Making Predictions During Birth – About as Magic as the 8 Ball!

Magic 8 Ball

Did you ever have a Magic 8 Ball? I did. I loved that thing. I loved being able to ask a question, any question, and have the almighty oracle predict my fate. Inside the little window floated a single die, with twenty possible answers to life’s biggest questions. Some of which included: “Signs point to yes” and “My sources say no.” When the Magic 8 Ball was certain, yes or no, then that was it. But sometimes there would be the confounding response of “Cannot predict now.” That always meant another hard shake of the ball and the search for a more straight forward answer. No matter how many times it took to get one!

I think too many of us are looking for straight forward answers to one of the biggest questions of all time. We want so badly to be able to predict what is by it’s very nature unpredictable – birth.

Today, I want to speak directly to those of us who work with pregnant and birthing couples.

Could you stop setting them up? Stop making predictions? Please, I’m begging you!

I recently had a reunion with some of my families. More than once I heard the report that someone on their birth team tried to make a prediction during their birth experience. I groaned and asked, “Why do they do that?”

One new Momma said, “so then, the nurse said to me “You’re really cooking! I bet we’ll have a baby before lunch!”

A second Momma said “the doctor came in and told me to get ready for a really long night, because he didn’t think I was going to have the baby until the next afternoon!”

Guess what really happened with these two women?

The first Momma’s labor came to a complete standstill about thirty minutes after her nurse had predicted a late morning baby. She started watching the clock and when the lunch hour came and went unceremoniously, no baby to be found even considering entering her birth canal, she became despondent and discouraged. She started to freak out that something was wrong with her body – with her baby. Given the strong connection between the mind and the body of a birthing woman, it’s no wonder all of this extra anxiety shut her body down for hours! It took an incredibly long time (and a new nurse at shift change!) before this woman’s labor started moving again. She ended up giving birth close to midnight – twelve hours longer than had been “predicted.”

The second Momma and her partner settled in for their “really long night.” But soon after she started second guessing her ability to handle the contractions that felt like they were right on top of one another. Instead of recognizing that her labor had kicked in big time and she was almost fully dilated, she thought that she was “just wimping out.” She was feeling very disappointed in herself and her ability to cope with what she’d been told by her provider was supposed to be early labor. Imagine the surprise when her husband had to run out of the room to grab someone to come catch the baby! It had only been about ninety minutes since she was last checked. So much for their marathon labor!

Birth is unpredictable. It can slow down, and appear as though it’s stopped altogether. It can speed up in the blink of an eye. The issue is not the unpredictable nature of birth, it’s our intense desire to make it predictable that’s the problem! There are way too many unique variables in every labor experience to make it impossible to predict consistently what will actually occur.

But we all still do it! Why?

Pregnant Mommas and their partners hear the due date and create an expectation that this is the day the baby will arrive, instead of recognizing their due month as closer to the reality of when the baby will actually be born.

As a Childbirth Educator, I’m guilty of it as well. I teach, as most do, textbook averages for birth. But do I explain that as a first time Momma, it’s completely within the range of normal to have a birth go super fast? Do I adequately prepare them for an ultra marathon labor experience? We all need to be more on top of this, so our students understand it is possible to have active labor begin almost immediately! And it’s also possible to be in early labor for three days before any changes in their cervix occur. As Childbirth Educators we need to provide our students with realistic expectations of the unpredictable nature of the birth process itself.

But once they’re at the hospital, too many nurses and providers think they’re doing a service for these women when they try to predict what will happen next. I know that this is not born of ignorance. These are professionals who have been at this job for a long time – decades in some cases – and they’ve seen an awful lot. The laboring woman in front of them is presenting as many have before her. The mind just wants to go there. “Here’s a pattern that I’ve seen before. So I’m going to predict what will happen next.” And in a lot of other areas of life, this might not be a bad policy. But not when we’re talking about birth.

This unpredictability of birth (and our refusal to embrace it) is what trips all of us up when it doesn’t have to. In fact, I would argue that we’re missing out on the most important aspect of birth while we’re busy trying to predict what will happen next.

As expectant couples, you go into birth with a rock solid Birth Plan that you wrote a month before your first contraction. But due to circumstances you could never have predicted, your birth has gone rogue. If you’re still clinging to the plan of your ideal birth (as opposed to participating in your real birth) you’re setting yourself up for disappointment instead of moving through your birth as it unfolds. When you’re able to adopt this attitude of flexibility, you’ll be surprised at what you’re really capable of! “Wow, this is not at all what I expected, but look at us and how we’re handling this completely unpredictable experience together!” It matters how you respond to your birth in real time, as it really happens. Not based on what you had predicted (hoped, wished, or expected) would happen.

As Childbirth Educators and Doulas, we are hurting ourselves and our couples when we try to make predictions about how we think our couples will move through their births. Let’s not prejudge how the people we work with will cope with their labors. Let’s give them all the benefit of the doubt in that they will have births that are, by nature, unpredictable. Let’s try our best to prepare them better for that reality.

As for the L&D nurses and providers who encounter these women in labor and try to make predictions about what will happen next, please understand how much that undermines a woman’s confidence in her ability to know her own body. For the woman before you, it doesn’t matter one little bit how many times you may have witnessed what she’s currently experiencing. She doesn’t need predictions from you about how much shorter or longer her birth might be. She just needs your support and your listening ear – right now. Even the least experienced laboring woman will be able to provide you with clues about what is actually happening in her body. And this is so much more valuable than what you think might be happening in her body.

I completely understand why we do this whole thing of planning and discussing averages and making predictions – all of us are wanting to avoid vulnerability. But vulnerability and birth are inseparable. They have to be. Birth without vulnerability lacks the key ingredient that’s necessary for deep and lasting transformation to occur.

All of us who work in this field should be experiencing that transformation on a regular basis. That’s why most of us got into this whole thing in the first place – the beauty, the mystery, the surprise, the unpredictable nature of birth stirs something in our soul. After each encounter, we should leave that new family feeling grateful we were once again able to witness their transformation – and be transformed ourselves at the same time. This is how we can continue to best serve our families, when we recognize the sacredness of our own work with them and strive to preserve that sacredness for our families no matter how unpredictable their birth ends up being.

There is magic in birth – it’s just not of the 8 Ball variety.

Experienced parents: Did you try and make predictions about your pregnancy, birth or parenting? Did any of them come true? Did anyone on your birth team try to make a prediction about your birth? How did his make you feel?

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?