Options from 40 weeks of gestation
Serotinity
If a child is born after a gestation period of more than 42 weeks, it is referred to as ‘post-term’. We speak of impending or threatened post-term pregnancy from week 41 of your pregnancy and of actual post-term pregnancy from week 42. Provided both mother and child (or baby and you) are in good condition, there are no medical reasons to induce labor quickly. The choices—waiting, membrane stripping, or induction—lie with you and your partner. You will find more information about these options in this leaflet.
De uitgerekende datum
The due date is determined at the beginning of the pregnancy. 40 weeks (280 days) are added to the first day of the last menstrual period. The due date is established more precisely and definitively with the dating scan.
Very few women give birth exactly on their due date, only 3-5%. Normally, delivery takes place between 37 and 42 weeks. This is the estimated period or term for a normal pregnancy. Almost 10% of all pregnancies last longer than 41 weeks.
If you give birth before 37 weeks of gestation, that is too early. If you have not given birth two weeks after your due date, you are considered to be ‘overdue’. You are then 42 weeks pregnant. After 42 weeks, there is a medical indication to induce labor. You will then give birth in the hospital under the supervision of a gynecologist.
We know that the function of the placenta can decrease towards the end of your pregnancy. The placenta then meets your baby’s needs less effectively. The amount of amniotic fluid may also decrease. The passing of baby stool into the amniotic fluid (meconium) occurs more frequently if delivery takes place after the due date. We do not know exactly if and when this process begins. It is important that your baby maintains their normal movement pattern. If there is any doubt about this, a check-up can take place at the hospital. Your baby’s condition is assessed using a fetal heart monitor (CTG). This involves recording your baby’s heart rate over a longer period, specifically about 30 minutes. Additionally, an ultrasound is used to check whether the amount of amniotic fluid is sufficient.
Option 1: wait
If all checkups are good and the pregnancy is progressing well from a medical perspective, it is safe to wait until the end of your due date (i.e., until 42 weeks) for labor to start spontaneously. It is important that you feel well and that you feel your baby moving well, just as you were used to in the preceding weeks.
By waiting, you give your body maximum time to complete the ripening process. After this, your body is ready to give birth, meaning you do not need to force it, or need to force it less. Moreover, a natural birth usually proceeds more smoothly and easily. Most women look back more positively if the birth has proceeded as naturally as possible.
If you choose to wait until 42 weeks, the midwife will check the amniotic fluid using an ultrasound around week 41. To keep a close eye on everything, you will also come for check-ups twice a week starting from 40 weeks. If you have not given birth before 42 weeks, we can schedule a check-up at 41 weeks and 5 days at the hospital of your choice. There, the baby’s condition will be assessed using an ultrasound and a fetal heart monitor (CTG). We will check if there is still sufficient amniotic fluid and how big the baby is. Furthermore, an internal examination will be performed to check if the cervix is somewhat ripe. It remains important that you continue to feel the baby moving well. After these examinations, we will discuss with you when you will be induced. However, if you feel less movement, have low amniotic fluid, or the fetal heart monitor is not optimal, action will be taken in the short term.
Stripping
One way to stimulate the uterus is to have your membranes stripped by the midwife. This is possible from your due date (40 weeks). During an internal examination, the membranes are loosened from the inside of the uterus. The membranes are, as it were, stuck to the inside. Stripping releases hormones that promote the ripening of the cervix and can act as a catalyst for the onset of labor. The membranes remain intact during this process and are generally not ruptured. Stripping does not cause any additional complications. Before we can strip, we perform an internal examination to assess the ripeness of your cervix. To be able to strip, your cervix must be supple and soft and slightly open. This occurs more frequently if you have given birth before. Stripping is not possible with a stiff, closed cervix.
Stripping the membranes during the internal examination can be an unpleasant sensation. You can always let us know if it is uncomfortable for you, so that we can stop. A little blood loss may occur after an internal examination or after stripping. Sometimes this is also accompanied by mucus discharge or the loosening of your mucus plug. This is a normal phenomenon: the blood comes from the highly vascularized cervix and therefore does not come from your baby. You do not need to worry about this. If the blood loss is as much as on the worst day of your period, or more than that, we ask you to call us. Furthermore, stripping the membranes often causes some menstrual-like cramps. These promote ripening.
Stripping the membranes during the internal examination can be an unpleasant sensation. You can always let us know if it is uncomfortable for you, so that we can stop. A little blood loss may occur after an internal examination or after stripping. Sometimes this is also accompanied by mucus discharge or the loosening of your mucus plug. This is a normal phenomenon: the blood comes from the highly vascularized cervix and therefore does not come from your baby. You do not need to worry about this. If the blood loss is as much as on the worst day of your period, or more than that, we ask you to call us. Furthermore, stripping the membranes often causes some menstrual-like cramps. These promote ripening.
