca Dekker, there’s an optimal time to receive an ultrasound to determine gestational age, and that range is between 11-14 weeks. The most common time for a woman to receive an ultrasound, however, is somewhere between 16-20 weeks. The study referenced here showed a significant decline in accuracy happening at that 20 week mark. And 3rd trimester ultrasounds are even less accurate than earlier ultrasounds and LMP. But even if a woman has an ultrasound at the optimal range of 11-14 weeks, this study found that about 68% of women gave birth + or – 11 days of their estimated due date via ultrasound! If you were a betting person, these are not good odds for putting any amount of money down that a baby will be born on a specific day

Calculating a due date can be helpful, I guess. It allows your provider to have a guide by which to measure the growth and development of your baby in relation to your gestation. And it also allows Mommas and partners to have some idea of when pregnancy will finally be over! And it is a helpful planning tool! It lets friends know when they should send out invites to the baby shower, and it allows the Grandmas to figure out when they should be flying out to help after baby is born. It’s helpful. It is. 

But, unfortunately, by the time I see couples in my classes this due date has long been cemented in their minds as “The Day The Baby Will Be Born.” As if any other date will be off somehow. In reality, less than 10% of babies arrive on their actual due date. Some studies place this number even closer to 5%.

You’re actually considered “due” for about 2 weeks before that due date and about 2 weeks after that due date. So, it would be wise for you to start considering your due month, rather than your due date. Why is this so important? 

The exact trigger for spontaneous labor is not really well understood. But it’s widely regarded that there’s a complex interaction between the baby and the Momma that causes the uterus to begin contracting and labor to start.

Some ideas that have persisted over time include the following: a significant shift in the estrogen/progesterone ratio prior to labor beginning. When estrogen levels increase toward the end of pregnancy, it increases the levels of prostaglandin production which is known to assist in the ripening of the cervix. These heightened levels also increase the number of oxytocin receptors that exist on the uterus, as well as increase the contractility of the uterus overall. The baby’s adrenal glands and pituitary glands may actually play a significant role in controlling the timing of labor. The fetal production of the hormone cortisol can lead to increased levels of prostaglandin, as well increase the maturation of their lungs which in some way might trigger that babies are ready to be born.

In “normal person speak,” the hormones of the Momma and her baby play an important role together in signaling the start of labor. If and when it is possible, we should honor this natural, normal and physiological start to labor. It benefits both Mommas and babies – not just in pregnancy and birth, but also in their immediate postpartum experience. 

Women who get very attached to their due date as the day their baby will arrive have a couple of potential issues from the get-go. If the baby comes anytime in those two weeks prior to the due date, couples can find themselves either caught completely off-guard or risk feeling and acting as though they have had a pre-term birth. This, in turn, might cause them to parent with unnecessary caution, concern or added anxiety, when in fact – their baby was born term, just a little bit before the estimated due date. 

Women who deliver on the other side of their due date, women who are already sick of being pregnant, face an even bigger challenge in my opinion. Because, let’s face it, at 38 weeks gestation most pregnant women repeat this mantra daily, “Get it out of me – now!” They start counting not only the days they go past their due date, but the hours, and then the minutes and then the seconds… It’s a slow and painful kind of self-inflicted torture.

It’d be great if much earlier in pregnancy, a couple could realize the futility of trying to determine the actual date that the baby will be born and instead focus on the due month

So try this little exercise…

Your estimated due date as determined by LMP, ultrasound or what your provider has told you is: (A)_____. The date on the calendar 14 days before this due date is: (B)_____. The date on the calendar 14 days after this due date is: (C)_____. Now you know the approximate timeline in which your baby will make their arrival, their due month.

Begin to look at your calendar in this new way. Tell everyone you know that you now understand that your baby will arrive sometime between dates B & C. Get a marker and highlight those dates on the calendar if it will help you to get rid of the idea that your baby will come on a certain and particular day. It is, and has always been, only an estimate.

And that is something you can count on.

Experienced Parents Please Share: When you were pregnant, how invested were you in your due date? Did your baby actually arrive on that date? Was your baby “early” or “late”? What would you have done differently if you’d considered your due month instead of a particular date?

What You Look Like on the Outside is Only Half the Story!

Kate vs Kim

What were your expectations about how you would look while pregnant? Maybe you were hoping that you’d look like Kate whose picture gets plastered on the front of magazine covers in the checkout aisle with a tiny arrow pointing out her adorable little “baby bump.” Maybe you really look more like Kim and now you’re feeling frustrated because your baby bump is neither little nor adorable! I can’t believe that I actually have something in common with Kim Kardashian, but apparently I do! We both “carry big.”

If you’re not careful, this can lead you down a path of negative thinking about your body just by virtue of how you carry the baby that’s inside of you. I want to talk about your amazing body – no matter what size it is – because what you look like on the outside does not tell the full story of all that is going on in the inside.

It’s important to change your negative thinking about this sooner than later. Stop agonizing about how “fat” you’re getting and instead start appreciating all that your body is doing to accommodate your growing and developing baby. Hopefully, this will lessen your anxiety about how you look, and more importantly, lessen your fears about not being able to give birth to “a really big baby.” These fears are only heightened when you listen to the misinformed opinions of others who make predictions of the size of your baby based on how you look on the outside! You might start to consider an induction to avoid giving birth to a baby you’re afraid won’t fit.

A thorough search of the ACOG Guidelines (American Congress of Obstetricians and Gynecologists), found no mention of suspected large baby as a medical indication for induction. In fact, in their paper “Safe Prevention of the Primary Cesarean Delivery” they state:

Suspected Fetal Macrosomia (Suspected Big Baby)
Cesarean delivery to avoid potential birth trauma should be limited to estimated fetal weights of at least 5,000 g (over 11 pounds) in women without diabetes and at least 4,500 g (9.9 pounds) in women with diabetes. The prevalence of birth weight of 5,000 g or more is rare, and patients should be counseled that estimates of fetal weight, particularly late in gestation, are imprecise.

If women are of normal weight pre-pregnant, the suggested range for gaining weight during pregnancy is 25-35 lbs. For underweight women, the range is slightly more, 28-40 lbs, and for women who are overweight or obese the range is less,15-25 lbs and 11-20 lbs, respectively. Many women gain outside this weight range – and I like to use myself to illustrate this point.

My husband is a testicular cancer survivor, diagnosed only 6 months after we were married. After 18 months of chemotherapy, surgeries and other treatments, we weren’t convinced we could even get pregnant. I was just finishing the gig of being his full-time caregiver when I was surprised to find out that I was pregnant! There was no established exercise regimen – at all. I ate well and eventually I did a little bit of pre-natal Yoga and some swimming, but nothing strenuous. Over the course of my first pregnancy, despite being considered normal weight going in, I gained 45 lbs.

With my second pregnancy, I was chasing after my 2 year old. Now, if you’ve ever spent a couple of hours with a toddler than you know that it’s quite the cardio workout! Again despite normal weight going in, I still ended up gaining 45 lbs.

Before getting pregnant with my 3rd child, I’d been seeing a personal trainer. After becoming pregnant, I continued to work out at the gym three times a week until I was about seven months into my pregnancy. And… I gained 45 lbs.

With my fourth and final baby, I had completed a couple of half-marathons, and had discovered Boot Camp classes! I continued to work out in my Boot Camp class three times a week until I was 36 weeks along. Guess how much weight I ended up gaining? Yep, 45 lbs!

Apparently, no matter what kind of exercise program I’m doing while pregnant, my body thinks it has to gain about 45 pounds in order to give birth to a healthy baby. But even though I was 10 years older with my 4th baby, my pregnancy, birth and recovery were all easier than any I’d had before! Why? Because I was in much better shape than I’d been with the other three. (Disclaimer: This does not mean you should start taking a Boot Camp class while pregnant! And if you haven’t yet had any exercise during this pregnancy, don’t beat yourself up about it. Walking, swimming and pre-natal Yoga are fantastic ways to prepare for the birth of this baby and all of them can be started at any point in your pregnancy. These simple and joint-gentle exercises help you build up stamina for the hard work of labor ahead – and they’ll also make you feel good now.)

So, if they’re not interested in embarrassing you every time you step on the scale at your clinic visits, why does your provider insist upon weighing you? Because they need to track your weight gain from visit to visit. If you have a significant jump in weight, or you gain very little or no weight at all, these could be indicators for your provider to check on your baby’s development. For example, if you end up not gaining enough weight, you could end up with a baby that has a very low birthweight. If you end up gaining more than what is recommended, you could be at higher risk of having high blood pressure or gestational diabetes. It is important to be mindful of your weight gain.

But I think what surprises women more than how much weight they gain, is how they actually look during pregnancy. If you’re a woman who has a longer torso in comparison to the rest of your body, then you might be able to sneak that baby up and inside of you for most of your pregnancy. You really are one of those women who has a tiny baby bump! But believe it or not, there’s a downside to this. People ask if your baby is okay, or if they’re developing properly because you “look too small to be carrying a healthy baby!” Or they just don’t believe you when you say you’re pregnant!

I had the opposite problem with all of my pregnancies. Maybe you’re like me and my BFF, Kim. I have less than a couple of finger widths between my hips and ribs. There’s very little room for my baby to hide and there’s nowhere for my baby to go but out. People always asked me, “Are you carrying twins?” or “You have how much time left?!” And while fielding these questions is annoying, those of us who “carry big” run the extra risk of buying into the idea that our babies are huge and there’s no way we’ll be able to deliver them vaginally.

You need to stop that train of thought – now. Inside of you, there are many things at work not visible to the eye that should provide a sense of relief and a solid belief that you can give birth to the baby inside of you – no matter what you look like on the outside.

When you were first seen by your provider and they performed that lengthy and uncomfortable pelvic exam, one of the things they were trying to determine is whether there were any concerns about the size and shape of your pelvic structure. If any anomalies were discovered (which would be rare) a Cesarean birth would have already been discussed. It’s safe to assume that your pelvis is just fine size and shape-wise.

But if you still find yourself catching your reflection in the mirror thinking – “How can I possibly deliver a baby this big?” or secretly measuring your partner’s head while they’re sleeping, then remember what’s happening inside your body that will help you give birth to whatever size baby you’re carrying.

There’s a hormone coursing through your bloodstream during pregnancy called relaxin. Relaxin, which is 10x more prevalent in pregnancy, has many properties, but is especially helpful for birth. Relaxin has a softening and widening effect on your cervix and it also relaxes the ligaments in your pelvis creating some “give” for when your baby is passing through during birth. In addition, your baby’s skull is made up of five bony plates that mold together as the baby’s head passes through and out your birth canal. This allows for the smallest circumference of their head to be moving through the birth canal at any one time.

The combination of your pelvis being plenty big enough to birth a baby, the hormone relaxin on board to loosen the ligaments in your pubic symphysis, your baby’s ability to mold its head to fit the space, and the addition of positions in labor that provide even more space for all the twists and turns your baby needs to make on their way out – translates to most women being perfectly capable of giving birth to whatever size baby they have within.

Toward the end of your pregnancy, many people – including your provider – might try and tell you what size baby they think you’re carrying. They might do this by palpating your belly at a prenatal visit but at best, it’s only a guestimate. Some studies show that even when an ultrasound is used to estimate fetal size, the measurement can be off by a pound or more in either direction!

I know a woman from my classes who went through an induction for a suspected large baby, and after a cascade of interventions which ultimately lead to an unexpected Cesarean delivery, she gave birth to a 7 1/2 lb baby! Not exactly the 10+ pound baby her provider guessed it would be if she went to full-term.

Try not to compare your body with other pregnant bodies that you see in the world. Understand that your uterus can expand anywhere from 50-75x it’s original size to accommodate your growing and developing baby. And even though your uterus was considered a pelvic organ before you were pregnant, once the baby gets big enough it becomes an abdominal organ. Depending on how much space you have between your hips and ribs, that baby might have nowhere else to go but out.

Now is not the time to think of your changing body as getting “fat” – this is the time to celebrate all of the amazing things your body is doing to bring a healthy baby into this world. Celebrate those changes! Find some time to give your body and your self-image some much needed TLC.

And remember, whether you’re a “Kate” or a “Kim” what your body looks like from the outside means little compared to what it is capable of doing from the inside!

Did you have a hard time with your changing body while pregnant? Did you feel “too small” or “too big?” How did you handle the comments of others, from your friends, provider or even complete strangers? Did what you looked like on the outside actually translate to you having a “big baby?”

Comparisons… Why do we do it to ourselves?

Comparison

Comparison is the thief of joy.

So said Teddy Roosevelt, our 26th President. I’m guessing that he was not talking about women and their birth experiences, but this quote absolutely applies to what can happen when we compare our own birth stories with others.

Recently I facilitated a postpartum support group for new parents and their babies. And on that particular day, the group was made up of new Mommas and babies all of whom were younger than six months of age. Some of the babies weren’t even two months old yet! So for these women, their births were fairly recent and I wanted to explore with them their expectations about birth and their actual birth stories to see where they had merged and where they were completely different.

As I imagined, all of the women present stated that their births did not match their expectations at all! But, as I also imagined, this did not mean that they had negative birth experiences. Just births that ended up being very different from what they had expected.

One of the stories that struck me the most was a young Momma who said that she’d had to have an epidural – which was not what she had expected to choose before the birth. She had planned and expected to go through her birth completely medication and intervention free. But what she hadn’t expected was a baby in a posterior position, a really long labor (close to 40 hours from start to finish!) and the intense combination of exhaustion and back pain that led her to ask for the epidural.

In her re-telling of her birth story, I was able to see that this decision to use the epidural as a tool in her labor and delivery allowed her to rest, progress in her labor and eventually deliver her big and beautiful baby boy vaginally. As she was telling her story, though, I could sense some sadness about having to make this decision to use the epidural. I explored this a little bit more with her and what she told me next, made me understand why she was having such issues about her experience and why she was feeling unhappy about how her birth had turned out. She offered this as an explanation:

Out of all of my friends, I’m the only one who had to have an epidural. I’m obviously not as strong as they were, or I would have been able to do this without drugs.

I had to ask a few more questions about her friend’s births before she was able to see clearly and then reframe her own birth story. “All of her friends” were graced with babies who were in the anterior position for labor and delivery, they all progressed fairly easily and ended up with labors that were 12 hours or less from start to finish.

But in her hurry to compare herself and her birth with those of her friends, she failed to recognize what made her story different from theirs. In her comparison, she didn’t recognize just how much more time and work she had needed to put in, and unfortunately this comparison robbed her of being proud of her hard work and effort toward the birth she was working toward. Instead, she only focused on the fact that she had somehow “failed” because she had “caved” and gotten the drugs.

When we spend our time comparing our birth stories to others, we deprive ourselves of owning our own story and finding and celebrating the accomplishment and joy in what we have just done. We’ve brought a brand new human being through our body and into this world! Whether that be through vaginal or Cesarean Birth makes no difference to the magnitude of our accomplishment. Holding up our birth story in comparison of those around us only highlights the details of what they got – and what we didn’t get. When we engage in this negative comparison, we only see our births as less than, instead of all the ways in which it was so much more than. It diminishes our own story. It shrinks it. It makes our birth experience less than the miracle that it was.

This “Comparison is the thief of joy” addiction that we all seem to have starts long before you’re pregnant, and if you can’t get hold of this and start working on weaning yourself off of this addiction, it will follow you straight into the early weeks of postpartum and then into the days, weeks, months and years of parenting that are to follow.

If you’re not careful, you’ll find yourself comparing stories of breastfeeding, baby’s sleep habits, infant development, and one parenting decision after another – until all the joy of having this baby to love and care for and raise into a productive human being has been stolen from you. You’ll be filled with self-doubt about every little decision you make. Your insecurity about making the “right” decision about what pre-school your child should go to will cause you to lose sleep when your baby is only 18 months old – a full year and half away from even being able to attend pre-school.

Stop for a moment and be grateful. Be grateful for the opportunity to have a baby inside of you, growing and developing in that perfect environment that you’ve created without even thinking about it, without analyzing and struggling over just how to achieve it, without comparing it to other women’s ability to create a more perfect environment. Just breathe and be grateful for this new life inside of you.

This little person who is coming to teach you so much about yourself – who you are and what you believe and how you will be as a new parent. Understand that for your baby, there is no comparison.

You are, by virtue of being their mother and father, the very best they could hope for. They will not be spending their time as your new little baby comparing their experience with others.

They will be doing what new little babies do so well – living moment by moment, not worried about what might have been or concerned about what could be better. This is their experience right here, right now. They have no need for comparisons. And neither do you.

Do not let anyone steal your joy.

Did you find yourself comparing your experience with others when you were pregnant? How about your birth story? It’s fun to hear others stories at times, but when it’s a negative comparison, it doesn’t feel too great. Has comparison been an issue for you as a new parent?