"We'll book you in for a home birth, but if you go to 42 weeks you'll have to come in to hospital to be induced"
The chances are that you will not actually reach 42 weeks anyway, as when the date of conception is known, this is quite unusual. Many pregnancies which are thought to be "overdue" are just inaccurately dated.
Standard pregnancy dating based on your last period date (LMP) is only accurate if you have a 28-day cycle and you ovulated on day 14. If your cycles are sometimes longer than this then there is a good chance that your due date is actually later than the 'standard' one.
Conception has to happen in the 24 hours after ovulation - you cannot conceive before your egg has been released, but the egg dies if unfertilized 12-24 hours later. So your most accurate way of dating the pregnancy is knowing when you ovulated. This is not necessarily on a day when you had sex; sperm can survive for up to four days, possibly longer, so the intercourse which resulted in conception could have occurred several days before the actual conception. If you have been charting your cycles or practising natural family planning you will know all about this - if not, see the links on dating your pregnancy for more info.
One very thorough study of over 24,000 pregnant women in the UK who had dating scans which were compared with their LMP date , found that:
"Most pregnancies undergoing post-term induction are not post-term when assessed by ultrasound dates"
A review of the study noted that:
"If we look at how many women end up going 2 weeks over their due date, it is 9.5% according to dating by LMP but only 1.5% when dated by scan. This suggests that the dating of pregnancy by LMP tends to overestimate the gestation. Therefore if scan information is available, it is preferable to use this for dating a pregnancy (presuming it was carried out during the first half of pregnancy, when dating is most accurate)." 
Ultrasound scans for dating are pretty accurate in the first trimester, but get less and less accurate as time goes on.
Sometimes a scan will suggest that your due date is actually later than the LMP date, but the revised date may not have been entered on your notes as your 'new' due date. Check that any recommendations for induction are based on the most accurate assessment of your due date, not on LMP dating.
Even if you are genuinely post-dates, your chances of going into labour naturally increase with every day which passes:
"of women at 40 weeks, 65% labour spontaneously within the next week. Of those at 10 days over their dates, 60% will enter spontaneous labour within the next 3 days." 
It is undeniable that the rate of stillbirths and neonatal deaths does rise as pregnancy becomes more and more prolonged. However, many of these deaths are due to congenital abnormalities, or occur in babies with intra-uterine growth restriction. It is not clear how much the death rate rises for normal babies who do not show any signs of being growth-restricted. It can be alarming to hear that the death rate for pregnancies over 42 weeks doubles, but it is perhaps more informative to let people know the figures rather than the relative chance. Some sources suggest that the death rate for apparently normal babies, ie those without detected abnormalities, may rise from around 1 in 1,000 to 2 in 1,000. See the US Midwife Archive detailed paper on post-dates pregnancy.
The methods of induction of labour normally offered by medical staff are membrane sweeping, prostaglandin gel or pessaries which are inserted into the vagina (or occasionally given orally), artificial rupture of the membranes ('breaking the waters'), and an oxytocin drip, which is given in the synthetic forms of Syntocinon (in the UK) and Pitocin (in the USA).
Membrane sweeping can be performed at home or in an antenatal clinic, and there is no reason why you cannot have a home birth after it has been carried out. However, it is not as effective at inducing labour as other methods.
Artificial Rupture of Membranes is sometimes carried out to induce labour at home, but nowadays this is uncommon as it can place the baby under stress and increases the risk of infection. Used carefully, though, it can be highly successful - for instance see Danielle's story. For more about breaking the waters in general, see the UK Midwifery Archives (www.radmid.demon.co.uk/arm.htm)
Induction with drugs, using prostaglandins or oxytocin drips, is not carried out at home as it significantly increases the risk of foetal distress, and can cause hyperstimulation of the uterus. It is usual to have continuous electronic foetal monitoring after these drugs are given in hospital, to watch for signs of distress. Many women also find contractions significantly more painful after drug induction and an epidural may be needed.
There are also various Do-It-Yourself methods of inducing labour which you can try at home.
It is, of course, your right to refuse any medical treatment which is proposed, including induction of labour. It is up to you to make the decision which is right for your family. The vast majority of women who decline induction of labour will go on to have healthy babies. See for example the stories about "Ten Month Mamas" on birthlove.com.
You can ask for monitoring to check your baby's wellbeing, instead of choosing induction. There is a very small risk of foetal death occurring suddenly despite reassuring monitoring, but this can happen at any stage of pregnancy - and as the sources above show, it is extremely rare. Some women feel that it is not appropriate to accept induction on the basis of a one-in-a-thousand risk.
The UK's National Institute of Clinical Excellence and the Royal College of Obstetricians and Gynaecologists offer this information to pregnant women and their families :
If your pregnancy is more than 41 weeks
Even if you have had a healthy trouble free pregnancy, you should be offered induction of labour after 41 weeks because from this stage the risk of your baby developing health problems increases. An induction because you are overdue does not increase the chance of you needing a caesarean section.
If you choose not to be induced at this stage then from 42 weeks you should be offered:
- Twice weekly checks of your baby's heartbeat using a piece of equipment called an electronic fetal heart rate monitor.
- A single ultrasound test to check the depth of amniotic fluid (or "waters") surrounding your baby.
An ultrasound scan in early pregnancy (before 20 weeks) can help to determine your baby's due date more accurately. This reduces your chances of unnecessary induction.
If you find yourself under pressure to accept induction at 42 weeks and you are not happy with this, then it may help to discuss these guidelines with your doctor or midwives; the Royal College of Obstetricians and Gynaecologists (RCOG) does make clear that monitoring beyond 42 weeks is an alternative to induction.
The full Guidelines on Induction of Labour from the RCOG emphasise that:
Women must be able to make informed choices regarding their care or treatment via access to evidence based information. These choices should be recognised by health professionals as an integral part of the process. 
You can still have a home birth if your pregnancy is over 42 weeks gestation. This may involve some negotiation with your caregivers as different midwives and obstetricians have different views on the risks of post-dates pregnancy. Some are relaxed about it while others will be very concerned. However, the bottom line is that nobody can force you to go into hospital to give birth. See 'Birth Stories about long pregnancies' for some case studies of women who have decided to stay home.
If you are told that you 'cannot' have a home birth beyond a certain point in your pregnancy, it may be worth taking a "we'll cross that bridge if we come to it" approach. There is little point in putting yourself in stressful situations and having conflicts with your midwives, when the situation may well not arise. Such debates have their place, but maybe campaigning is better carried out when you are not at the end of your pregnancy! However, if you do find yourself 'overdue' and your midwives say that you 'cannot' have a home birth, you may have little choice but to argue your corner.
One approach which many people find helpful is to write a polite, no-nonsense letter to the Supervisor of Midwives. If you put things in writing then your position is made clear and it will usually be taken seriously. Here is an example of a letter you might use:
Dear Supervisor of Midwives,
I am expecting a baby, and my due date was ........ I would like to inform you that I am continuing with my plans to give birth at home. I appreciate that your advice is to give birth in hospital post 42 weeks, but I have made an informed decision to decline this offer of hospital admission at present.
I will of course transfer to hospital if my baby's condition, or my own, makes it necessary, but for the time being I would appreciate your continued support of my informed decision.
Many thanks for your help,
If you find yourself under continuing pressure to accept hospital admission, you may need to be more forceful. Contact the Association for Improvements in the Maternity Services (www.aims.org.uk) for advice as they are very experienced in helping women in this situation.
One issue to be aware of if you do stay at home for a post-dates pregnancy is meconium-stained liquor. This is where the baby has passed meconium (done its first poo) while still in your womb, and when your waters break, they are found to be stained brown or green. It becomes more and more likely as pregnancy progresses beyond 40 weeks. Many health authorities will request that you transfer to hospital whenever meconium-staining is found as it can be an indicator that the baby is, or has been, in distress. It can also lead to Meconium Aspiration Syndrome, a dangerous condition which can occur if the baby breathes in meconium while still inside the womb.
In post-term pregnancies, many midwives believe that passing meconium does not necessarily indicate that the baby has been in distress, as it is also often simply an indicator that the baby's gut is mature. It is sometimes said that meconium-stained liquor before 40 weeks is far more significant than it is in post-dates pregnancy, and for this reason some mothers choose not to transfer to hospital for meconium staining if the meconium is not thick. It is a difficult issue and controversial issue, and one which you are more likely to have to deal with in a post-dates pregnancy. I am still searching for good sources of information on this, but have been doing so for five years without much success!
The RCOG Guidelines on Induction of Labour emphasise that a membrane sweep should be offered before other forms of induction are considered. Sweeping the membranes does not seem to put babies under any additional stress, so there is no reason why you should not have a home birth after your membranes have been swept. Here is some info on membrane sweeping from the NICE/RCOG patient information document on induction of labour:
This has been shown to increase the chances of labour starting naturally within the next 48 hours and can reduce the need for other methods of induction of labour.
Membrane sweeping 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. It can be carried out at home, at an outpatient appointment or in hospital.
If you have agreed to induction of labour, you should be offered membrane sweeping before other methods are used. The procedure may cause some discomfort or bleeding, but will not cause any harm to your baby and it will not increase the chance of you or your baby getting an infection. Membrane sweeping is not recommended if your membranes have ruptured (waters broken).
See also Sweeping the Membranes: discussions from the UK Midwifery egroup (www.radmid.demon.co.uk/sweep.htm)
Women's experiences of membrane sweeping vary widely. Some find it mildly uncomfortable, while others find it extremely painful.
There is a risk that your waters could be accidentally broken, which then increases the risk of your baby contracting an infection. Because of this, if your waters break, you will normally be put under pressure to give birth within 96 hours (NICE guidelines) or less, with induction offered if your labour does not progress that fast naturally. You can, of course, refuse such induction, but you'd need to consider your individual infection risk first.
There is a risk that a weak, stop-start labour could be triggered, because your body or baby was not really ready for labour - see the discussion about DIY induction methods, below. If this happens, you may find yourself exhausted in the early stages of labour, and transfer to hospital for an epidural for rest, and to have your labour artificially speeded up. I am not aware of any research on the rates of induction or augmentation of labour after membrane sweeping, so this is speculation rather than evidence-based.
Here are some birth stories where mothers had their membranes swept:
If you are desperate to see your baby, or are finding it hard to decline offers of hospital induction, then you may be considering ways to bring on labour yourself. There are plenty of links and suggestions on the UK Midwifery archives page on complementary therapies.
It might be worth thinking through exactly you do not want induction in hospital. If you would not accept medical treatment to bring on labour, what is different about using complementary therapies? Fine, if your intention is just to avoid hospital - but if you are concerned about interfering with your body's ability to give birth, then DIY methods might not be right for you.
If your baby is not ready to be born, in a difficult position, or your body is not ready to go into labour, then DIY induction might bring on a weak pre-labour which peters out. If this happens, and you have already informed your midwives, then you might find yourself under pressure to go into hospital for acceleration of labour, or you might find yourself tired out by the time true labour begins.
DIY labour induction has worked well for many women, and may work for you - but do be aware that it is an intervention, albeit usually a gentler one than hospital induction, and it may well alter the course of your labour.
Here are some birth stories where women used DIY induction methods:
It may be that there is a very good reason why you have not gone into spontaneous labour so far. If your baby is not in a good position to pass through your pelvis, then it may not be exerting enough pressure on your cervix to trigger labour. The ideal position for labour is with the occiput - the back of the baby's head - towards the front ('occiput anterior' or OA). The position is normally further described according to which side the baby is leaning towards, ie Left Occiput Anterior or LOA when the occiput and back is towards your left side, which is most common, and Right Occiput Anterior or ROA when the baby's occiput and back is towards your right side.
As well as the baby's position being 'anterior', the baby's chin should be tucked down on its chest so that the occiput is nearest to your cervix. This ensures that the baby's head has the best chance of fitting through your pelvis. Babies normally try to get themselves into this 'ideal' position for birth, but sometimes they may take their time doing so.
If your baby is in the occiput posterior position (facing outwards, its back against your spine) then you may not go into spontaneous labour until it has moved around to face the other way. There is a very good reason for this - labour with the baby in the posterior position may be harder than usual for first-time mothers (although often no problem if this is not your first baby), and vaginal birth is sometimes impossible as the baby's head may get stuck as it attempts to turn in your pelvis. For more information, see 'Get your baby lined up'.
Similarly, if your baby is positioned so that its face, forehead or ear is nearest to your cervix at the moment, then vaginal birth could be very difficult or impossible, and labour will often not start on its own until the baby has moved.
If you are induced when the baby is malpresented, then the result could be a very difficult labour or a caesarean section. This is one of the reasons why many women prefer to avoid induction - we usually just don't know why labour hasn't started yet, and there may be a very good reason for it.
If you are considering induction, you can first of all ask your midwife to check your baby's position, and do so yourself (see 'Get your baby lined up'). It is not possible to identify all malpresentations before labour, and some babies start labour in a good position and then decide to move to a worse one! However, you should at least be able to check whether your baby is anterior or posterior.
Sarah H fought off an induction-happy consultant, and a waterbirth-shy midwife, to deliver safely at home at 42 and a half weeks. Sarah's story should be compulsory assertiveness training for all aspiring homebirth mums! Sarah's third baby, Sally, was born at 43 weeks, safe and well and 'lovely in every way', weighing 8lb 6oz. An obstetrician had feared that baby Sally was growth-retarded after a late scan and inaccurate weight estimation. Fourth baby Benedict arrived at 43+2 after further discussions and negotiations with Sarah's healthcare team.
Naomi W's 7th baby was her latest, at 12 days past her EDD - he was in the OP position and she had seemingly endless 'Is it? Isn't it?' prelabour and weeks of irregular contractions. She tried all the usual DIY approaches, had an unsuccessful sweep from her midwife, but a DIY sweep from herself and her husband appeared to do the trick. When she did go into established labour, it was very quick...
Sam RK had a sweep when she was 41 weeks, and went into labour with her OP first baby that night.
Kelso writes about the birth of his daughter, Herdis Hekla, 16 days after her due date; quite a lot on ways that the expectant father can help to bring labour on!
Lynne D had her second baby at 40+10 by her own dates and 40+17 by scan dates.
Cassandra had a history of long pregnancies, but was starting to worry when her third baby appeared at home at 41 + 5.
Rosie was looking forward to her daughter's birth for a long time..43 weeks and 2 days.
Rebecca was 11 days over her EDD, and was having regular monitoring in hospital and was booked for induction, when her first baby was born at home.
Joy Mottram's second baby, Malachi, was born at home at 43+3 gestation, weighing 10lb7oz.
Jackie Shute's third baby was born at home at 41 weeks and 3days.
Kate Marshall's first baby, Olivia, was born at home at 9 days past her EDD.
Jenny Poirier went into labour at 42 weeks, after taking castor oil.
Kirsty was 'desperate to avoid having another early baby' after her first baby was born in hospital at 35 weeks. Be careful what you wish for...... some very thoughtful consideration of post-dates issues here.
Buffy's 5th baby was 41+3 by scan dates and 42+3 by her dates, and her 4th, Lori, was born at 42 weeks..
Clare Emerson had her third baby at home at 12 days past her EDD, although two supposedly foolproof early scans had given her due dates 10 days apart!
Rosie Taylor's first baby was born at home at 41 + 5 gestation, on the day when an induction had been booked.
Helen O'Donnell had her third baby at home at 41 + 4, having been induced with her first and had a sweep with her second.
Peta thinks she was two or three weeks past her EDD, but was determined not to clock-watch!
Claire was 17 days past her EDD when she went into labour with her third baby, after several sessions of foetal assessment and discussions with obstetricians about her decision to decline their offer of induction.
Kathryn'sfourth baby was born at home, 20 days after his due date, weighing 9lbs. Oh, and he was breech too...
Katherine planned a homebirth for her first baby, but accepted a hospital induction at nearly 3 weeks past her estimated due date. Unfortunately her induction did not progress and ended in a caesarean. This is the story of her second labour, for which she planned a home VBAC (vaginal birth after caesarean). However, this baby was in there for the duration too, so Katherine again accepted an induction in hospital when she reached 14 days past her EDD - this time with much happier results. A very positive experience of hospital induction - and for all of us planning homebirth, it's good to know that if Plan A doesn't work out, Plan B can still be a triumph.
Victoria S gave birth to second baby Jocelyn at home at 40 weeks + 11 days. She was considering whether to accept induction or not. She suffered from pre-eclampsia during her first pregnancy and her first baby's placenta had signs of failure, but fortunately had no problems this time. Jocelyn showed signs of postmaturity but was healthy.
Jillian went to an antenatal appointment to decline induction at 10 days postdates, but she was already in labour. She ended up with an unplanned hospital birth.
Jessica's third baby, Adie, arrived at 19 days postdates, weighing 10lb 3 1/2 oz
Jo-Anne got to 43 weeks and 2 days with her first baby, but still found it hard to believe she was really in labour when things started to happen!
Shelley planned a home birth for her first baby when she went into labour at 15 days postdates.
Georgina's first baby, Jemima, was born at home at 43+6 weeks, and her second, Beatrice, at 43+4. In each case, Georgina and her husband carefully considered their options, and made an informed choice to decline induction.
Danielle Winser's first baby was born at home weighing 10lbs, eleven days after his due date. Danielle had been under pressure to accept hospital induction, but in the event her midwife (a close friend) induced her labour at home by breaking her waters.
Fiona Beckman's first and second babies were both born at home, while hospital induction dates were looming.
Sarah Calvert's second baby, Nayt, was born at home, three weeks after his due date.
Joanne King's second baby, Tabitha, was born at home on 8th September 2002, at 43 weeks and 3 days' gestation.
Ruth Gallagher's second baby, Robbie, was 12lb (5.45 Kg), and was 3 weeks post-dates.
Caroline Creasey's fourth baby, Mia, was born at home in water, at 43 weeks + 1 day.
Emma Frayne had two hospital births with induction and acceleration of labour, before her third was born at home, at 12 days post-dates.
Rosie B's first baby, Alice, was born at home, 11 days post-dates, after a very fast first labour.
Hatty has plenty of experience of being 'overdue', including two inductions.
Sun also has lots of experience of long pregnancies. Her son Sam was born at 43 weeks...around six weeks after her waters broke.
Tikki Potter's last two children were both born at home, at 42 weeks.
Alison Tooth's second baby, Matilda, was born at home at 41 weeks + 6 days, the night before she was due to be induced in hospital.
Deborah's website describes the hospital birth of her first child, and the home births of her second, third and fourth babies at 42+4 (42 weeks + 4 days), 42+1 and 41+6. Deborah's second baby, Matthew, was 18 days post-dates and moulding on his head after birth showed that he had been a brow presentation until shortly before she went into labour. If she had agreed to induction, his birth would have almost inevitably ended in a caesarean.
UK Midwifery Archives - page on Post-dates pregnancy and induction of labour.
UK Midwifery archives page on complementary therapies and DIY induction
Routine induction of labour at 41 weeks gestation: Nonsensus consensus by Menticoglou and Hall. Review published in British Journal of Obstetrics and Gynaecology, 2002, arguing that the research basis for routine induction at 41 weeks is deeply flawed. Link to pdf file of full text.
Induction of Labour, by Virginia Howes - article published in THE PRACTISING MIDWIFE (2004 Jul-Aug;7(7):45-6). Virginia is an independent midwife in Kent.
US Midwife Archives
General discussions on postdates.
Lots of comments from midwives and obs on how they 'manage' postdates pregnancy. Steel yourself for lots of them saying that they will "let" their clients get to 42 weeks, 43 weeks, or whatever. If I was the editor I would take my delete button to that word!
Includes one tragic cautionary story from a midwife whose own baby died at 44 weeks, apparently normal, but just postterm - she had been relaxed about prolonged pregnancy because all the babies in her family arrived that late.
US Midwife Archives paper about postdates pregnancy
Discussion on how much of the increased mortality post-dates is due to congenital abnormality and babies with intra-uterine growth retardation (IUGR). Quite heavy going but packed with info
Subscription - only website has a page called '10 - Month Mamas' with stories from and about women who carry their babies for a long time. - (www.birthlove.com/pages/ten_month_mama.html)
UK Midwifery Archives page on induction, and links to 'natural' methods of bringing on labour.
Royal College of Obstetricians and Gynaecologists Guidelines on Induction of Labour
- 90-page guideline available as a .pdf file. (www.rcog.org.uk)
NICE (National Institute of Clinical Excellence)Inherited Clinical Guideline D : Induction of Labour
Issue Date: June 2001 Review Date: January 2004
short-form guidelines on Induction of Labour - based on the RCOG document (www.nice.org.uk)
About Induction of Labour - Information for Pregnant Women, Their Partners and Their Families
from the National Institute for Clinical Excellence (www.nice.org.uk), based on RCOG guidelines.
Pregnancy page from Women's Health site, by UK obstetrician Danny Tucker.
Figuring your Due Date, by KMOm
Fertility FAQs (frequently-asked questions) - how to get pregnant or deal with fertility problems, date pregnancies, etc.
Fertility UK Understanding your cycle and hormonal
balance, and using natural family planning
Fertility Friend - discussion forums, charting software, and info for people who are trying to conceive.
Taking Charge of Your Fertility (TCOYF) - Toni Weschler's website, with the same name as her wonderful book. The book is an invaluable aid to natural family planning. The website includes discussion forums and charting software which you can buy and download.
: Br J Obstet Gynaecol 1997 Jul;104(7):792-7
Gestational age and induction of labour for prolonged pregnancy.
Gardosi J, Vanner T, Francis A.
Department of Obstetrics and Gynaecology, Queen's Medical Centre,
OBJECTIVE: To examine the length of gestation according to menstrual and ultrasound scan dates, and the rate of induction of labour in a unit with a routine induction policy for prolonged pregnancy. DESIGN: Retrospective analysis of computer files of 24,675 pregnancies delivered in a teaching hospital between 1988 and 1995, which had a record of the last menstrual period and a dating ultrasound scan. Detailed survey of 168 casenotes of consecutive inductions of labour to establish the indications given. SETTING: Teaching hospital with policies of routine mid-trimester ultrasound scan and routine induction for prolonged pregnancy at 290 to 294 days.
MAIN OUTCOME MEASURES: Gestational age at delivery by menstrual history and ultrasound biometry in spontaneous and induced labours.
RESULTS: The single largest category of reasons given for induction of labour was prolonged pregnancy. 'Post-term pregnancy', from the date of expected delivery as recorded in the notes, together with 'maternal request' and 'social factors', were the reasons given for induction of labour in 71.3% of cases. Menstrual dates systematically overestimated gestational age at term when compared with scan dates. After 41 weeks, this difference exceeded the confidence limits for second trimester scan dating error, suggesting that most pregnancies which are considered 'prolonged' according to menstrual dates are in fact mis-dated. The median gestational age for induced labours was 286 days by last menstrual period but only 280 days by scan, and most (71.5%) inductions done post-term (> 294 days) according to menstrual dates were not post-term if scan dates alone are used to calculate the gestational age. The average induction rate over the seven year study period was 16.6%. It was higher when there was any gestational age error in either direction (16.8%) compared with when menstrual and scan dates were in complete agreement (13.7%, OR 1.27, CI 1.09-1.47, P < 0.001). The induction rate was highest (up to 21.8%) in the cases where menstrual dates overstated gestational age without exceeding the usual limits for adjusting dates according to scan. Such overestimation within tolerance limits of 7, 10 or 14 days occurred in 37.1%, 45.8%, or 52.6% of all pregnancies, respectively.
CONCLUSIONS: Most pregnancies undergoing post-term induction are not post-term when assessed by ultrasound dates. Regardless of whether prolonged pregnancy is considered to be a risk factor requiring intervention, the proportion of pregnancies considered 'post-term' can be reduced considerably by a dating policy which ignores menstrual dates and establishes the expected delivery date on the basis of ultrasound dates alone.
PMID: 9236643 [PubMed - indexed for MEDLINE]
 : Women's health site page on Prolonged Pregnancy: (www.womens-health.co.uk/prolonged.htm)
 : About Induction of Labour - Information for Pregnant Women, Their Partners and Their Families
National Institute for Clinical Excellence (www.nice.org.uk)
 Also in the full guidelines,: Royal College of Obstetricians and Gynaecologists guidelines on Induction of Labour, section 2.2.1, p8
 : Royal College of Obstetricians and Gynaecologists guidelines on Induction of Labour, section 2.1.1, p7
This page updated 20 March 2007
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