Going past your due date

What is it?

A due date is an estimate. Most babies are born within a window around it, and going a little past is normal.

What changes after the due date is a set of gradual shifts.

The placenta ages. Its ability to deliver oxygen and nutrients declines gradually, which for most babies is fine and for some is not.

Fluid falls. Amniotic fluid volume tends to decrease, and less fluid means less cushioning of the cord, which increases the chance of compression and of variable decelerations in labor. ²

meconium becomes more common. The bowel matures, so passing meconium before birth becomes more likely, and that raises the possibility of meconium aspiration. ¹

The baby grows. Which raises the chance of macrosomia and of shoulder dystocia. ^{3 4}

The risk of stillbirth rises, which is the reason the timing question is taken seriously. ¹

Why dating is the foundation

Everything above depends on knowing how many weeks pregnant you actually are. Dating by an early ultrasound is more accurate than dating by the last period. A pregnancy that is wrongly dated can be induced too early or watched too long. ¹

What does standard care look like?

Accurate dating, ideally established by early ultrasound. ¹

Antenatal fetal surveillance in the late-term and post-term period, typically including nonstress testing and assessment of amniotic fluid volume. ¹

A discussion about the timing of delivery, which guidance addresses for late-term and post-term pregnancy. ¹

Monitoring in labor, with attention to the higher chance of cord compression when fluid is low. ²

Preparation for meconium, meaning a team ready to support a baby who needs it, without routine airway suctioning. ⁵

Attention to fetal growth, and the discussion around suspected macrosomia. ³

What can go wrong?

Dating never established properly, so the whole timeline is uncertain. ¹

No monitoring after the due date, where guidance addresses surveillance in this period. ¹

Reduced fetal movement not acted on. A change in movement is a reason for assessment at any gestation.

Low amniotic fluid not identified or not acted on. ¹

Delivery not discussed or not offered at the point guidance addresses. ¹

Meconium with a concerning tracing not acted on. The combination is what matters. ²

Routine airway suctioning of a vigorous baby born through meconium, which is no longer recommended and which delays effective breaths. ⁵

Whether any of this amounts to a departure from the standard takes a physician expert reading the whole record.

Which injuries can follow?

• Meconium aspiration syndrome and PPHN. ⁶
• HIE, where oxygen delivery falls and is not relieved. ⁷
• Shoulder dystocia and brachial plexus injury, where the baby is large. ^{4 8}
• Low blood sugar in a large baby. ⁹
• Stillbirth, the risk of which rises with advancing gestation. ¹

For the mother, a longer pregnancy is associated with higher rates of operative delivery and of severe perineal tearing. ¹⁰

What does this look like in the records?

From the prenatal record

• How the pregnancy was dated, and whether an early ultrasound was done. ¹
• Every antenatal test after the due date, with results and dates: nonstress tests, biophysical profiles, fluid measurements. ¹
• Growth scans and estimated fetal weights. ³
• Any documented discussion about induction and its timing.
• Any report of reduced fetal movement, and what was done.

From the labor record

• The gestational age at delivery.
• The fetal monitoring strip, with attention to variable decelerations. ²
• When meconium was first noted.
• The cord blood gas and Apgar score scores. ¹¹
• The resuscitation record. ⁵
• The placental pathology report, which can describe placental aging.

What can you do this week?

1. Request the complete labor and delivery record for you and your baby. The records request builder writes the letters for you.
2. Write down what you remember while it is fresh, using the delivery timeline builder.
3. Read how to read your labor and delivery records before the records arrive.
4. Check the deadline to file in your state with the statute of limitations lookup.