It is safe to say that while the 40 weeks of pregnancy are physically exhausting, crossing over to the 41st week can be a tad scary and unnerving! Indian television actress Drashti Dhami, who has been blessed with a baby girl, seemed to have found herself in this predicament Her Instagram post, where she is flaunting a full-term baby bump, with the text “41 weeks still no baby” was the perfect testimony to this frustration. However, turns out that experiencing no labour pain at 40 weeks is not always worrisome. Factors such as the baby’s position, her lungs, weight, and the mother's health, all determine when labour starts. A ‘post-term pregnancy’ can extend to 42 weeks. Having said that, this is not the time to sit tight either. Read on to know some women have no labour pain after due date, and what to do next.

What is the right time for labour to start?

In normal pregnancies, the onset of labour is expected to occur between the thirty-seventh and forty-second week of gestation, with normal labour invariably beginning around the thirty-ninth week. There are some major changes that the body undergoes while preparing to go into labour. “There is the softening of the cervix to begin with, followed by its effacing (thinning out) which helps it to dilate before the delivery of the baby. Hormonal changes like an increase in the levels of oxytocin assist in the contraction of the uterus,” says obstetrician and gynaecologist Dr Vishnu Priya.

However, there are no definite reasons why labour starts. “There are hypotheses which include a drop in progesterone, fetal lung maturity releasing cortisol, which triggers labour, or overstretching of the uterus that can initiate contractions,” explains obstetrician and gynaecologist Suruchi Desai. The baby also descends into the birth canal, which is referred to as 'lightening', and may exert pressure on the lower abdomen affecting the mother’s comfort and breathing patterns. All these physical changes suggest that the body is getting ready for the labour process, having moved from the pregnancy stage to that of childbirth. Additionally, the National Institute of Child Health and Human Development in the US, states that labour that occurs before 37 weeks of pregnancy is considered premature.

Check out Drashti Dhami's pre-delivery post!

Can a pregnancy exceed 40 weeks?

Yes, pregnancies can go beyond the due date, that is 40 weeks. “Usually, pregnancy lasts till 32 to 40 weeks. In the cases that a woman is pregnant for longer than this period, it is known as post-term pregnancy,” explains Dr Priya.

A study published in the journal Facts, Views & Vision states that post-term pregnancy can be associated with fetal, neonatal and maternal complications including morbidity and perinatal mortality.  Therefore, if you have no labour pain at 40 weeks, then you must consult your doctor to understand what to do next. “Generally, a Colour Doppler, NST (Non-stress Test) and physical examinations are conducted every three to four days, if you cross 40 weeks,” explains Dr Desai.

Causes of no labour pain at 40 weeks

While every pregnancy is unique and needs to be handled differently, there can be multiple reasons to have no labour pain at 40 weeks of pregnancy. Here are a few of them:

1. Different women have different pregnancies

Every woman is different and due to reasons such as genetics and hormones, there may be a difference in how or when labour starts. For some women, there could be territorial tendencies in a body that holds its labour for a longer duration. Your medical history also makes a difference. A research paper, published by the National Institutes of Health in the US, reports that women, who have already had a baby who was born much later than their due date, are more likely to have an overdue baby in future pregnancies.

2. Cervical Ripening

When a woman is pregnant, her cervix is closed despite multiple forces acting upon it. However, at the time of labour, the cervix must open. It must soften and dilate, to allow the baby to pass through, states this study, published in Translational Research in Anatomy. The amount of time it takes to prepare the mother’s cervix, including softening and thinning (effacing), is different as well. In some cases, even if the mother is past her due date, a hard and closed cervix has been observed.

3. Foetal Position

The way a mother and her child position themselves may also affect the labour process might also be why a woman has no labour pain at 40 weeks. It may be delayed due to inadequate positioning of the child in the womb for normal delivery, for example, when the child is in a breech position. A study, published by the Cochrane Library, states that the best position for the baby during the time of birth is the head down, with the back of there head facing forward.

4. Maternal health

Many physical ailments such as obesity, diabetes, or thyroid problems can dictate the onset of labour. These conditions are likely to play a role in hormonal balance as well as the body’s preparedness for labour, thus delaying the same. Even when labour starts, the first stage of labour would be longer if the mother is obese, states this study, published in Obstetrics & Gynecology.

5. Psychological factors

The psychological state of a woman can affect her hormonal system primarily during labour and delivery. In some cases, it has been noticed that the state of mind may influence the position of the baby and the commencement of labour, for example, when one is calm and relaxed, oxytocin is released which in turn causes contractions. Even if labour starts, there are more changes of dystocia, or obstructive and difficult labour, if the mother is anxious or nervous, states a study, published in the Journal of Perinatal Education.

No labour pain at 40 weeks: How much should you wait?

If a pregnancy goes beyond 40 weeks, it must be monitored closely. “In most cases, another period of one to two weeks is allowed, which leads up to 42 weeks, before induction is recommended,” explains Dr Priya. This is mainly to help understand the advantage of letting labour start naturally as compared to the risks associated with post-term pregnancies. Waiting until 42 Weeks allows for natural processes to take their course, which can be crucial for the mother and the baby. “The patient needs to be fully aware that she is going beyond 42 weeks, and there should be mutual consent between her and the doctor,” says Dr Desai. However, beyond this time, the risk factors may start to rise. “Risks may include, decreased levels of amniotic fluid, chances of having a macrosomic baby, and problems in delivery leading to high rates of a caesarean section,” says Dr Priya.

What to do if there is no labour pain at 40 weeks?

Here is what you should do if you have crossed 40 weeks in your pregnancy journey and have no signs of labour:

• Monitoring: It is advisable to go in for non-stress tests or ultrasounds, in which the fetal heart rate and general conditions of the infant are closely observed. This assesses the condition of the baby as well as the levels of amniotic fluid.
• Discussing options: Talk to your doctors to find out more about the different things that you can do next. This may include a conversation about how long to wait and the possibilities of waiting or applying for induction.
• Induction planning: Whenever the pregnancy extends to 41 or 42 weeks, the doctors may recommend induction of labour. Several approaches can facilitate induction such as cervical ripening medications, amniotomy and oxytocin infusion.
• Induction process: This is done after a thorough pre-induction checkup to ensure that the fetus is safe, the baby is in a head-down position, and the patient's and family's consent is taken.

Some of the causes of experiencing no labour pain at 40 weeks can be lack of certical opening as well as fetal position. Image courtesy: Freepik

Can you prevent this late delivery?

There aren’t any guaranteed means of eliminating late delivery. “Factors such as the baby’s position, fetal lung maturity, the baby’s weight, and the mother's health all determine when labour starts,” says Dr Desai. However several recommendations may help the onset of labour at the appropriate time.

• Being physically active throughout the gestation period is helpful for the development of reproductive health and hence exercises like walking, prenatal yoga or even pelvic tilts are significant. Check out the pregnancy exercises that you can do.
• Eating high fibre food cuts down the chances of a person being constipated and improves the general fitness of the individual.
• Staying hydrated and managing stress can also help in improving the body’s functionality.

However, it is important for expectant mothers to follow up with their doctors before undertaking any methods, to make sure it is effective and safe. These recommendations can be beneficial, but the time in which a mother goes into labour can vary from person to person.

Is there any impact on the baby due to late delivery?

Unfortunately, yes. Delivery in overdue cases may affect the baby especially if the gestation period stretches beyond 42 weeks. “Potential risks include problems such as cord compression, macrosomia, and placenta ageing which causes underdeveloped tissues in the baby along with a deficiency of oxygen and nutrients. The risk of meconium aspiration also increases, and very rarely, stillbirth,” says Dr Priya. Due to these dangers, births past 42 weeks tend to be very suppressive and many physicians opt for induction of labour, for the mother and the baby's safety.

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