Lesson 13: Misleading Due Dates & Ultrasounds
"Mothers need to know that their care and their choices won't be compromised by birth politics." ~ Jennifer Rosenberg
introduction
One of the first questions a pregnant couple is asked when announcing their joyful news usually involves something along the lines of "When is your due date?!" If given an elusive answer, such as "in the Fall", or even "this September", its a bit mind-boggling just how many people will continue to press the issue... "No, really, what DAY will your baby be born?!?"
When we allow ourselves to consider all of the varying factors that are at play regarding a particular baby's gestational period, it is really quite incredible that the idea of a due "date" ever came into being! The fact is, no matter how much we might try to ignore that magical date on the calendar it can be quite difficult to view it as any other day. Estimated due dates can have incredible power over our birth experience, if we allow them. Therefore it's very important that we study the evidence regarding the accuracy of estimated due dates, as well as ultrasounds, which at times are heavily relied upon when making decisions about induction.
When we allow ourselves to consider all of the varying factors that are at play regarding a particular baby's gestational period, it is really quite incredible that the idea of a due "date" ever came into being! The fact is, no matter how much we might try to ignore that magical date on the calendar it can be quite difficult to view it as any other day. Estimated due dates can have incredible power over our birth experience, if we allow them. Therefore it's very important that we study the evidence regarding the accuracy of estimated due dates, as well as ultrasounds, which at times are heavily relied upon when making decisions about induction.
learning goals & focus guide
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After viewing and completing Lesson 13 - "Misleading Due Dates & Ultrasounds", students will be able to:
~ Offer 3 reasons why an estimated due date could be inaccurate, assuming a woman is allowed to go into labor spontaneously.
- Recall at what gestational week the evidence could be argued to support inducing labor to improve birth outcomes, (per ACOG's Bulletin #146).
~ Paraphrase the 4 main reasons why induction and planned C-sections for big babies are not based on evidence, per the Evidence Based Birth video by Rebecca Dekker.
~ Calculate the window of "accuracy" for a first trimester, second trimester and third trimester ultrasound when predicting due dates, per the "When is that Baby Due?" article by Henci Goer.
~ Offer 3 reasons why an estimated due date could be inaccurate, assuming a woman is allowed to go into labor spontaneously.
- Recall at what gestational week the evidence could be argued to support inducing labor to improve birth outcomes, (per ACOG's Bulletin #146).
~ Paraphrase the 4 main reasons why induction and planned C-sections for big babies are not based on evidence, per the Evidence Based Birth video by Rebecca Dekker.
~ Calculate the window of "accuracy" for a first trimester, second trimester and third trimester ultrasound when predicting due dates, per the "When is that Baby Due?" article by Henci Goer.
video lesson
The Inaccuracy Of Due Dates
Please read the article by Henci Goer & Anne Frye, "When Is That Baby Due", prior to viewing our class discussion on estimated due dates and the potential inaccuracy of ultrasounds. * Please note that recent studies now estimate the window for ultrasound accuracy in predicting due dates to be even WIDER than indicated in this article... The widely accepted window for accuracy is now +/- 7 days in the first trimester, +/- 14 days in the second trimester, and +/- 20 days in the third trimester. That's up to a 40 DAY WINDOW for accuracy!!! (Or should we say inaccuracy?!)
Audio Only:
resources
~ Article by Henci Goer & Anne Frye, "The Due Date", also found here: "When Is That Baby Due?" (PDF version).
~ "Evidence on Inducing Labor for going past your Due Date", ©2015 Evidence Based Birth®, Blog Post By Rebecca Dekker, PhD, RN, APRN. Linked with permission.
~ "What is the Evidence for Induction or C-section for a Big Baby?", ©2013 Evidence Based Birth®, Blog Post By Rebecca Dekker, PhD, RN, APRN. Linked with permission.
~ Per the American Congress of Obstetricians and Gynecologists:
"Ultrasound done late in pregnancy is associated with an increase in cesareans with no evidence of neonatal benefit. Macrosomia is not an indication for cesarean." ~ "Safe Prevention of the Primary Cesarean Delivery: ACOG and SMFM Change the Game" A blog post by Judith Lothian, Science & Sensibility, February 19, 2014.
~ FWF - 024 - "Prenatal Ultrasound Update", by Jeanne Ohm, D.C., Tuesday, 19 May 2009
"A new study: "Ultrasound Can Affect Brain Development" is bringing attention to what has become a routine prenatal procedure. The use of ultrasound has dramatically increased in prenatal care however, its safety and efficacy are still highly questionable. Even the FDA cautions, "While ultrasound has been around for many years, expectant women and their families need to know that the long-term effects of repeated ultrasound exposures on the fetus are not fully known..."
~ "ACOG states that there is good and consistent scientific evidence to recommend induction after 42 0/7 and by 42 6/7 weeks of gestation; but only limited or inconsistent evidence to consider induction between 41 0/7 and 42 0/7 weeks of gestation." ~ American College of Obstetricians and Gynecologists (ACOG.) (2014). Practice bulletin #146: Management of late-term and postterm pregnancies. Obstetrics and Gynecology, 124(2, part 1), 290-396.
~ "Evidence on Inducing Labor for going past your Due Date", ©2015 Evidence Based Birth®, Blog Post By Rebecca Dekker, PhD, RN, APRN. Linked with permission.
~ "What is the Evidence for Induction or C-section for a Big Baby?", ©2013 Evidence Based Birth®, Blog Post By Rebecca Dekker, PhD, RN, APRN. Linked with permission.
~ Per the American Congress of Obstetricians and Gynecologists:
"Ultrasound done late in pregnancy is associated with an increase in cesareans with no evidence of neonatal benefit. Macrosomia is not an indication for cesarean." ~ "Safe Prevention of the Primary Cesarean Delivery: ACOG and SMFM Change the Game" A blog post by Judith Lothian, Science & Sensibility, February 19, 2014.
~ FWF - 024 - "Prenatal Ultrasound Update", by Jeanne Ohm, D.C., Tuesday, 19 May 2009
"A new study: "Ultrasound Can Affect Brain Development" is bringing attention to what has become a routine prenatal procedure. The use of ultrasound has dramatically increased in prenatal care however, its safety and efficacy are still highly questionable. Even the FDA cautions, "While ultrasound has been around for many years, expectant women and their families need to know that the long-term effects of repeated ultrasound exposures on the fetus are not fully known..."
~ "ACOG states that there is good and consistent scientific evidence to recommend induction after 42 0/7 and by 42 6/7 weeks of gestation; but only limited or inconsistent evidence to consider induction between 41 0/7 and 42 0/7 weeks of gestation." ~ American College of Obstetricians and Gynecologists (ACOG.) (2014). Practice bulletin #146: Management of late-term and postterm pregnancies. Obstetrics and Gynecology, 124(2, part 1), 290-396.
diving deeper
Want to Dive Deeper? Let's Go!
Please watch this video regarding induction, (and even c-section recommendations!), based only on the baby's suspected size:
~ "Evidence Based Birth Class on Big Babies", © 2013 Evidence Based Birth®, Blog post By Rebecca Dekker, PhD, RN, APRN. Linked with permission.
reflection opportunities
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Student Poll: |
Journal Entry:
Please visit the forum below under "Unit 4: Preparing For Potential Pre-Labor Interventions - Misleading Due Dates And Ultrasounds" to reflect on the following question:
~ It's time to do some soul-searching! Ask yourself, how emotionally attached are YOU to your estimated due date? How might you feel when that day has come and gone? What if you go early? Will you feel prepared to "go with the flow"? What if you are still pregnant after that magical, promised "due date"? How comfortable are you in allowing your baby to decide when they are ready for this world?
~ It's time to do some soul-searching! Ask yourself, how emotionally attached are YOU to your estimated due date? How might you feel when that day has come and gone? What if you go early? Will you feel prepared to "go with the flow"? What if you are still pregnant after that magical, promised "due date"? How comfortable are you in allowing your baby to decide when they are ready for this world?