Waiting for Labour. Timing of Birth of Low Risk Women: a Collaborative Approach

In those first few weeks after the confirmation you have new life growing inside of you, being pregnant and becoming a mum consumes your thoughts. As the weeks go by and your ability to find any position comfortable in your third trimester, your excitement is still there to meet your baby, but your thoughts turn to “when”.


Family and friends weigh in and tell you all their stories of having a baby early, or quickly, or on the flip side others tell you they carried until 42 weeks, the labour went for days, or as a first time mum you are more likely to go over.

From 36 weeks your birth preferences start to become more of a hot topic during your weekly visits. We see many women want to talk about their options for timing the birth of their baby, whether that is because they don’t want to go overdue, or trying to avoid a date or had a previous fast birth and wanting to control the uncertainty.

Of course in a private model of care, you have this choice, but it is important that we as your health care providers ensure you know all the interventions and potential outcomes of this decision as the mode of birth is not the only outcome that warrants discussion.

In modern times we are used to schedules, plans, and being organised. This unpredictability of when labour will start is stressful to many. Learning you are considered “term” from 37 weeks automatically sets the countdown. You more commonly experience contractions at night-time, so each night you go to bed looking for those small signs of early labour and wonder if tonight is the night. You feel baby engage into your pelvis, you start to feel stronger Braxton hicks, waking frequently in the early hours of the morning as mother nature prepares you for a newborn.

You finish up work, you have nested for weeks and exhausted Netflix and Stan. You edge closer to your due date, a day in a month that was given to you at the start of your pregnancy based off your last period or dating scan and used to calculate your gestation in weeks and days. Your loved ones have saved the date too and although mean well, the texts and calls start flooding in those last couple of weeks asking you if there is any sign yet. Now you feel like you are also on other people’s timeline.

With fluctuating hormones, and sleep disturbance often causing an irritable mood, your thoughts turn to “I’m done, how can I get this baby out”.

At all times we need to balance the health of mum and baby versus the risks of an induction or continuing the pregnancy. We will want to make sure you have a realistic expectation of when babies are born. Yes, term is from 37 weeks, but every week counts towards brain development that occurs between 37-40 weeks and therefore care providers will only recommend booking an induction before 39 weeks if medically indicated.

Only 4-5% of babies are born on their due date, women should know that labour is most likely to occur between 39-41 weeks therefore on a bell curve this would mean only 50% of women awaiting spontaneous labour will have had their babies by their due date.

If your preference is to not go past this date, then importance is placed on ensuring a balanced view on the differences for your labour when induced and of the possible short and long term implications of the medicalisation of this process, especially when you are considered low risk.

Evidence informs our practice and recommendations; at times we often hear advice from different care providers can feel conflicting. It is not because the information is different, it is often in the way the information is delivered or what aspects of the research is valued most by the clinician.

At the core of these discussions, is respecting a woman’s right to choose, and ensuring she has adequate information to make an informed decision.

In brief there are two types of research: Quantitative (statistics or relative risk of an outcome) and Qualitative (women’s personal experiences). Both need to be considered and given equal weight to ensure women are well informed, because birth is not all about the end result or outcome, it is about the making of a mother and family unit. How a woman feels about herself and her birthing experience forms lasting memories that has the power to transcend other life experiences, whether positive or negative and impact on relationships around her.

Yes, pregnancy may feel like its dragging towards the end and every waking moment of each day you do not feel those first signs of labour turns into a yearning to meet your baby safe in your arms. Yes we have a duty of care for “a healthy baby and healthy mum”; but with a growing statistic of 1:3 women saying they experience birth trauma (which can mean different things to different people), ensuring women feel empowered and involved in all decision making is also a top priority.  A good way to consider you options is to use the B.R.A.I.N acronym (created to www.elitedoula.com)


B           What are the benefits of having an induction?

  • Control the uncertainty, arrange childcare, choose a date, if induced between 39-40wks research has shown a decrease in emergency caesarean section rates


R           What are the risks of having an induction?


A           What are my alternatives?

  • Wait or consider natural methods – some of which may or may not work, but if there is no harm and women feel actively involved in encouraging labour, she may feel more in control: nipple stimulation, intercourse, eating dates, membrane sweeps, raspberry leaf tea, acupuncture/acupressure.


I             What does my intuition say?

  • Spontaneous labour is driven by hormones, in particular oxytocin. If you are anxious about the uncertainty or going overdue your body may release adrenaline that inhibits oxytocin. On the flip side, you may feel well prepared for the expectations, excited for birth and enjoy being pregnant so happy to wait until baby decides its own birthday.


N          What if I do nothing?

  • Remember most babies are born between 39-41wks. As long as you have weighed up all the differences for you and your baby, we continue to respect your wishes and monitor any alterations to each of your health needs.


For more information, here is some further reading and resources:

Every Week Counts

Hormonal Physiology of Childbearing Fact Sheet

QLD Clinical Guidelines for Induction of Labour – Consumer Information

Evidence Based Birth – Due Dates

RANZCOG – Patient Information Pamphlets

Mercy Perinatal Journal