Q: What is happening to my baby after 40 weeks?
A: In many pregnancies, there are no changes to your baby's activities after 40 weeks and their movement patterns will be the same, although your baby's head will probably move lower into your pelvis as it gets ready for labor, resulting in a lighter feeling under your ribs and a heavier feeling down in the pelvic area. In other pregnancies, mothers may notice a slowing down of movements as the pregnancy progresses. The placenta, which feeds the baby, operates on a lower efficiency after about 38 weeks, and certainly after 41–42 weeks. This means that your baby's growth tends to slow down the further your pregnancy goes. Since it is not possible to accurately predict whether or not the placenta will continue to function well, most hospitals have an induction policy to avoid the risk of distress to the baby, which increases the longer the pregnancy continues.
Q: What happens if you go over your due date?
A: This varies slightly from site to site, however you would normally be offered an induction of labor between 41 and 42 weeks of pregnancy, which means that your labor will be started artificially (see Types of induction). Different hospitals have their own criteria for how long past your due date they will wait before suggesting an induction of labor, but this is usually between 7 and 10 days after your expected date of delivery (EDD).

If an induction is considered, your doctor or midwife should discuss all your options with you before any decision is reached. Although you are within your rights to decline induction, you should make sure that you are fully aware of the reasons why it has been suggested so that you can make an informed decision.

Q: I have a long menstrual cycle. I don't think I'm as overdue as they say. Can nature take its course?
A: The best time to agree on dating is at the initial visit when memory is fresh and the size of the uterus reflects a better picture of gestational age. If there is any discrepancy between size and dates, an ultrasound can be performed early enough to be very accurate at estimating a due date. When a menstrual history is collected, if a mother has a consistently long cycle, days can be added to the EDD (estimated date of delivery). Ultrasound usually confirms this if done by early in the second trimester. You can always decline an induction of labor however, antepartal testing of fetal well-being will always be initiated if there is any chance you are 41 weeks or greater.
Q: What is a “membrane sweep” and could I have this instead of being induced?
A: Prior to an induction of labor, at 41-plus weeks of pregnancy, your midwife or doctor may offer to “sweep” or “strip” the membranes. A membrane sweep involves your midwife or doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. The aim of this is to stimulate the release of hormones that may start labor contractions. Although this is likely to be an uncomfortable procedure, it should not cause you actual pain; you may also experience a mucus/bloodstained “show”—like a discharge—following this, which is quite normal .

Membrane sweeps have been shown to increase the chance of labor starting naturally within the next 48 hours and therefore reduce the need for other methods of induction.

Q: I don't like the sound of the amniotic hook. What exactly is this?
A: An amniotic hook is a long, thin piece of plastic with a hook shape at one end. This is used to make a hole in the membranes surrounding your baby to release the amniotic fluid in an attempt to kickstart labor. The procedure, known as “breaking the water,” amniotomy, or AROM (artificial rupture of the membranes), is as uncomfortable as an internal examination, and isn't usually painful. An amniotomy is carried out by the midwife or doctor, who will carefully guide the hooked end of the instrument into the vaginal canal with his or her fingers. He or she will then press the end of the instrument against the membranes to pierce them, which can help to stimulate contractions and in turn start labor or make the contractions stronger.

In some cases, contractions become established quite quickly after this procedure is carried out. However, if this is not the case, then you will need to remain in the hospital and be induced with an oxytocin IV.

Q: Can an amniotic hook harm my baby?
A: An amniotic hook, which is somewhat like a long crochet hook used to tear a little hole in the amniotic membrane surrounding the baby and the amniotic fluid, is actually fairly blunt and shouldn't come into contact with your baby at all, so there isn't really any risk that he could be harmed.
Q: Why do I need to be induced?
A: The main reason for induction of labor is when your pregnancy continues past your EDD, or estimated delivery date, as after this stage the efficiency of your placenta can decline, which can put the baby at risk.
Q: Can I refuse an induction of labor?
A: You have a right to say no to any intervention and when induction is considered, your doctor or midwife should discuss all your options before any decision is reached. However, if you want to delay induction beyond 42 weeks, then it may be suggested that you attend the maternity unit for regular monitoring to check on your baby's and your own health, which may include a Doppler ultrasound to check the blood flow in the placenta. You will also be offered an ultrasound scan to check on the amount of water surrounding your baby, since this can be a good indicator of how efficiently the placenta is working and the overall well-being of your baby.
Q: I 'm scared about sudden hard contractions after induction. Will it be more painful?
A: Some women do report that an induced labor is more painful than a spontaneous labor. This may be because induced labors can be longer, although this is not always the case. In a spontaneous labor, the body responds to the gradual onset of contractions with the release of natural painkillers called endorphins. In the case of induction, where the onset may be more sudden, the body has less of a chance to do this. However, some women do still get a gradual build up of contractions after induction.

It is quite natural to be scared of pain, but you may find it a help to be prepared mentally and physically by planning which pain relief options you are going to consider and ensuring that your birthing partner knows your plans so that he or she can give you plenty of support. Many women opt for “low-tech” forms of pain relief, such as TENS, massage, being active and changing position, and aromatherapy, in early labor, and these are all options with an induced labor. If you find these are not enough, you can try medication, such as narcotics, and even consider an epidural. If you know in advance how you may want to cope, then you will be better able to deal with the pain.

Q: Will I need to be monitored continuously throughout labor if I'm induced?
A: If an oxytocin (hormone) IV is used to stimulate the contractions then, yes, continuous monitoring of your baby's heart rate is recommended. This is so the midwife and doctor can ensure that the contractions are not too close together and that your baby is coping with the contractions and not becoming distressed. As long as oxytocin is running you will need external ultrasound scans. Many units now have “wireless” monitors, which means that you are not physically attached to the machine and can still move around during labor.
Q: Can my partner be present throughout?
A: Yes, your partner can be with you throughout your induction and labor, and his continued support is likely to have a positive impact on your well-being and help your ability to cope with the pain and stress of labor. Ensure that your partner is aware of your birth plan too so he can support you in any decisions you need to make. A lot of units allow more than one birthing partner, which can be a good idea if things are going to be long and drawn out.
Q: What will happen if I don't go into labor after I've been induced?
A: Very rarely, women will experience an unsuccessful induction, especially if their cervix is unfavorable, meaning that it has failed to soften and dilate. This may ultimately result in a cesarean section being performed. As always, discuss the options with your midwife or doctor so that you are fully informed about the procedures being offered.
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