Health: No one likes to play the waiting game

Do you kick-start labour with a medical induction, go to the reflexolog ist or try a more appetising option - a curry? Joanna Moorhead says it's never too late

Joanna Moorhead
Monday 21 September 1998 23:02

No-one likes being late, which is why being overdue with a baby is so god-awful depressing. Especially when it's combined, as it almost inevitably is, with a constant stream of phone calls from well-meaning friends and relatives who trot out, the moment you lift the receiver: "Well? Has anything happened yet?"

Actually, lots has happened: I have taken the children out for lunch, fed the ducks on the common, and I am about to finish off a couple of articles.

But that, of course, is not what they are interested in. It is the baby they want to know about: due nine days ago, and there is still no sign. And then comes the most infuriating question of all: "How long will they let you go?"

It is a little strange - though entirely in character - that the obstetric profession, having decided that 40 weeks from the date of the last menstrual period is the "right" time for a pregnancy to last, should have stuck to its guns quite so tenaciously in the light of the evidence from women's bodies. The fact is, around one-third of babies arrive before the so-called "due date', with two thirds after - and only six per cent on the actual date itself.

What is more, around 20 per cent of babies in Britain are medically induced, the majority because of "lateness" - so has nature made a terrible mistake, or are our (or rather the obstetricians') calculations up the spout?

Many midwives - mine, thankfully, included - believe that giving a pregnant woman a hard-and-fast date for delivery is a mistake: babies simply don't appear to order like some dial-a-pizza, and it is unfair to give us the idea that they do.

Given that those who arrive at 37 weeks are considered term, and that most obstetricians agree that intervention is not usually worth thinking about until 42 weeks, wouldn't it be more realistic to give every mother- to-be a five-week window during which to expect the birth?

One or two enlightened hospitals are now taking this route, it seems. "But the trouble is," says Jilly Rosser, the editor of Practising Midwife magazine, "there's a lot of pressure from women - and perhaps, from their families - for an actual date. I think many midwives and obstetricians would be happy to give a vague idea of when a baby is due - it is often the women themselves who demand a date."

That is because, ironically, while the childbirth professionals are getting more relaxed about when a baby is due, for many women themselves the actual date matters more than ever before.

The reason is maternity leave: to maximise time with the baby, more and more women are working right up to the time that their child is due, in order to take the bulk of their time off afterwards.

"Obviously it would be more convenient to anyone in this situation to know precisely when their baby is due," says Rosser.

Many women take the view that they're "wasting" maternity leave time if they are taking even days off before the birth. And while a conference last week was told that working long hours in pregnancy can bring on a premature delivery, so some midwives believe that for other women working can have the opposite effect, psychologically blocking the mechanisms that start labour even when the baby is ready to be born.

Exactly what triggers the start of labour remains unknown, though it is certainly a hormonal change. Theories abound on self-help strategies that can induce labour: best-known of these, and certainly the one with the biggest giggle-factor, is intercourse. If I had a nappy for each time a friend has asked whether we have tried sex, I would have at least the first fortnight's supply sorted out. Sex can work, it seems, because semen contains prostaglandin, an increase in the amount of which in the body is known to be a prerequisite for labour.

Some authorities cite frequent sex as giving the best chance of labour, and suggest you lie on your back with a pillow under your bottom for half an hour afterwards. If sex does not sound very congenial (and frankly by 41 weeks, with a ballooning, concrete-like stomach and elephantine ankles, it is not the biggest turn-on), why not go out for a curry? Do not bother reading the menu - just ask the waiter for the hottest dish they have got, and you could well be hearing your baby's first cries by midnight.

That is the theory, at least - though I have got friends who seem to have spent a fortnight in the curry shop after their due date, and still ended up reporting to hospital for a medical induction.

Castor oil, mixed with fruit juice, is possibly the most stomach-curdling self-help remedy I have encountered - definitely one to leave until you're absolutely desperate.

Before that there are alternative therapies worth trying - homeopathic remedies include taking Caulophyllum 30 every half-hour until contractions start, and some women report good results from acupuncture, though it usually takes two or three treatments.

Reflexologists will give your feet a good pounding to switch the right hormones on, and cranial osteopaths, too, have a treatment to offer based on stimulating the pituitary gland into action though this can apparently take several days to take effect.

Why, though, does it matter so much? Why don't women like me simply sit tight and wait for nature to take its course - as it surely will in the end? The answer is that the placenta, the baby's life-support system, is apt to get a bit past its sell-by date around week 42: it is not necessarily a dramatic decline, but there is evidence that babies can lose weight and fail to thrive as it gradually packs up. Added to which, of course, there's the psychological pressure of all those phone calls, the fact that your diary has been cleared to make way for the new arrival, and an increasing curiosity to see your feet again (not to mention the child you've been cooking for so long).

And so, in extremis. There is the medical route - although for many women it's not exactly in extremis, more to fit in with the possibly arbitrary views of their consultant on "how long it's safe to go".

Medical induction ranges from the fairly innocuous sweeping of the cervical membranes, in which the midwife rummages around inside to speed the process up, through to the use of a hormonal pessary and artificial rupture of the water sac to a syntocinon drip, in which a synthetic version of the hormone oxytocin is given via injection. But the downside to any of these, particularly the latter, is that contractions so kick-started can be very painful indeed, far more so than with the slow build-up typical of a natural labour. Personally, I am going to give the curry a try...

Footnote: And it worked. A few hours after finishing this article Joanna Moorhead gave birth to an 8lb, 10z baby girl, Miranda

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