MY PREGNANCY - WEEK 41

While we are aware that many of you will have had your baby by now, we thought we had better add an extra week for those who are still waiting, and possibly becoming rather impatient about when your labour will finally get start!

If your baby doesn’t come by your due date, your health care professional may wait for up to 14 days for you to go into labour naturally. If you reach 42 weeks, most health care professionals will agree that the baby should be delivered if it is in the proper presentation. You may be monitored for another few days in the hope that you will go into natural labour, or your health care professional may discuss the possibility of inducing labour or performing a caesarian section.

Good luck with whatever option you and your health care professional decide on for you!

If you are a new mum by now, Congratulations! Don’t forget to share your birth story with others in the Essential Baby Birth Stories Discussion Group or in your diary. Also take a look at Essential Baby’s Birth Announcements area, an easy, convenient way to announce your baby’s birth details and post a picture for all of your friends to see!

MY PREGNANCY - WEEK 40

Your Baby.

• Fetal size: crown-rump 37-38cm (14.8-15.2 inches), crown-toes 48cm (21.5 inches). Fetal weight: 3.4kg (7.5 pounds).

• If your baby hasn’t already been born, he/she is preparing to be born. By the end of this week your baby is fully mature and all organs are developed and working ready for life outside the uterus. Your baby will also be plumper, and will need to curl up to fit inside your uterus. You will still be able to feel your baby kicking, but the increasingly limited space in your uterus will mean movements are much less than they were a few weeks ago.

• By now your baby should have “engaged” or moved into a head down position ready for birth. When engaged, your baby’s head settles deeply into your pelvis, resting against your cervix.

• Your baby’s skin is now much smoother. When awake, your baby’s eyes are open, and will probably be blue when he/she is born. If the eyes are going to be a colour other than blue, they will change within a few weeks of birth. Your baby’s fingernails are long, and it won’t be long before they need a trim. The lungs are maturing in preparation for breathing air outside the uterus.

• Your baby’s immune system still needs to mature. Until it does, he/she receives your antibodies through the placenta. Breast milk is also an important source of antibodies for your baby after he/she is born, particularly colostrum, secreted for the first few days before your milk comes through.

• Your baby will get rid of bilirubin (breakdown product from red blood cells) before he/she is born. Bilirubin will be transferred from the fetus, across the placenta, through to your blood circulation. After your baby is born, it will be able to handle the bilirubin its body produces on its own.

• Your baby’s intestine is filled with a dark green to black substance called meconium. After your baby is born, this will be the first bowel motion he/she passes. Sometimes babies pass meconium during delivery.

Your Pregnancy.

• You will probably start to see your health professional on a more regular basis (usually weekly) during the weeks leading up to the birth of your baby. During this time you may also experience the “nesting instinct”, translating to a desire to clean the house or make things ready for the baby. Don’t overdo it - you’ll need lots of energy for the birth. This week you should be resting if possible.

• When your baby engages, you will feel a bit more comfortable, mainly because your baby drops a bit and some of the pressure is taken off your diaphragm. Because you are carrying so much weight at the front of your body, you may tend to lean back more. This may result in clumsiness, so be careful and take it slowly.

• Getting a good nights sleep is probably quite difficult now, as your size makes it hard to get comfortable. If you’re not sleeping well, try to rest as much as possible during the day.

• You may find that your breasts begin to get swollen as the placenta starts to produce the hormones that stimulate milk production.

• By now you are eagerly anticipating the birth of your baby - if only because you are so uncomfortable! If your baby doesn’t come by your due date, your health care professional may wait for up to 14 days for you to go into labour naturally. If you reach 42 weeks, most health care professionals will agree that the baby should be delivered if it is in the proper presentation. You may be monitored for another few days in the hope that you will go into natural labour, or your health care professional may discuss the possibility of inducing labour or performing a caesarian section.

MY PREGNANCY - WEEK 39

Your Baby.

• Fetal size: crown-rump 36cm (14.4 inches), crown-toe 48cm (21.5 inches). Fetal weight: 3.25kg (7 pounds).

• Your baby will still gain weight during the last week or two of pregnancy. By now, there is very little room for your baby to move.

• All your baby’s organs are developed and in the right place. The lungs are the last thing to mature, and your baby is still receiving your antibodies in order to produce surfacant (the lining of moisture present on healthy lungs). The brain also steadily grows and matures during this last week.

Your Pregnancy.

• You will now be about as big as you can get during pregnancy, and no doubt you feel it too! Your weight shouldn’t increase much, if at all from Week 39. Up to and including Week 39 your total weight gain should be between 9-13.5kg (20-30 pounds).

• Before you have your baby, you will probably have an opinion about procedures such as episiotomy, and you may have included instructions about such procedures in your Birth Plan.

  An episiotomy is an incision (either down and away from the vagina and perineum, or straight down through the perineum between the vagina and anus) that helps to deliver your baby’s head and avoids natural tearing. An episiotomy isn’t always needed, and healing of episiotomies can be less efficient than that of natural tears.

  It is possible to avoid natural tearing and episiotomy by refraining from pushing while your baby’s head is being born. This means the head has time to ease out, rather than being delivered suddenly, giving your perineum time to stretch slowly to accommodate your baby’s head.

  An episiotomy may be necessary if:

  • your baby’s head is too big
  • your baby’s birth is happening too quickly for you to stretch slowly, or if you are unable to control your pushing
  • your baby is distressed, or other complications arise
  • you require other methods of intervention (such as forceps or vacuum extraction)
  • your baby is in the wrong position

  You should know if an episiotomy is necessary when your baby’s head reaches the vagina. At this point you should ask if it is necessary and discuss the reasons why.

  After you have had your baby, your episiotomy and the resultant scar may be the most painful part of your recovery. It can take weeks or even months for you to recover fully. If this is the case, talk to your health care professional about what can be done to ease the pain and promote healing.

• You may want to ask your hospital if they have a cord blood donation scheme, and if so, give some thought to donating your cord blood. Cord blood is obtained from the umbilical cord and placenta after the birth of your baby. Cord blood contains the same cells that are found in bone marrow and can be used to treat cancer and other genetic diseases that are being treated with bone marrow transplants, especially childhood leukaemia and other blood and immune diseases.

MY PREGNANCY - WEEK 38

Your Baby.

• Fetal size: crown-rump 35 cm (14 inches), crown-toe 47cm (21 inches). Fetal weight: 3.1 kg (6.8 pounds).

Your Pregnancy.

• Although many women don’t get any bigger during the last few weeks of pregnancy, you may still grow a little bit. By now you could be feeling very uncomfortable and wanting to get the baby out!

• You should have an antenatal card on which your health care professional records notes during your antenatal visits. Each visit should have an entry. You will need to take this card with you when you go to hospital, so remember to pack it in your hospital bag.

• In the past, having an enema was a routine part of early labour. These days it is probably not a routine procedure at your hospital, and if you think you would like one, you will probably need to ask. An enema during early labour may help if your bowels are full and you are unable to go to the toilet in the onset of labour. If you are unable to go to the toilet before or during labour, you may lose whatever is in your rectum when the baby’s head comes through the birth canal. An enema before birth may help to make you more comfortable during labour and birth, and will minimise the possibility of contamination from faeces during birth. If you have an episiotomy, you may also be more comfortable if you don’t have to empty your bowels too soon after birth. The choice is entirely up to you!

• At this stage of your pregnancy you will be feeling quite uncomfortable. A common complaint around this time of pregnancy is the feeling that the baby might fall out. This feeling occurs because the baby has moved lower into the birth canal and you will feel the pressure associated with this move. You probably have nothing to worry about, but if you need reassurance that everything is OK, see your health care professional.

  You may also experience pins and needles, numbness or tingling in the pelvis. This is also a result of the added pressure of your baby, and is a common complaint at this time. Again, if you are at all concerned, see your health care practitioner for reassurance.

MY PREGNANCY - WEEK 37

Your Baby.

• Fetal size: crown-rump 35cm (14 inches), crown-toe 47cm (18.5 inches). Fetal weight: 3 kilos (6.5 pounds).

• The average size of a healthy full term baby in Australia is 3.5 kilos. There are many variations on this figure, and the size of your baby is linked to both parents’ birth weight and their adult height.

• Your baby is still growing and gaining weight!

Your Pregnancy.

• By Week 37, you should have reached your peak for weight gain during your pregnancy. Your total pregnancy weight gain should be between 9 and 13.5 kilos (20-30 pounds).

• This week your health care practitioner may do a pelvic examination. Things he/she will evaluate include:
  • Condition of the cervix - how soft, firm or thin it is (the cervix thins out and softens during labour),and whether there is any dilation
  • Amniotic Fluid (intact or leaking)
  • Presentation of your baby (head or breech) and how far your baby has advanced into the birth canal
  • Your pelvic bones and their shape

• Signs of Labour - The first signs of labour can be missed, but when labour is establishing the signs are definite.
  • Show - this is the protective plug of mucous and old blood that comes away from the neck of the uterus and passes into the vagina. The show generally indicates that labour will start within a few days. If a lot of blood is passed it is advisable to contact your health care professional.
  • Contractions - these are the regular painful tightenings of the uterus that occur throughout labour. They may be far apart to begin with, but will gradually become longer, stronger and closer together. Contractions initially feel like period pain coming and going, and last for about 20 seconds. Once they are regular and more painful, it is a sign that labour has started. Backache and even sore legs can accompany contractions. It is important to be aware that the birth can take up to 18 hours to occur from the start of painful regular contractions.
  • Waters breaking - this is when the membranes of the amniotic sac break. It can either be a slow trickle or a sudden gush of fluid from the vagina. This can happen when labour starts, or during labour or sometimes even hours before labour commences. Your health care professional should be notified if you think that your waters have broken and you should take note of the colour of the fluid.

MY PREGNANCY - WEEK 36

Your Baby.

• Fetal size: crown-rump 34 cm (13.5 inches), crown-toe 46cm (20.7 inches). Fetal weight: 2.75 kilos (6 pounds).

• How is the baby lying? - From about 24 weeks it is possible for your health care professional to determine what position your baby is in. This may change quite a few times as the baby grows, until some time between 32-36 weeks, when the baby runs out of room. A baby usually lies in the cephalic position, that is head down and legs curled up towards your ribs. This is an ideal position, as a baby’s head is larger than the rest of its body, so if the head fits through your pelvis then the rest of the body will have no trouble. On less frequent occasions the baby can be in a breech position, where its head is under your ribs and the feet are pointing towards your pelvis. If the baby is in the breech position during birth, this can present health care professionals with a problem. Your health care professional will discuss your care if your baby is in a breech position. Another rare position is transverse, where the baby lies across your body. This is more common in women that have had at least one child and there is a more room for the baby to move. The baby usually turns before labour commences.

• Engagement - this is when the baby’s head has entered the pelvis. It usually occurs at around week 36 for a first time mother, and later if you have already had a child. You may notice a change in your abdomen, in that the baby does not sit as high under your ribs, or that your belly is protruding a little further. This may happen gradually or quickly. Some women are unaware of any changes, but will be informed by their health care professional. It is a good indication that everything is going to plan and that your pelvis is a good size for the baby.

Your Pregnancy.

• Birth plan - this is usually a written plan of the way that you would like your labour and birth to be managed. It can be developed in consultation with your partner and/or health care professional. It is recommended that at the very least, you discuss all aspects of your care prior to the onset of established labour, as once labour establishes you may not be able to think clearly or have the time to discuss important issues. A birth plan is used as a guide only. You can never be too sure of what is going to happen during childbirth and is important to remain flexible. Take a look at the Essential Baby Birth Plan information to get some ideas.

MY PREGNANCY - WEEK 35

Your Baby.

• Fetal size: crown-rump 33cm (13.2 inches), crown-toe 45cm (20.25 inches). Fetal weight: 2.5 kilos (5.5 pounds).

• Fat has continued to build up under your baby’s skin, and is responsible for providing energy and regulating body temperature. These fat deposits have also changed the appearance of the skin, making it pinker (rather than red) and less wrinkled.

• Fingernails are developed on the fingers, but may still be growing on the toes. Eyelids can be opened and closed and blinking is possible. The irises are also now light sensitive, and will dilate and contract depending on exposure to light.

• Most babies engage (assume the head down position) some time after 36 weeks, although some will turn and engage now.

Your Pregnancy.

• By week 35 your weight gain should be approximately 9-13 kilos (20-29 pounds).

• Labour and birth can seem quite daunting, so it’s only natural that you and your partner may start to get a little bit nervous as Week 40 draws closer! You may experience mood swings (possibly as a result of discomfort or anxiety), and irritability. It’s important for you and your partner to recognise that this can be a stressful time in your lives, and to keep things in perspective. Make sure you take the time to talk to one another, reassure each other and spend some time relaxing together. Things will change once you have a newborn in the house

• Remember to write down any last minute questions for your visits to your healthcare practitioner or antenatal class instructor. Have a look at the Labour and Birth section of the Essential Baby web site.

• Another sign of labour is the show. This is when the mucus plug that seals your cervix during pregnancy is dislodged and passes out through the vagina. Having a show doesn’t necessarily mean your labour is about to start - your cervix may simply have stretched a little. The show doesn’t present any danger for you or your baby, but you should contact your health care professional immediately to advise them that you have had a show.

MY PREGNANCY - WEEK 34

Your Baby.

• Fetal size: crown-rump 32cm (12.8 inches), crown-toe 44cm (19.8 inches). Fetal weight: 2.25kg (5 pounds).

• Your baby is now perfectly formed and has the proportions of a newborn. Now it’s simply a matter of your baby gaining some weight and doing some further maturing before he/she is ready to be born. It’s becoming more cramped in your uterus as your baby continues to mature. Consequently your baby curls up more and starts to move a bit less.

• Everything is mature except the lungs, which will continue to prepare themselves for breathing air after birth. Although the lungs aren’t fully developed, almost all babies born at 34 weeks will survive, but will probably experience some breathing difficulties.

Your Pregnancy.

• Your health care professional will continue to check that you and your uterus are growing at the right rate to ensure that your baby is growing normally. Don’t worry if you look different to other people at this stage in your pregnancy - everyone is different and there is no effective means of comparing yourself to others.

• Ruptured membranes - or “waters breaking” is when the membranes of the amniotic sac (that has been holding the baby) break. It can either be a slow trickle or a sudden gush of fluid from the vagina. This can happen during labour or even hours before labour commences. Your health care professional should be notified if you think that your waters have broken and you should take note of the colour of the fluid.

• False Labour - will sometimes happen before your real labour begins. You may believe you are in real labour because false labour contractions can be very painful. You may be able to identify false labour by observing your contractions and comparing them to what you should feel in real labour. False labour contractions may also be felt as discomfort in other parts of the body (back, lower abdomen and groin). They will be more irregular than real labour contractions, and are usually shorter (less than 45 seconds). Real labour contractions result in pain that starts at the top of the uterus then radiates outwards to the whole uterus, the lower back and into the pelvis.

  Braxton Hicks contractions can be felt from early on in your pregnancy. If these irregular, painless contractions increase later in your pregnancy they are also considered to be false labour rather than real labour.

• Now is a good time to start thinking about what you will need to take to hopsital. When preparing your bags for hospital, keep everything in one bag (to avoid rushing off and leaving one bag behind), but separate items within the bag as much as possible into:

Hospital bag.

• You will use your delivery bag during the time you are in the labour ward or birthing centre, but if you are staying in hospital for a couple of days, the following is a guide to what you will need for you and your baby.

• Basics for you:
  • Comfortable nightwear that will enable you to easily breastfeed - nightshirts are particularly good.
  • Underpants
  • 3 packets of super sanitary pads
  • Nursing bras
  • Nursing pads
  • Toiletries
  • Hairdryer (if required)
  • If you are staying in hospital for a few days, you may want to pack comfortable day clothes rather than wearing nightshirts during the day.
  • Phone cards come in handy as you cannot use mobile phones in hospitals.

• Basics for Baby:
  • An outfit to take baby home in - including nappies and a wrap.
  • A carry cot to take baby home(your partner can bring this in when you are getting closer to going home)

  Check with your hospital whether you will need any clothes or other items for the baby - most hospitals will provide clothes and nappies for baby while you are in hospital. If you plan to bottlefeed, check if you will need to bring your own bottles, formula and sterilising equipment. Remember you will need to have arranged a restraint for your car to get your baby home.

MY PREGNANCY - WEEK 33

Your Baby.

• Fetal size: crown-rump 30cm (12 inches), crown-toe 43cm (19.4 inches). Fetal weight: 2 kg (4.4 pounds).

• Until Week 20, your baby spent most of its time in a wakeful state. Between Weeks 20 and 28, he/she started to have periods of activity and quiet. After Week 28 your baby started to experience active sleep (eyes and body moving, heart rate speeding up then slowing down, facial expressions changing, and changing breathing patterns). From Week 28 onwards, it is likely that your baby starts to develop a pattern of deep sleep and active sleep. During the active sleep periods, your baby’s brain undergoes stimulation, which probably helps it to mature.

Your Pregnancy.

• Up to and including Week 33, your weight gain should be between 10 and 12.5 kilos (22-28 pounds). You may start to gain weight faster from this week on, as your baby also grows very rapidly at this time.

• It’s important to keep eating well, and to ensure that you don’t skip any meals. You will probably need to eat smaller meals more frequently due to the lack of space in your abdomen and the incidence of heartburn.

• At this stage of your pregnancy, you may find that your vaginal discharge has increased. You may also leak small amounts of urine due to increased pressure on your bladder. If you are concerned that you are leaking more fluid than you should be, or if you have had a gush of water, visit your health care professional to ensure that your membranes haven’t ruptured.

• As you become more uncomfortable, it’s only natural to wonder about the comfort of your baby. Your baby will let you know if it is uncomfortable in the womb, probably by moving about and elbowing and kicking you! Other than a lack of space, your baby is probably quite comfortable in the womb, enjoying the warmth and muffled sounds in utero.

MY PREGNANCY - WEEK 32

Your Baby.

• Fetal size: crown-rump 29cm (11.6 inches), crown-toes 42cm (18.9 inches). Fetal weight: 1.7kg (4 pounds).

• Your baby has continued to grow, and his/her lungs and digestive system have also continued to mature. Your baby’s senses are functioning, and by week 32 the mind may even have started to function. Your baby still needs more time in the womb to continue maturation, and the build-up of fat stores.

Your Pregnancy.

• Keep a list of questions to ask your health care professional or antenatal class instructor each time you visit. It’s important to feel relaxed, so if anything is worrying you, or if you are unsure about anything to do with your labour and birth, it’s best to ask questions now and put your mind at ease.

• Apgar score - this is a general well being assessment used to scale a baby’s fitness immediately following birth. The apgar score is carried out between one and five minutes after birth, and assesses the baby’s heart rate, breathing, skin colour, muscle reflexes and response to stimulation. The score is from 1 to 10 and the higher the score the better.

• What to do during the early stages of labour - there are many ways to take your mind off the discomforts of labour, particularly early labour, as it can often be quite some time (up to a few days) before labour establishes (regular contractions). Good distractions include long walks, completing any last minute shopping, talking to close friends and having warm baths. Heat packs, showers and rest are also very helpful. In early labour it is important to provide your body with energy and hydration, so you should eat small regular snacks and drink lots of fluids (preferably water).

• Pain relief during labour - it is inevitable that you will seek some form of pain relief during labour, be it natural or synthetic. Walking, showers, baths, heat packs and massage can be used very effectively throughout labour as pain relief. Other forms of pain relief that may be available to you include nitrous oxide gas, pethidine injections, and an epidural. These are usually available in all hospital maternity units.
  • Nitrous oxide is a form of pain relief that is inhaled through a mask or mouthpiece during a contraction. It works quickly and has minimal side effects. Some women state that it can make them feel nauseous but you can be nauseated during labour anyway. Nitrous oxide generates a “happy” feeling and can cause temporary dizziness, but it may help you relax a little more between contractions.
  • Pethidine Injections are a synthetic narcotic given as an injection into the muscle during labour. Pethidine has a similar effect to the Nitrous oxide, but it is stronger and lasts longer. Pethidine can also cause nausea and is usually given with an anti-emetic (anti-nausea) injection. Pethidine may help to ease the intensity of contractions and encourage you to relax more (or sometimes even sleep) between contractions. Pethidine can also have a similar effect on the baby, but its effects are usually worn off before the baby is born. If pethidine is given too close to the birth, a reversal drug (Narcan) may be given to the baby to prevent any side effects.
  • Epidural is a form of local anaesthetic used as a pain relief in labour. It works by numbing the nerves that carry the feelings of pain to the brain. It is often used if a caesarean section is necessary, because it allows the mother to be awake while the baby is being born. A specialist doctor (anaesthetist) is needed to give an epidural. A needle is inserted in between the bones of the spine, and then a plastic tube is fed down the needle to an area just outside the spinal cord (the epidural space). The needle is removed and the tube is kept in place with sticky tape. The anaesthetic is injected down the tube and begins to work after 15 to 20 minutes. “Top ups” can be given by injecting more anaesthetic down the tube. Although this form of pain relief offers an almost pain free labour, there are risks and disadvantages. It can delay birth, as a woman is unaware of her own urges to push unless the epidural is allowed to wear off. Consequently, women who opt for an epidural have a higher rate of intervention, for example forceps deliveries. There is a small risk of getting a headache following the anaesthetic.