Fixed point due dates and wider windows (part 2)…

5110988361_9e01390c88In my last post, I wrote about the problem of fixed point expectation syndrome and suggested that the act of calculating and then focusing on an estimated due date is problematic.  It is problematic because this one date becomes a much-anticipated fixed point.  When it then passes before the arrival of a baby, as it inevitably will for a good proportion of women, the expectations that have been built around this can lead to difficult feelings, decisions and/or situations.

It would be unrealistic, however, to suggest the eradication of the fixed point due date (though I am still very much open to my trip in the TARDIS to visit any universe where this notion has never occurred to anyone).  Instead, I propose that, alongside whatever we do right now, we open discussions about wider windows with women, families, colleagues and everybody else.  This problem is not limited to the confines of the antenatal clinic.  Discussion of due dates permeates every corner of modern society.

The notion of substituting a wider range of probable birthing time for the current fixed point due date isn’t new.  Midwife Brenda van der Kooy (1994: 5) notes that, “as elsewhere in nature, normality has a range” and Stickler (1994: 325) recommended using “less specific terminology such as ‘month of expected delivery’ … [which] would cure the many ills stemming from the pseudoaccuracy of the EDC”.  Until I carried out my research, however, I hadn’t found any studies which demonstrated midwives or any other practitioners using these idea in everyday practice.  (If you want to read more about my findings generally, you might like Post-term pregnancy: the problem of the boundaries or Stretching the fabric: from technocratic normal limits to holistic midwives’ negotiations of normalcy.)

As one of the article titles above implies, the concept of stretching the fabric was important to the midwives in this research.  In fact, this phrase was used by one of the midwives, who said “I like to stretch the fabric of what is normal…”  Several of these midwives described how they stretched the fabric of the obstetric notion of the fixed point due date further by widening the window to encompass a week or (more often) a month rather than a single date:

 I always talk to them about having a due month, and, you know, if that is like the beginning to the end of a month or a whole, you know the middle of a month to the next.  (Xena)

 [I tell women] a lot that the date is not a set date, that it’s actually a whole month that the baby can be born in. If [the fixed point due date is] June 16th she should be ready between the 1st and the 30th of June, anytime. (Anna Andhra)

I just want to say that I know this is not unique in itself.  I am aware that a number of midwives like to mention the idea of a range, or at least note that the fixed point due date is not very reliable.  The midwives in my research went quite a bit further than this, in three ways.

1. Their discussions were ongoing.  The proposing of a wider window is not something they did during the initial reckoning of the due date and then forgot about; this notion of the wider window is emphasised and discussed throughout pregnancy, which was considered as a journey.  This means that adjustment was continual, and I imagine that the women whose pregnancies were longer than average found this less disappointing than they might otherwise have done, although let it be noted that I have no evidence of this other than the midwives’ perceptions.

2. They explained their rationale.  The midwives’ discussion of the wider window wasn’t some kind of secret incantation that was uttered in the hope that it would have some magical effect in reducing the risk of fixed point expectation syndrome.  They were open and honest about their motives and the way they saw it as part of their role to help women move away from the absolute nature of the fixed point due date and towards a place of more flexibility.  The midwives’ rationale for doing this is linked to what they perceive to be the potentially stressful impact that a fixed due date can have on the woman, especially where this is perceived as an appointment (Davies 2003) which for many women will pass without any sign of labour.

3. They didn’t just talk to women.  They understood only too well that pressure (often well intentioned and loving in nature) came from the woman’s family, and they took every opportunity to mention this, often making half-joking, half-serious comments about it (“Now don’t you [the woman’s partner] be booking time off work from that date onwards; it’ll just as likely come late in the due month as early [and] if the yard can’t be flexible about that, well you just tell them to call me [and] I’ll tell them.”)

In modern culture, it is not considered cool to be overdue – whether for a date, with a library book or when awaiting birth – and this can impact negatively on women.  But maybe there are things that we can do about this, not just to help women to avoid fixed point expectation syndrome, but to help our whole society understand that seeking this level of certainty may not be a good idea.

References
Davies, R (2003). “I’m ready for you, baby, why won’t you come?” How long is a pregnancy and how long is too long? New Zealand College of Midwives Journal 28(1): 8-10.
Stickler, G B. (1994). Expected date of confinement (correspondence). The Journal of Family Practice 39(4): 325.
Van der Kooy, B (1994). Calculating expected date of delivery – its accuracy and relevance. Midwifery Matters 60: 4-7, 24.

 

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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.

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2 comments for “Fixed point due dates and wider windows (part 2)…

  1. Geegee
    December 4, 2016 at 10:51 am

    I think this is a great approach and in pregnancy one we told everyone it was due in December at some point – easy! This time it’s due end of May and its much more obvious if I say mid may to mid June as it’s clearer the middle is the edd! As it is, my final exam is the week after edd(ish depending on my dates vs scan dates) so I’m settling for ‘ I’m hoping after my exam’ so if its before I have less nagging!

    Your website is superb and i look forward to doing many of the courses in a couple of years when I start applying to study Msc midwifery, thank you!

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