Fixed point due dates and wider windows (part 1)…

small_3749525146If Doctor Who turned up in front of you right now and offered you the chance to go elsewhere in time to change, remove or amend one tenet of modern maternity care, what would you choose?

Even though I understand that the ripples would ripple out to affect other elements of the cosmos in unforeseen ways and all that, I would REALLY like to spend a day in an alternate universe which didn’t contain the notion that it is useful to spend five minutes near the beginning of pregnancy using a whirly wheel, one’s fingers or a web-based calculator to calculate an estimated date of birth / delivery / confinement (please delete as appropriate according to your age and ideology) which is then used as a reference point for the next two hundred and eighty or so days.

Because that one calculation leads to so much grief and anguish for so many people, in so many ways.  Having a fixed point due date can cause women to feel desperate as it looms and passes without the arrival of their baby.  Fixed point due dates can lead to well-intentioned pressure from worried (and excited) families, and certainly to more intervention than some might consider necessary.  Some women abandon all of their previous desires in the face of the pressure, which isn’t necessarily problematic in itself but I know from experience that a proportion of these women later regret not awaiting spontaneous labour.  All of this might be more justifiable if the setting of a fixed point due date were based on sound reasoning but, as with so many aspects of maternity care, it is not built upon a solid foundation of evidence and can be (and has been) challenged in many ways.

I am sure that I will come back to the question of the evidence in this area at a later date, but today I would like to focus on explaining what I see as the problem of fixed point expectation syndrome.  (Yes, I did just make that up; let’s see if it catches on :D)

parcelI am using the term fixed point expectation syndrome to describe a human state that we can enter anytime we have been looking forward to something.   Like, for example, the arrival of something exciting that one has ordered online, though another example affecting someone close to me right now concerns waiting for news of whether one is going to be offered an exciting new job.  I am going to argue that, consciously or subconsciously, we sometimes create a fixed point in our minds which represents the time and/or date on which we think the thing we are anticipating – in this case the arrival of the parcel or the news of the job decision – should occur.

This is all a very natural and understandable human process, by the way, and no judgement or blame is intended.  It is also very necessary if we are to organise our lives, so please understand that I am not saying we shouldn’t do it.

The fixed point deadline we have created in our mind may or may not be a reasonable assessment of the likely timescale but, either way, the world we live in is uncertain and so in a percentage of cases the expectation will be met or exceeded and the person will be happy, but in other cases the deadline will pass without the event having occurred.  The result of a fixed point expectation not being met can range from minor disappointment and the need to make an adjustment in thinking to more major upset and potentially more radical decision-making which may be out-of-sync with what the individual might have chosen in a less emotive and disappointed state.

papapishu_Baby_girl_sittingNow magnify the excitingness of the parcel by a million, give a delivery estimate that is several months away and see how much fixed point expectation ensues…  This is why I would like to see what life – and birth – would be like in an alternate universe in which it had never occurred to anyone to calculate a fixed point due date.  No matter whether it is the woman herself or a health professional who is doing the calculating, the level of uncertainty that exists means that a percentage of women and their families are going to need to work really hard to adjust their thinking when the due date passes without even the first sign of a nesting urge.

Yet I don’t think we have to give up hope.

I believe that there is one thing that we could all easily do that would make a huge difference, even in a universe that seems to almost revolve around fixed point due dates.  We can accept that these are still going to be a reality and simultaneously embrace and share with women, families and others the notion of a wider window which offers a more realistic perception of when a baby will arrive.  If we can help people to understand the degree of uncertainty involved in estimating such an event from such a long way off, and spread the idea that it is better to view this as a range rather than a fixed point, then I think we can help them not to experience fixed point expectation syndrome.

A few years ago, I carried out research with holistic midwives that explored their knowledge in relation to ‘post-term’ pregnancy.  This notion of the wider window was one they discussed frequently, and in part two of this post I will share some of what I learned from talking with them 😀

 

Post-term pregnancy course slide purple

If you’d like to learn more about post-term pregnancy and build your confidence with the evidence, I’d love to welcome you to my online course on this topic 😀  And you can keep up with my research postings via my free updates and monthly Birth Information Update.

photo credit: NASA’s Marshall Space Flight Center via photopin cc

4 comments for “Fixed point due dates and wider windows (part 1)…

  1. Lynn Ratcliffe
    October 24, 2013 at 6:59 pm

    This is so true but it’s not just the women and her family is it? Health professionals also have this expectation and start to get “twitchy” as soon as 41 weeks approaches.

    • October 24, 2013 at 7:09 pm

      Oh, absolutely … this is only one tiny element of what is a massive and complex problem.

  2. October 25, 2013 at 10:15 am

    Recently had the experience of a woman by dates being 42 weeks plus….she declined intervention because she knew she and baby were not “done with the journey yet”…she birthed at what was deemed by calculation to be 43weeks…..she simply just did not “buy into” the EDD, preferring instead to trust that her journey would end when the time was right.

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