When a woman becomes pregnant it seems that suddenly everyone around her becomes pregnant with her: care doubles and everyone starts to worry about that little life that is growing inside.
As the belly grows, the questions increase: is it a boy or a girl? When is it born? And towards the end of the pregnancy, all this expectation regarding the birth begins to make the woman even more anxious.
But, after all, how long does a pregnancy last? How long is it safe to wait for the baby to give the signal that it is the right time to be born?
A full-term pregnancy occurs between 37 to 41 weeks and 6 days. Therefore, a pregnancy is considered post-term (that famous “past its time”) and only exists when the gestation exceeds 42 weeks.
At the first consultation, the Obstetrician calculates the DPP (probable date of birth) which corresponds to 40 weeks of gestation – counting from the date of the last menstruation reported by the pregnant woman. With the first trimester ultrasound in hand, the Obstetrician compares the dates and thus defines the PPD with a little more precision. This data will serve as the basis for all pre-natal monitoring.
What few people know is that PPD is just a basis, it does not mean that the baby should be born before 40 weeks – although there is a high chance of this happening. Around 5% of pregnancies exceed 41 weeks and those that extend beyond 42 weeks are rare, but it can happen.
I’m 40weeks pregnant no sign of labor, is it normal?
If you have reached 40 weeks of gestation and are not feeling contractions yet, don’t worry, we consider it normal for birth to happen between 37 and 42 weeks of gestation.
When the baby is born before 37 weeks, we can say that he is premature. On the other hand, a pregnancy that exceeds 42 weeks is called a prolonged pregnancy.
Normally, prenatal protocols recommend that when reaching the 40th week of pregnancy, consultations should be intensified. There are usually 2 consultations per week.
In addition, fetal vitality tests should be requested, such as ultrasound and cardiotocography. It is also interesting that you start to control the number of times your baby moves during the day. This is a very practical and inexpensive assessment of your baby’s vitality, known as a mobiligram.
Know that the main cause of pregnancies that exceed 40 weeks is an error in dating the pregnancy. In other words, in fact, you haven’t reached the fortieth week yet, there is probably an error of a few days in your gestational age estimate.
Possibly when you reach 41 weeks your doctor will recommend terminating the pregnancy. This happens because we know that if you did not go into labor spontaneously until 41 weeks, the chance of this happening naturally between 41 and 42 weeks is small.
Likewise, it is important to keep in mind that after the 42nd. week the chances of having any complications during pregnancy begin to increase. Hence the recommendation to interrupt at 41 weeks.
What if the baby is not well?
One of the ways for a woman to know that the baby is well is to feel its movements as they demonstrate its vitality, without the need for special tests. The Ministry of Health states that the baby must have at least 6 movements in 1 hour (always after the mother has fed).
If the baby does not move 6 times within an hour, he may be sleeping, so it is recommended that the pregnant woman get up, move the baby and do the count again. If the number of times of movement continues to be less than 6, you should seek out a health service or a professional who is providing prenatal care.
Will I need to have a cesarean section?
Definitely not. Even though you are 40 weeks pregnant and don’t feel anything, this does not mean you will need to have a cesarean section.
The first step is to assess how your baby is doing. Is he with his head down? Is there any dilation of the cervix? Is he at an adequate weight and with normal amniotic fluid?
All these questions (and others if necessary) should be evaluated by your doctor before making any decision. If everything is as expected, your obstetrician may recommend an induction of labor.
Induction of Labor
During consultations, the team evaluates movements by monitoring fetal vitality. In addition, prenatal care at this stage is very important to plan how long it is possible to wait.
If there are no signs of labor after 41 weeks, the team should talk to the pregnant woman/couple and explain the advantages and disadvantages of induction and expectant management. After explaining all the risks, both of induction and waiting for spontaneous labor, the Obstetrician and couple can make the best choice.
More than a deadline for how long to wait, it is important to evaluate the pregnant woman individually. Some systematic reviews suggest that labor induction be performed between 41/42 weeks, however, there are not many studies with pregnancies longer than 42 weeks, which makes it impossible to truly know the risks and outcomes after 42 weeks.
How does induction work?
Labor induction can be done in two ways: using natural or pharmacological methods. To decide which method is best to use, it is necessary to evaluate the condition of the woman’s cervix, parity and possible existing pathologies.
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Natural methods are Acupuncture, Krause method (placement of a probe inside the cervix), Homeopathy, breast stimulation, sexual intercourse and detachment of ovular membranes. The pharmacological ones are Oxytocin (serum), Misoprostol (tablet inserted into the cervix) and Dinoprostone (tablet also placed in the cervix, but difficult to find in hospitals). It is worth remembering that pregnant women with a previous cesarean section should not receive induction with the use of Misoprostol.
Natural methods are better but not always more effective. Pharmacological treatments, despite their efficiency, bring unwanted effects that must be considered and explained to the couple before application.
What are the risks of going beyond 40 weeks of pregnancy?
As the pregnancy passes 40 weeks, there is a small increase in the risk of complications. However, most women who give birth between 40 and 42 weeks have an uncomplicated birth and give birth to healthy babies. After 42 weeks (post-term pregnancy), these risks increase substantially. Risks associated with post-term pregnancy include the following:
- Fetal or neonatal death due to complications during childbirth;
- Macrosomia (very large fetus);
- Post-maturity syndrome;
The fetus may aspirate meconium, which can cause serious respiratory problems after birth; - Oligohydramnios ( decrease in amniotic fluid volume );
- Other risks include a greater chance of a cesarean section or the need to use forceps.
There is also a greater chance of infection and postpartum hemorrhage when the pregnancy goes beyond its due date.
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