How to Win Your Office Baby Pool

All right, I'm going to let you in on some secrets to help you win your next Baby Pool at your place of work.

In case you don't know what a baby pool is, or what it looks like, it is a game where everyone in your office guesses the date that they their pregnant co-worker will have her baby. Sometimes it includes the baby's weight and length, too. The person who comes the closest to guessing the correct date, wins!

Recently, my SO's office did a baby pool and he texted me to ask me what a good baby weight to guess might be. (I told him I'd guess between 7 and 8 pounds) He brought home a copy of the calendar with everyone's date (and length and weight) guesses on it so that I could see how much he knew about labor/birth from listening to me - he did not guess on the moms' actual EDD, but guessed a due date after the mom's due date. But what was interesting to me about the calendar is that every single person in the office guessed before the due date except my SO and one other gentleman who had 3 kids. However, the latest guess was only a couple days past the EDD. So I wrote on the calendar the latest guess date - exactly her 41 week mark. And I was right!

So, here are some tips for guessing in a Baby Pool, based on my knowledge of pregnancy and childbirth in the United States if your pregnant co-worker is a First Time Mother:

1. Weight: Go with 7.5 lbs. 

I even asked a perinatal epidemiologist about this one - for a first time mother this is the average. This is the hardest to guess, though - babies at term can range anywhere from 5.5 pounds to 10 pounds. 

2. Length: Go with 21 inches.

I'd say that the babies I've seen born have been between 19 and 22 inches, with the most common at 21 inches. 

3. Due Date: Guess exactly at their 41 week mark (one week after the estimated due date).

A. Most first time mom's have their babies past their due date. 

B. Most obstetricians get trigger happy and will find a reason that mom must be induced at 41 weeks. This is certainly true of the doctors in my area. Despite the fact that you're not "post dates" until after 42 weeks, and most first time moms have longer pregnancies, and induction on a first timer doubles the chance of a c-section, and many of the reasons give are not evidence-based (i.e. suspected "big baby"), most OB's will convince most mothers to agree to an induction at 41 weeks. 

Another bonus: Sometimes a mom who has her induction scheduled for the next day will spontaneously go into labor the night before. 

GOOD LUCK! 

You Learn Something New Every Birth

artwork (c) Amy Haderer mandalajourney.com

I'll admit, I don't usually back my doula bag until my client's are 40 weeks. I know this isn't perfect doula practice, but there are two reasons: 1. My bag stays almost entirely packed with my doula tools all the time anyway (I just have to add things like toiletries, snacks, medications, phone charger, sweater, etc), and 2. My clients never seem to go into labor before 40 weeks.

This is another reason that I find the whole "40 weeks is your due date and then after that you're late" thought-process to be completely flawed. Nearly all my clients have gone into labor AFTER their 40 week mark. There is no timer to go "ding!" that means you are "done" at 40 weeks! (but for more on estimated due dates, see this other post, or this one)  And not just first time moms!

Back when I was a brand new doula, my bag used to be packed at exactly at the 38 week mark. I was also more paranoid in general - not a single drink during my on-call period, no foods with onion or garlic (so my breath wouldn't smell bad), obsession with checking my phone all the time and with every single plan I made (can I go to the movies?), and so forth. I remember each birth that occurred prior to the due date:

I had a first time mom go into labor before 40 weeks, but that was an effort on her part - she asked her midwife to sweep her membranes at around 39 weeks (see bottom of post for an explanation if you don't know what this is), and it worked the very same day. I knew in advance why she wanted to go into labor earlier than her due date and she kept me informed of her techniques.
A third time mom went into labor at 38 weeks, a week after I met her and she hired me.
I also had a first time mom go into labor on her exact due date, which is so rare that it was shocking.

And then just recently, with no warning at all, I got a phone call in the middle of the night from a mom who had no major warning sign that she would give birth before 40 weeks (other than the fact that she really didn't want to be pregnant anymore, which is like most women), and had to scramble around and pack my bag! I found out that she was taking evening primrose oil capsules, on her midwife's advice. I'm not sure why she was taking them, or why the midwife advised her to take them, prior to her estimated due date. Perhaps the midwife always prescribes it. Perhaps the mom was incredibly impatient and so that's why the midwife suggested it.

Evening Primrose Oil is a supplement that can ripen the cervix because it is high in prostaglandins. Prostaglandins are sometimes administered directly in the vagina by a doctor to prepare for a labor induction. Semen also contains prostaglandins, which is one reason why they say sex can start labor! Evening primrose oil doesn't exactly induce labor; it helps soften the cervix in preparation for labor. I don't know much about EPO so I asked about it on twitter.  Respondents said that it can have side effects and should not be used routinely and perhaps not unless an induction is looming for post dates, and that there is not a lot of research on EPO. Apparently side effects can include upset stomach and headaches.

A quick survey of the literature came up with a retrospective quasi experimental study of 108 low-risk nulliparous women that found:

Findings suggest that the oral administration of evening primrose oil from the 37th gestational week until birth does not shorten gestation or decrease the overall length of labor. Further, the use of orally administered evening primrose oil may be associated with an increase in the incidence of prolonged rupture of membranes, oxytocin augmentation, arrest of descent, and vacuum extraction.

Another article on midwives' use of herbal preparation for stimulation of labor found that there were no reported complications in the use of evening primrose oil or red raspberry leaf tea and that evening primrose oil was the most efficacious herbal preparation for cervical ripening. Most else of what I could find just says that there is a lack of evidence. Basically, that more research is needed.

Anyway! She went into labor prior to 40 weeks and the labor and the birth went well. I always tell my clients that I will come when they feel they need me. Sometimes in the middle of the night I really hope that even though they're calling me, they'll see that their contractions are still "early labor" contractions and they won't "need me" right now. With this one, I did end up getting to her house a bit before an active labor pattern was established. This has happening to me a couple times. This is hard for a couple reasons: First, now everyone feels like we're in active labor mode and it's hard to not feel rushed once the doula is there and you feel like everyone is waiting on you and watching you labor. Second, it would be nice if everyone (mom, partner, and doula) all got some more sleep, but now sleeping arrangements are awkward. And third, several other things are also awkward - instead of needing active help all the time, we're hanging around at home watching TV and making lunch, etc. But the second ones are more about me, and so... see number one!

But it is also highly beneficial for me to come early in several instances. Once, it was because mom and dad had me meet them at the hospital and mom was only about 4 cm dilated. They walked around trying to decide what to do: Be admitted and be in the hospital the entire labor, being pressed for time and to adhere to the ridiculous "1 cm per hour" rule? Or go home and try to sleep, and hope that in their own environment labor would move along at a comfortable, un-stressed pace. Perhaps if I hadn't been there at the hospital to discuss things they wouldn't have gone home (and ended up having a great labor!)

Most recently, I was glad to sacrifice my time/comfort/sleep/whatever to be with mom and dad early in order to reassure them and keep them at home. This is a big one. I have been told so many times, "if it weren't for you, we would have just gone to the hospital at [2 am, 4 am, etc]!" And mind you, this is JUST after labor contractions start. You really shouldn't go to the hospital at the start of labor, for a multitude of reasons. 1. they might send you home if you're not 4 cm or more anyway, 2. hospitals can be stressful places where labor actually slows, 3. if you want a natural labor, the longer you are in the hospital the more likely things will be done that make this harder (i.e. stay in bed the whole time, pressure to get pain meds, you aren't allowed to [eat, drink, pee, use the shower for pain relief, etc], let's manage this labor a bit more with drugs, etc), 4. you will be rushed for time (it's been ___ hours since ___ so we need to do ___) even though there is no medical reason to do so, and 5. I could probably think of more if I wanted but I'll stop there.

Several times if I hadn't showed up right away mom and dad would have just listened to some direction (that always changes) like, "come in when contractions are 5, 1, 1" or "come in when your water breaks" or "come in so we can see how far you've progressed" which have no basis other than they just want to manage labor. I have been told a million times, "I am so glad we labored at home," and "this is really great laboring at home," and "I'm glad we didn't go to the hospital right away." And even from hospital midwives, who are impressed that the mom comes in at 8 cm or 10 cm because that is so rare for them (and I've even got a "way to go, doula!"). But it is hard, especially for first time parents, to want someone there with them to can reassure them about what is normal and answer a million questions about labor positions, eating and drinking, whether or not they should try sleeping or walking, and of course the big one - when should we go to the hospital? [And in this instance, interestingly, many a question was answered along the vein of "is this going to make the contractions worse? Such as "Is a cold beverage going to make the contractions worse?" and "Is a shower going to make the contractions stronger?"] I have witnessed many many more labors than they have and I know what a contraction pattern or mom's temperament means.

Just as an aside, I always let the couple decide when it is time to go to the hospital. I give advice if asked, but if they feel it is time, we go. The only instances in which I say "ok it's time to go now" are when mom says her first "I feel the urge to push"! And I should also add, here, that we've left while mom felt like pushing many times and always made it to the hospital in time (even with a third time mom); They have all still had to actively push for a period of time in the hospital. This is always a big worry, but the stories you hear about babies being delivered in the car are rare (though I'm not denying that is possible to wait too long to go, or to have an exceedingly fast labor).

Talking about doula self-sacrifice - my body was really aching after my last doula labor! Whoever thought that becoming a doula was all fun and babies, you should really recognize how hard being a doula can be, sometimes.

I also wanted to mention that a recent labor was attended at a Baby Friendly Hospital. I want to share this experience, because it wasn't quite what I thought it would be. Firstly, the nurses asked the mom immediately after delivery if she would be bottle feeding or breastfeeding. This is interesting in two ways:  1. I did actually think it odd that a hospital with the highest support for breastfeeding there currently is is even asking a mom if she is breastfeeding, instead of assuming that she would do the norm (and yes, wanting to breastfeed is the 'norm' - 75% of women in the U.S. initiate) and only require formula in case of complications (which is what formula should be used for), but...  2. For the people who say that going baby friendly hurts moms who want to bottle feed because it pushes breastfeeding on everyone, clearly if they are asking moms, this isn't true.

Secondly, I was under the impression that BFH's do uninterrupted skin-to-skin and make sure mom has help in trying to initiate breastfeeding in the first hour after birth. I was under that impression... (Perhaps you see where I am going with this?) This mom had her baby on her maybe 20 minutes of the entire first hour and twenty minutes of baby's life. They were doing the usual - weighing, measuring, drawing blood, eye ointment, letting dad take photos, etc in the baby warmer instead of letting all that wait and giving mom the chance to warm and feed and bond with the baby, all of which is good for both the baby's blood glucose levels and the breastfeeding relationship. Oh, and they did the typical swaddle the baby and we had to un-swaddle him to put him back on mom, and then they took him off a second time. And the entire time no one was helping with breastfeeding but me! Until finally a baby nurse came back in and then repeated EVERYTHING I had just been saying and doing. Grr. So frustrating. I do think this nurse was trained in lactation, luckily, but I don't know if all the nurses are, because all she said is "you can ask any nurse for help with breastfeeding." Which is what they all say everywhere, even if the nurses aren't trained in lactation.

The point of all this is... you learn something new every birth. Or many somethings. For instance, I also learned that if a mom is GBS+ she should really get the IV antibiotics in her system at least 4 hours before delivery (so don't wait too long to go to the hospital with a GBS+ mom).

Or sometimes, many things are affirmed. For instance, you really can't tell if a mom is going to take one hour or several hours to go from ___ cm to 10 cm. Or like how sometimes L&D nurses are all the same. And sometimes they're idiots (Sorry, just really annoyed at an L&D nurse who told my client to tell her if she had a continual urge to push,  even in between contractions, which is NOT how it works. And then wouldn't let mom stand beside the bed when she felt pushy because she was afraid she'd have the baby on the floor, even though she had just checked her and she was only 8 cm and was not going to push a baby out that fast. Ok, rant over).

Ok, POST OVER! Thanks for sticking with it til the end :)


--> A membrane sweep, or stripping the membranes, is not the same as breaking the bag of waters (amniotic sac). It is done by inserting a finger between the membrane that goes around the amniotic sac and the wall of the uterus to loosen the membranes from the wall. Sometimes this stimulation of the uterine wall can help to start labor. It doesn't work for everyone, may or may not be uncomfortable, and can sometimes cause the water to break.

Baby is NOT at Term at 37 Weeks

I've already blogged about the inaccuracy of due dates, but I wanted to take the time to emphasize the fact that though many women and their doctors believe that 37 weeks is "at term" it is NOT.

A recent study conducted by a group of physicians associated with the March of Dimes organization points out that considering babies term at 37 weeks may not be such a good idea after all. There seems to be new evidence that suggests that the outcome for a baby born after less than 37 completed weeks of pregnancy is significantly different for one born after 38 completed weeks.
The study proposes that the phrase “late preterm” be used when describing neonates born between 37 0/7 weeks and 38 6/7 weeks because of the new research which states that babies born during this period suffer from increased mortality and neonatal morbidity when compared to children born later in the pregnancy. (via the unnecesarean)

Why is this a concern?
Many women find the end of pregnancy uncomfortable and exhausting. They and their family members have been waiting for months and they are anxious to finally meet their new baby. Women frequently request that their doctors deliver their baby once they've reached term, which many believe to be 37 weeks. Doctors are frequently happy to oblige to an induction or a cesarean section before the due date is reached. However, a baby that does not reach full gestation and initiate spontaneous labor may face severe complications.

Complications of non-medically indicated deliveries between 37 and 39 weeks:

• increased NICU admissions
• increased transient tachypnea of the newborn
• increased respiratory distress syndrome
• increased ventilator support
• increased suspected of proven sepsis
• increased newborn feeding problems and other transition issues
• Morbidity rates double for each gestational week earlier than 38 weeks

Via dou-la-la:

New research shows that those last weeks of pregnancy are more important than once thought for brain, lung and liver development. And there may be lasting consequences for babies born at 34 to 36 weeks, now called "late preterm."

A study in the American Journal of Obstetrics and Gynecology in October calculated that for each week a baby stayed in the womb between 32 and 39 weeks, there is a 23% decrease in problems such as respiratory distress, jaundice, seizures, temperature instability and brain hemorrhages.

A study of nearly 15,000 children in the Journal of Pediatrics in July found that those born between 32 and 36 weeks had lower reading and math scores in first grade than babies who went to full term. New research also suggests that late preterm infants are at higher risk for mild cognitive and behavioral problems and may have lower I.Q.s than those who go full term.

What's more, experts warn that a fetus's estimated age may be off by as much as two weeks either way, meaning that a baby thought to be 36 weeks along might be only 34.

Timing of Fetal Brain Development: cortex volume increases by 50% between 34 and 40 weeks gestation, brain volume increases at a rate of 15mL/week between 29 and 40 weeks gestation

Furthermore, the process of generating a due date relies on sometimes faulty memories of mothers about their cycle, and assumes all women’s cycles are the same length. Research shows that women’s cycles can vary widely, and these variances can profoundly impact when a baby will be mature enough to be born. (via lamaze)

Don't believe it when your doctor tells you he can tell by ultrasound that the baby is nice and big and so ready to come out -- ultrasound for measuring the baby's weight can be 1-1.5 lbs off!

And please please please do not ask your doctor to perform an induction or cesarean section once you've reached "term at 37 weeks." Baby is ready to come when he/she comes!

Non-Drug methods for Inducing/Speeding up Labor

If there is a medical reason why labor must start, but you'd like to try some non-medical methods to induce labor, here are some self-induction methods (always discuss with your caregiver!). These methods also work to speed labor up!

1. Nipple Stimulation
Stimulating the mother's nipples causes the release of oxytocin, the hormone that contracts the uterus. Mom or partner can massage the nipples in many ways, using hands, warm towels, a breast pump, mouth, etc.  If contractions become too strong with this method you should stop.

2. Walking!
It is also a pleasant distraction :)

3. Sex
Orgasm causes the release of oxytocin (and contraction of the uterus) and may also release prostaglandins, a hormone-like substance that softens the cervix. Semen also contains prostaglandins, and sex is a more enjoyable way to deposit prostaglandins on the cervix than the methods used in the hospital! Once membranes have ruptured, however, avoid putting anything within the vagina (increased risk of infection).

4. Acupressure or acupuncture
Certain points on the body can be "activated" to start contractions. Make sure acupuncture is done by someone who is trained and always check with your caregiver first.

5. Bowel stimulation with castor oil
I've heard of this being used by cultures all over the world to stimulate labor.  I've also heard of using a raw egg to induce vomiting, but that seems like it would be gross and unsanitary! Castor oil causes powerful contraction of the bowels (and diarrhea) which can help induce uterine contractions and maybe produce prostaglandins.

6. Homeopathic remedies
Make sure the person prescribing these knows what they're talking about. Herbal teas and oils, such as primrose oil can speed up contractions. Proper dosage and potential side-effects should be noted.

7. Changing Positions
Like walking, changing positions helps loosen up the shape of the mother's pelvis, takes advantage of gravity and may encourage the baby to wiggle into a more favorable position. Open knee-chest position, pelvic rocking, the lunge, side-lying, squatting, etc.

Almost Jan 1... Time to Induce?

Another economics-type look at births... A NY Times article from 2006 called To-Do List: Wrap Gifts. Have Baby talks about how the number of births in late December has shot up since families frequently schedule births during this time so that they can receive the year's tax incentives for having a child before the year ends.

But my favorite part of the article asks: "In addition to being an entertaining bit of trivia, the end-of-the-year baby boom also raises a legitimate policy question: just because we have the medical ability to do something, does that necessarily mean it’s such a good idea?"

Induced births and Caesarean sections are considerably more expensive than natural births on average. There are clearly cases when labor needs to be induced for a baby’s health or the mother’s. It’s much less clear, however, that the health care system should be subsidizing parents’ desire for a smaller tax bill.

The health effects of scheduled births are also murky. A big study led by a researcher at the Centers for Disease Control and Prevention found that voluntary Caesareans increase the risk of infant mortality. Another study found that weekday births are slightly more risky than weekend ones, all else equal, suggesting that a drug-induced birth can also cause health problems. The differences are small, but the stakes are big enough to take any change seriously.

“When you induce labor, you compress this long process into a few hours,” said Dr. Emmet Hirsch, the director for obstetrics at Evanston Northwestern Healthcare near Chicago. “When you do that, you can run into all sorts of problems.”

To minimize those problems, the largest medical provider in Utah, Intermountain Healthcare, now discourages women from electively inducing labor before their 39th week of pregnancy. “This is what’s best for moms and babies,” said Janie Wilson, a nurse who helps run the newborn program at Intermountain. “It just seems like a no-brainer.”

What an Induction Looks like

A portion of the original post Re-Blogged from Public Health Doula:

"I think the impression many women of an induction is that it's similar to regular labor, but you just get to pick your day. Let me be one of many doulas who can tell you: this is not the case!

When you start regular labor at term, it's because a complex set of signals and changes in your body say "This baby is ready; let's get it out." (One way to measure whether the body has begun preparing for labor is a Bishop's score.) When inducing labor, medical staff try to replace those natural signals and changes with manufactured ones: promoting cervical softening and dilation using prostaglandin gels or misoprostol (Cytotec), inducing contractions with artificial oxytocin (Pitocin).

As this cervical ripening and early dilation is generally the longest part of labor anyway, and is much less efficiently done by medications than by normal physiological processes, all of this takes a long time. Often by the time a woman in spontaneous labor would be showing up at the hospital (4-5 cms) you have already been in the hospital 12-24 hours, and still have a ways to go. You're also likely to experience a more intense, painful labor because induced contractions are different from natural contractions, so you're more likely to need pain medications."

True Reasons to Induce Labor:

1. Pre-Existing Maternal Health Conditions
2. Pre-Existing Baby Health Conditions