What to Do When You're 40 Weeks Pregnant With No Signs of Labor

Ask any person whose pregnancy went into extra innings what happened, and they'll all say the same thing: Right around the due date, the phone calls, emails, and texts start coming. "Is anything happening?" "What does the doctor or midwife say?"

Playing the waiting game is hard, but it becomes especially difficult when you're 40 or more weeks pregnant. But what should you do when you're overdue, contractions have yet to start, and there's no sign of labor? Well, relax, breathe, and remember your due date is just an estimate. In fact, researchers estimate that over 10% of pregnancies last 41 weeks or longer.

What You Should Know About Due Dates

"No one should feel nervous or anxious if they're still pregnant past their due date," says Alex C. Vidaeff, M.D., MPH, an OB-GYN and maternal-fetal medicine researcher and practitioner at Texas Children's Hospital in Houston. Due dates are tricky because it's hard to pinpoint the exact age of a fetus.

Doctors and midwives use several methods to calculate their best estimate of a due date, including:

• Ovulation: This estimation is based on your last ovulation or embryo transfer date if doing IVF (the most reliable method).
• Menstruation: The most common method of estimation is based on the first day of your last menstrual period.
• Fundal height: A clinical examination of the uterus can help estimate the age of the fetus.
• Ultrasound: During early pregnancy, your doctor can estimate fetal age within seven to 10 days (it's not as effective later in the pregnancy) based on an ultrasound.

Even so, the reality is that 80% of babies arrive between 38 and 42 weeks of pregnancy, so your due date window is much bigger than you might think. "You might really be 39 weeks when you think you're at 40," says Dr. Vidaeff, adding that pregnancy length is, in many cases, genetically determined.

The Risks of Going Past Your Due Date

Fewer than 1 in 10 babies is officially overdue, which means that the baby is born after 42 weeks of pregnancy. Research has shown that delivery after 40 weeks may come with certain risks, and OB-GYNs have responded. "We now change our clinical practices at 40 weeks to prevent potential complications," says Carri R. Warshak, M.D., an OB-GYN and professor in the department of maternal-fetal medicine at the University of Cincinnati.

While they're rare, complications associated with going overdue include:

• Placenta function: The placenta's ability to provide the baby with adequate oxygen and nutrients may be compromised.
• Amniotic fluid levels: The volume of essential amniotic fluid may decline as the baby grows, which increases the possibility of a pinched umbilical cord.
• Fetal distress: The possibility of fetal distress increases.
• Fetal macrosomia: The baby could grow too large to pass safely through the birth canal.

What You Can Expect If You Are Overdue

At the 40-week mark, your doctor or midwife will become more vigilant about monitoring the overdue baby. "Expect twice-a-week visits if you go past 40 weeks," says Sheryl A. Ross, M.D., an OB-GYN in private practice in Santa Monica, California. Methods that your prenatal health care provider can use to monitor your post-term baby's condition include the following.

Kick count

A "kick count" is a record you keep of how often your baby moves. Your doctor will tell you to contact them immediately should you notice your baby suddenly decreases their movements. This could be a sign of fetal distress, requiring immediate testing to determine your baby's condition and assess whether delivery should be initiated quickly.

Nonstress test

Nonstress tests, a type of electronic fetal monitoring, use a special instrument to measure how your baby's heart reacts when its body moves. This helps the doctor determine if your baby is in distress.

Contraction stress test

When your uterus contracts, this test (which is another form of electronic fetal monitoring) measures your baby's heart rate with a special instrument, it helps determine your baby's condition during labor and allows your doctor to see if there's any fetal distress.

Ultrasound

Your doctor can determine your baby's size, position, respiratory rate, heartbeat, and body movements with an ultrasound. Ultrasound is also useful in determining how much amniotic fluid surrounds your baby. The fluid level is important because insufficient amniotic fluid for prolonged periods can cause labor complications.

In addition, your doctor can assess the size and position of the placenta using ultrasound. This information is important for your doctor to know because the placenta provides your baby with life-sustaining oxygen. Plus, "if the fetus weighs more than 8 pounds, 13 ounces, you may have difficulty pushing during labor, and using a forceps or vacuum may be necessary for delivery," says Dr. Warshak.

No Signs of Labor at Week 40

After 39 or 40 weeks, it's sometimes best to deliver sooner rather than later. Studies have shown that newborn admissions to the neonatal intensive care unit (NICU) increase slightly when a pregnancy lasts 40 to 42 weeks. And stillbirth, though rare, becomes a concern.

At 40 weeks, the risk of stillbirth is approximately 2 to 3 per 1,000 babies; at 42 weeks, it's 4 to 7 per 1,000. If labor hasn't started spontaneously, you'll probably be induced at 41 weeks—at the latest. "If your cervix has started to dilate, odds are in your favor for a successful induction," Dr. Warshak says. Translation: You probably won't end up having a cesarean section (C-section).

Whether or not you'll be induced depends on your own health, the status of your cervix, and the baby's well-being as determined by a non-invasive procedure called fetal non-stress testing. The conditions inside your uterus past the due date may also stress the baby during labor and vaginal delivery. As a result, Dr. Warshak says, "Even if your cervix is at 8 centimeters and labor is progressing, we'll do a C-section if the overdue baby is not tolerating labor well."

The midwife philosophy

Midwives tend to wait a little longer for induction than OB-GYNs do. "In our practice, we wait until 42 weeks to go into labor naturally," says Joanne Hasman, C.N.M., a certified nurse-midwife at Special Beginnings Birth and Women's Center in Arnold, Maryland. "If they don't by then, we schedule an induction at our hospital. We also try natural methods, including acupuncture, reflexology, or reiki."

At 40 to 41 weeks, if your cervix is dilated at least 2 centimeters, the midwives in Hasman's practice perform what's called a "cervix sweep" (or "membrane sweep") by inserting a gloved finger into the cervix to loosen the amniotic sac from the uterus. This can sometimes kick-start labor. "If the person is really ready [to go into labor], I'll see [them] back here in 24 to 36 hours," Hasman says.

The C-section question

An ongoing concern has been whether induction, as opposed to what's known as expectant management (waiting for labor to start spontaneously while monitoring the parent and baby's well-being), might lead to a higher risk for emergency C-section, and studies have been conflicting.

However, a comprehensive study funded by the National Institutes of Health found that inducing labor at week 39 is not connected with higher C-section rates compared with waiting for labor to begin spontaneously. In fact, researchers found that the rates of surgical intervention were lower in the group that was induced by a rate of 18.6% compared with 22.2% for the expectant management group.

Things To Do While Waiting for an Overdue Baby

Backaches, heartburn, hemorrhoids…at 40 weeks, all you want to do is hold your baby in your arms. Here are a few tips to help you cope.

Get a massage

Some Eastern healers believe that certain pressure points on the hands and feet may stimulate the body's natural labor process, although Dr. Ross says this hasn't been proven. Even if you can't get your tired body to a prenatal massage therapist, asking your partner to give you a rubdown might help your aching back, not to mention your mood.

Get spicy

Sadly, there's no magic meal that's guaranteed to bring on labor (although there's that famous maternity salad dressing that some swear by). Still, Dr. Ross has had several clients report that things, ahem, got moving after they indulged in a spicy meal.

Spicy foods fall into that "can't hurt, might help" category, and we say that once you're more than 40 weeks pregnant with no signs of labor, go ahead and eat your baby's weight in your favorite spicy food.

Have an orgasm or two

Remember what we said about distraction? The hormone oxytocin surges when you have an orgasm, which can trigger labor in at-term individuals. So, the more orgasms, the better!

Keep moving

We're not saying that exercising is easy when you're 40 weeks pregnant with a baby overdue, but try to stay active. Although stretching, doing prenatal yoga, or going for a short walk isn't likely to bring on labor, they're all good for you and your baby. (But don't overdo it: If you do go into labor, you don't want to be tuckered out from the get-go!)

Stay off social media

At this point in pregnancy, it's acceptable (and maybe even advised) to pretty much avoid anyone and everyone, both in the flesh and online, who isn't your medical provider, your partner, or your family. (Or, in other words, anyone who might ask if you're still pregnant.)

Keep family and friends up-to-date with a daily blog entry, such as: "Just visited the doc, who said everything's fine." Record a new voicemail with an upbeat message: "No, baby's not here yet. Thankfully, we're all healthy. Keep checking this message for daily updates!"

Make good use of your time

If your baby is overdue, take advantage of the time to rest, finish the nursery, and stock your freezer with ready-made meals. Also, consider addressing birth announcements and thank-you notes.

The Bottom Line

It can be frustrating or disappointing when your due date comes and goes, and you're still pregnant. But don't worry, you'll be in labor—and your little one will be in your arms—before you know it. In the meantime, enjoy your last days of pregnancy (as best you can) and consult your doctor and/or midwife about any concerning symptoms or questions you have.