Due dates are taking pregnant pause

Babies: With due days often turning into due weeks, obstetricians are shying away from circling the calendar.

March 31, 2002|By Charlotte Moore | Charlotte Moore,Cox News Service

Somewhere in the deep recesses of Patricia Witcher's subconscious hangs a calendar with the date July 15 circled in red marker.

But, as future Mondays go, the next one is so much more significant.

"Mondays are my 'turnaround' day," the first-time mother-to-be explains. "Each Monday marks the beginning of another week of my pregnancy."

July 15 is Witcher's due date, but if that day passes without her baby's arrival, she won't be surprised. Neither will her doctor.

Increasingly, obstetricians are moving away from the notion of a due date, downplaying the 24-hour time span that occurs 266 days after conception and shifting the focus to other issues surrounding pregnancy. To-the-day delivery predictions are de-emphasized and patients are advised to expect delivery after anywhere from 38 to 42 weeks.

Considering that 95 percent of expectant women don't deliver on the due date ordained by the pregnancy calendar, this change in thinking may be overdue.

Three physicians and a midwife at Oregon's Sacred Heart Medical Center said as much in a jocular commentary published last year in an American College of Obstetricians and Gynecologists journal.

"Obstetricians have known, for a long time, that women don't deliver on their due date," says co-author and obstetrician Vern Katz.

Instead of performing "pseudoscientific calculations" at the onset of pregnancy, Katz proposes assigning an expected week of delivery. This allows doctors and patients to focus on more important issues and individual needs, he says, and reduces patient anxiety that can arise when a baby doesn't appear on the prescribed day.

Katz, who specializes in high-risk pregnancies, says there are valid reasons for using obstetric markers to determine a woman's "estimated gestational age," or EGA -- the point to which her pregnancy has progressed. It's the "estimated due date," or EDD, that he and some of his colleagues suggest replacing with an "assigned week of delivery," or AWD.

Katz's views are shared by many doctors.

Dr. Jeffrey Marcus, Patricia Witcher's obstetrician at Northside Hospital in Atlanta, estimates that 75 percent of his patients deliver before their due date. Still, when an expectant woman visits his office, he whips out his trusty "pregnancy wheel" to calculate her estimated due date.

Marcus believes there are valid reasons to consider the estimated day of delivery as well as the assigned week of delivery.

"The AWD is fine from an emotional point of view, but not so much from a clinical point of view," he says. "Doctors need to assign a due date in order to prescribe therapy. For instance, if a person is in premature labor, we may give her steroid therapy at 32 weeks to help mature the baby's lungs. At 34 weeks we might not."

The idea for expectant mothers, he says, is to think of the due date as a guide.

Thus, when July 15 rolls around, Witcher won't be watching the clock, willing her water to break sometime before the stroke of midnight.

"I hope I won't," she says. "But I probably will."

It's human nature to fixate on a due date, says Heidi Murkoff, co-

author of What to Expect When You're Expecting (Workman Publishing Co.), a mother-to-be manual turned cult classic.

"We know that very few women actually deliver on their due date, but still, lots of couples would prefer to hear a date rather than 'sometime during the week of ... ,' " Murkoff says. "It gives you something to mark on a calendar -- something to look forward to."

A time limit adds to the excitement, especially for first-time parents. But due dates can just as easily frazzle the mind and foil the best-laid plans.

Many a family member, wanting to get a glimpse of a newborn kin, has made due-date-centered travel arrangements only to find himself or herself finagling return schedules. Maternity-leave vacations have been carefully scheduled to begin as close to the due date as possible, resulting in days or weeks of squandered time before delivery.

Due dates can frazzle everyone involved. Doctors spend more time trying to explain to patients why they aren't delivering on their due dates than they do explaining childbirth itself, Katz jokes.

"The whole issue of the due date is based on the 28-day menstrual cycle," he says. "And who knows the exact point of conception?"

Witcher was actively trying to get pregnant and was keeping a journal of the comings and goings of her menstrual cycle. But many women don't track their periods so closely. And some have irregular cycles.

Doctors sometimes use ultrasound to more accurately determine fetal development, which is then converted into a theoretical age. But even that isn't a foolproof technique for determining a due date, Katz says.

Due dates: By the numbers

* 38 to 42 weeks: Normal gestational period after conception. (In 2,000, there were slightly more than 4 million live births in the United States.)

* 5 percent: Babies born on their exact due date.

* 80 percent: Women who give birth within two weeks (before or after) their due date.

* 10 percent: Births that occur after 42 weeks.

* 10 percent: Births that occur before 38 weeks.

Source: American College of Obstetricians and Gynecologists

Tips for Expectant Parents

The third edition of What to Expect When You're Expecting is due in April. Here are some of co-author Heidi Murkoff's due-date suggestions for parents-to-be:

* Mark your due date on the calendar in pencil, not red pen. The estimated date of delivery is an educated guess, but still a guess. You might want to call it your due month rather than your due date.

* Expect to be late -- especially if you're a first-timer. On average, first babies are born eight days later than their projected due dates, and second babies about three days later than their due dates.

* You'll hear many ideas about how to trigger labor, but virtually all are myths.

* The "10th month" is always the longest. Instead of sitting around waiting, enjoy your last couple of weeks of freedom.

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