The management of prolonged pregnancy - an analysis of women's attitudes before and after term

Prolonged pregnancy (a pregnancy that continues several days past the due date) is often treated by routine induction of labor after 10 days or more, but recent evidence suggests that the decision to induce may be influenced by somewhat arbitrary criteria. Many women want to avoid obstetrical intervention whenever possible. To learn more about women's attitudes regarding prolonging their pregnancies with conservative medical management, a study was carried out with 500 women. The subjects were 37 weeks pregnant when the study began. They received written information informing them of the prenatal clinic's new policy, which was to offer them the option of continuing their pregnancy under careful supervision after the 42nd week of gestation. Each woman completed a questionnaire indicating her preference for induction of labor or conservative management. During week 37, 226 (45 percent) agreed to conservative management. By 41 weeks' gestation, 122 women (24.4 percent) had not delivered. Thirty-eight of these (30 percent) wanted conservative management, a significant shift when compared with attitudes expressed earlier in pregnancy. All changes in desired care were away from conservative management; no subjects changed to this position. Reasons (at 37 weeks' gestation) for not wanting conservative management included: inability to stand the thought of being pregnant for more than 42 weeks (34 percent); perception of no benefit to waiting (21 percent); concern regarding fetal size (20 percent); and no family member available after 42 weeks' gestation (20 percent). The subjects' opposition to conservative management is discussed; such a position is of particular concern when the fetus's gestational age is unknown. It is recommended that the concept of 'expected due date' be abandoned, since women often become alarmed if the baby has not arrived by that date. It is concluded that pregnant women, as well as the medical profession, are inclined to chose induction of labor for prolonged pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)