IN THIS CHAPTER
Getting ready for life outside the womb — your baby will arrive soon!
Dealing with the discomforts of the home stretch
Knowing which tests may be administered
Planning for the main event at childbirth classes
Preparing to go to the hospital — and to bring your baby home
Knowing when to be concerned
You’re finally ready for the third act — your pregnancy’s final trimester. By now, you’re probably accustomed to having a protruding belly, your morning sickness is long gone, and you’ve come to expect and enjoy the feeling of your baby moving around and kicking inside you. In this trimester, your baby continues to grow, and your practitioner continues to monitor you and your baby’s health. You also begin making preparations for the new arrival, which may mean anything from getting ready to take a leave of absence from your job to taking childbirth classes (or otherwise finding out what to expect during labor and delivery).
Your Baby Gets Ready for Birth
At 28 weeks, your baby measures about 14 inches (about 35 cm) and weighs about 2½ pounds (about 1,135 grams). But by the end of the third trimester — at 40 weeks, your due date — she measures about 20 inches (50 cm) and weighs 6 to 8 pounds (about 2,700 to 3,600 grams), sometimes a bit more, sometimes a bit less. The fetus spends most of the third trimester growing, adding fat, and continuing to develop various organs, especially the central nervous system. The arms and legs get chubbier, and the skin becomes thicker and smooth.
During the third trimester, your baby is less susceptible to infections and to the adverse effects of medications, but some of these agents may still affect her growth. The last two months are usually spent getting ready for the transition to life in the world outside the uterus. The changes are less dramatic than they were early on, but the maturation and growth that happen now are very important.
By 28 to 34 weeks, the fetus generally assumes a head-down position (called a vertex presentation), like in Figure 3-1. This way, the buttocks and legs (the bulkiest parts of its body) occupy the roomiest part of the uterus — the top part. In about 4 percent of singleton pregnancies, the baby may be positioned buttocks-down (breech) or lie across the uterus (transverse). (See the “Breech presentation” section later in this chapter for details.)
Illustration by Kathryn Born, MA
FIGURE 3-1: How your baby may look inside your uterus during the third trimester.
By 36 weeks, growth slows, and amniotic fluid volume is at its maximum level. After this point, the amount of amniotic fluid may start to decline because blood flow to the baby’s kidneys decreases as the placenta ages, and the baby produces less urine (and therefore less amniotic fluid). In fact, most practitioners routinely check the amniotic fluid volume on ultrasound or by feeling your abdomen during the last few weeks to make sure that a normal amount remains.
Movin’ and shakin’: Fetal movements
Look down at your belly during times of fetal activity during the third trimester, and it may appear that an alien from outer space is doing an aerobic dance inside you. Although fetal movements don’t actually diminish as your due date approaches, the timing and quality of the movements change. Toward the end of pregnancy, fetal movements may feel less like jabs and more like tumbles or rolls, and you notice longer periods of quiet between movements. The fetus is adapting to a more newborn-like pattern, taking longer naps and having longer active cycles.
If you don’t sense a normal amount of activity, let your practitioner know. A good general rule is that you should feel about six movements in one hour after dinner, while resting. Any movement, no matter how subtle, counts. Some women find that they go for periods of feeling less fetal movement, but then the movements pick up again and are normal. This is very common and isn’t a reason to be concerned. However, if you notice a pattern of diminishing fetal movements or you feel absolutely no fetal movements over several hours (despite resting or eating), give your practitioner a call right away.
If you have certain risk factors or if you need specific guidelines to track the adequacy of fetal movements, your practitioner may suggest that you keep a diary to chart fetal movement, starting at 28 weeks. You can track fetal movements in a couple of ways:
· Lie down on your left side after dinner to count fetal movements, and write down how long it takes to count ten movements.
· Count fetal movements while lying down for an hour each day (it doesn’t have to be the same hour every day) and plot the number of movements on a chart given to you by your practitioner. This method shows the pattern of the baby’s movements throughout the day.
Flexing the breathing muscles
Fetuses undergo what are called rhythmic breathing movements from 10 weeks onward, although these movements are much more frequent in the third trimester. The fetus doesn’t actually breathe, but her chest, abdominal wall, and diaphragm move in a pattern that is characteristic of breathing. You don’t notice these movements, but a doctor can observe them with ultrasound. These movements are signs that the baby is faring well. During the third trimester, the amount of time a fetus spends performing the breathing movements increases, especially after meals.
Hiccupping in utero
At times, you may feel a quick, rhythmic pattern of fetal movements, occurring every few seconds. These movements are most likely hiccups. Some women feel fetal hiccups several times throughout the day; others sense them only rarely. Occasionally you may actually see the baby hiccupping during an ultrasound exam. These hiccups are completely normal.
Keeping Up with Your Changing Body
As the baby grows, so does your belly! Big is beautiful, but it can become uncomfortable. You may notice that your uterus pushes up on your ribs, and sometimes you notice kicking in one spot in particular — that is probably where the baby’s extremities are, either feet or arms. If you’re pregnant with twins or more, the discomforts are even more pronounced. Women with twins may feel one baby move more than the other, which is usually related to the babies’ positions — one baby may be oriented with the arms and legs facing out and the other with them facing in. Whether you are carrying one, two, or more babies, you notice that moving around like you used to becomes more and more difficult as you get bigger.
If you find rising after lying on your back is difficult and no one is around to help, try turning on your side first and then pushing yourself up to a sitting position (see Figure 3-2).
Illustration by Kathryn Born, MA
FIGURE 3-2: To give your back a break when you get up after lying down, roll over to your side and then push yourself up as you swing your legs down.
Accidents and falls
Being pregnant may make you more cautious about taking obvious risks, but it doesn’t prevent you from stumbling or otherwise having an occasional mishap. If you do fall, don’t worry. Chances are good that the baby remains well protected in your uterus and within its sac of amniotic fluid, which is an excellent natural cushion. But just to be careful, let your practitioner know of any falls. She may want you to come in to check that the baby is fine.
If, after your fall, you suffer severe abdominal pain, contractions, bleeding, or leakage of amniotic fluid, or if you notice a decrease in fetal movements, call your practitioner immediately or go to the hospital where you receive care. If the fall or injury involves a direct blow to your uterus (for example, the steering wheel hits your belly in a car accident), your practitioner will probably want to monitor your baby for a while.
Braxton-Hicks contractions
In the late second trimester or beginning of the third trimester, your uterus may, from time to time, become momentarily hard or feel as though it’s balling up. Most likely, you’re experiencing Braxton-Hicks contractions. They’re not the kind of contractions you have in labor; they’re more like practice ones.
Braxton-Hicks contractions are usually painless, but at times they may be uncomfortable, and they may occur with more frequency when you’re active and subside when you rest. Women who have already had children tend to notice more Braxton-Hicks contractions. You may have a hard time distinguishing Braxton-Hicks contractions from fetal movements, especially if this is your first pregnancy. Other times, Braxton-Hicks contractions can become uncomfortable and progress to false labor.
If you’re less than 36 weeks along and you experience contractions that are persistent, regular, and increasingly painful, call your doctor to make sure you’re not in premature labor.
Carpal tunnel syndrome
If you feel numbness, tingling, or pain in your fingers and wrist, you’re probably experiencing carpal tunnel syndrome. It occurs when swelling in the wrist puts pressure on the median nerve, which runs through the carpal tunnel from the wrist to the hand. It can happen in one or both hands, and the pain may be worse at night or upon awakening. Carpal tunnel syndrome is more common in women who are pregnant than in those who aren’t because of the swelling that goes along with pregnancy.
If carpal tunnel syndrome becomes persistent or bothersome, discuss it with your practitioner. Wrist splints, available at some drugstores or surgical supply stores, can relieve the problem. Try not to be discouraged if it doesn’t seem to get better during pregnancy, though, because it usually improves (often dramatically fast) after delivery.
Fatigue
The fatigue you felt early in your pregnancy may return in the third trimester. You may feel as if you’re just slowing down. You’re tired all the time, you’re carrying around more weight, you’re not very comfortable much of the time, and you may feel that you can’t accomplish everything you need to. Women may find their second or third pregnancies more tiring than the first because they have to care for one or more older children.
Try to be realistic about what you can do, and don’t feel guilty about what you can’t get done. Take time for yourself and get as much rest as you can. Delegate tasks. Whenever possible, let other people help with household chores and other responsibilities. Do whatever you can to take advantage of the quiet times. Rest as much as you can now, because after delivery, the work really picks up!
Feeling the baby “drop”
During the month before delivery, you may notice that your belly feels lower and that breathing is suddenly easier. If you’ve experienced regular heartburn, you may notice that that has improved as well. At the same time, however, you may feel more pressure in your vaginal area — many women feel heaviness there. Some women report feeling strange, sharp twinges as the baby’s head moves and exerts pressure on the bladder and pelvic floor. These feeling are because the baby has dropped, or descended lower into the pelvis, and no longer presses up against your diaphragm or stomach. This movement is also called lightening. It typically happens two to three weeks before delivery in women who are having their first child. Those who’ve had children before may not drop until they’re in labor. Having the baby drop doesn’t predict when labor will happen.
You may not notice that you’ve dropped. During your prenatal visit, your doctor may be able to tell by an external or internal exam how low the baby’s head is and whether it’s engaged. The fetal head is engaged when it has reached the level of the ischial spines, which are bony landmarks in your pelvis that can be felt during an internal exam (see Figure 3-3).
Illustration by Kathryn Born, MA
FIGURE 3-3: The baby’s head reaches the bony ischial spines in your pelvis and is engaged.
If the baby’s head is engaged prior to labor, you’re more likely to deliver vaginally, although obviously there are no guarantees. Similarly, although a floating (unengaged) head isn’t every obstetrician’s dream, it doesn’t mean that you won’t have a completely normal delivery.
If you’re having your second child or more, the baby’s head may not engage until well into labor.
Hemorrhoids
No one wants to talk about them, but hemorrhoids — dilated, swollen veins around the rectum — are a common problem for pregnant women. The enlarging uterus causes hemorrhoids by pressing on major blood vessels, which leads to pooling of blood and ultimately makes the veins enlarge and swell. Progesterone relaxes the veins, allowing the swelling to increase. Constipation makes hemorrhoids worse. Straining and pushing hard during bowel movements puts added pressure on the blood vessels, causing them to enlarge and possibly protrude from the rectum.
Hemorrhoids sometimes bleed. This bleeding doesn’t harm the pregnancy, but if it becomes frequent, talk to your doctor and possibly see a colorectal specialist or general surgeon. If hemorrhoids become very painful, you may want to discuss whether treatment is necessary. Meanwhile, you can try the suggestions in Book 1, Chapter 4 to avoid or relieve the discomfort of hemorrhoids.
Pushing during the second stage of labor can make hemorrhoids worse or make them appear where they weren’t before. But most of the time, hemorrhoids go away after delivery.
Insomnia
During the last few months of pregnancy, many women find sleeping difficult. Finding a comfortable position when you’re eight months along isn’t easy. You feel a little like a beached whale. Getting up five times a night to go to the bathroom doesn’t make things any easier. However, you may find relief in the following:
· Drink warm milk with honey before bedtime. If you have gestational diabetes, see Book 6, Chapter 3.
· Exercise during the day. Activity helps to tire you out, which means you’ll fall asleep sooner.
· Go to bed a little later than usual. You’ll spend less time trying to fall asleep.
· Limit your liquid intake after 6 p.m. Don’t limit it to the point that you become dehydrated, however.
· Invest in a body pillow. You can tuck it around your body in various places, making it easier to find a comfortable position.
· Take a warm, relaxing bath before going to bed. Many women say a bath makes them feel sleepy.
FOR PARTNERS: DEALING WITH TEARS, PANIC, AND DOUBTS
Doing anything for the first time can be stressful, overwhelming, and scary. Facing labor, delivery, and motherhood for the first time certainly qualifies. Yes, you’re also facing fatherhood for the first time — dealing with the prospect of labor, seeing your partner in pain, and managing a host of doubts and fears — but her concerns are fueled by hormones and the knowledge that some form of delivery, be it labor or surgery, is the only way to emerge with a baby after nine months of pregnancy. The inevitability of the end of pregnancy can be overwhelming at times.
Your partner won’t be the first woman to ever express the feeling that she can’t do this, that having a baby was a mistake, or that she’s changed her mind about the whole thing and wants to call it off. These feelings will intensify when she’s in labor, so if you deal with them rationally now, you’ll be better prepared for them then.
Allow your partner to vent and express doubts and concerns, but never fail to reassure her that you know she’ll be a great mom, that she was born to do this, and that you’ll be helping her every step of the way. Feel free to express your own fears and doubts about being a really good parent, but never in a “Can you top this?” way.
Many women at the end of pregnancy have vivid dreams about the baby or develop fears that something may be wrong with him. You can’t do much about these fears except let her talk them out and reassure her that no matter what happens, you’re there for her and the baby. However, if your partner becomes fixated on thoughts that she may harm the baby or that something is wrong with the baby, she may be experiencing a severe depressive disorder. Make sure she sees her medical practitioner promptly.
Rashes and itches
Pregnant women are subject to the same rashes that nonpregnant women get. One rash is unique to pregnancy, however: pruritic urticarial papules of pregnancy, or PUPP. It sounds scary, but it’s really more of a nuisance than anything else because it can cause some intense itching. It occurs more often during a first pregnancy and in women having twins or more (the more fetuses, the greater the likelihood).
PUPP tends to occur late in pregnancy and is characterized by hives or red patches that first appear in the stretch marks on your abdomen. These patches can spread to other areas on the abdomen and to the legs, arms, chest, and back. They almost never spread to the face (thank heaven for small favors). The good news is that the condition poses no risk to the baby. But if you develop this rash, your doctor may recommend that you have some blood tests to make sure you don’t have other conditions that can be associated with itching.
The only surefire way to make PUPP go away is to deliver. If delivery is still weeks away, it sometimes helps to bathe in a solution of colloidal oatmeal (Aveeno makes a good one). Skin lotions containing Benadryl can also help, but these products sometimes dry the skin, which only makes the itching worse. In very severe cases (which are rare), the doctor may prescribe a short-term course of steroids or other medications.
Even if you don’t have a rash, you may notice that you itch a lot, especially where stretch marks develop. This itching is very common and usually is caused by the stretching of your skin as the baby gets bigger.
Up to 2 percent of pregnant women develop cholestasis of pregnancy, which is a condition where an increase of bile acids in the blood causes the itching. If the itching is mild, you can treat it with skin moisturizers, topical anti-itching medications, or oral antihistamines such as Benadryl (but remember to talk to your doctor first before taking them). If the itching is severe, your doctor may recommend oral medications that help to clear the bile acids from the bloodstream. Some studies have suggested that the baby should be monitored with nonstress tests (see the later section “Nonstress test [NST]”) when the mother has this condition, because it’s associated with an increased risk of complications. The itching goes away shortly after delivery, but the condition may recur in future pregnancies.
PREPARING FOR BREASTFEEDING
If you plan on breastfeeding, you may want to take steps now to prepare yourself. Head to Book 5, where you can find the information you need.
Many women notice from early on in pregnancy that their breasts occasionally secrete a yellowish discharge. This discharge is colostrum, and it’s what the newborn baby sucks out and swallows in the first few days of life before actual milk comes in. Colostrum has a higher protein and lower fat content than milk; most importantly, it contains antibodies from your immune system that help protect your baby against certain infections until her own immune system matures and can take over.
Don’t worry if you don’t produce any visible colostrum during pregnancy; not producing colostrum in no way means that you won’t produce adequate milk if you’re planning to breastfeed your baby. Each woman is different; some leak from the breasts during pregnancy, and some don’t. Even if it isn’t obvious, your baby will still get colostrum the first few times she breastfeeds.
Sciatica
Some women experience pain extending from their lower back to their buttocks and down one leg or the other. This pain or, less commonly, numbness, is known as sciatica, because it’s due to pressure on the sciatic nerve, a major nerve that branches from your back, through your pelvis, to your hips, and down your legs. You can relieve mild cases of sciatica with bed rest (shift from side to side to find the most comfortable position), warm baths, or heating pads applied to the painful areas. If you develop a severe case, you may need prolonged bed rest or special exercises. Ask your doctor.
Shortness of breath
You may find that as pregnancy proceeds, you become increasingly short of breath. The hormone progesterone affects your central breathing center and may cause these feelings of breathlessness. Furthermore, as your enlarging uterus presses upward on your diaphragm, your lungs have less room to expand normally.
In most cases, shortness of breath is perfectly normal. But if it comes on very suddenly or if it comes with chest pain, call your doctor.
Stretch marks
As your skin stretches to accommodate the enlarging uterus and weight gain, stretch marks form. Some women probably also have some genetic predisposition for stretch marks. The marks typically appear as pinkish-red streaks along the abdomen and breasts, but they fade to silvery gray or white several months after delivery. Their exact color depends on your skin tone — they appear browner on dark-skinned women, for example.
No cream or ointment is completely effective in preventing stretch marks, although products continue to enter the market. Many people think that rubbing vitamin E oil on the belly helps prevent stretch marks or helps them fade faster, but the effectiveness of vitamin E has never been proven scientifically. Your best bet is to avoid excessive weight gain and to exercise regularly to maintain muscle tone, which eases the pressure of the uterus on the overlying skin.
Recently, some dermatologists have started offering a special laser procedure that may help reduce stretch marks after delivery. Also, some advise using a cream containing retinoic acid to treat stretch marks after delivery. However, don’t use these creams during pregnancy; also, you shouldn’t use some of them when you’re breastfeeding. If your stretch marks are particularly noticeable, consult a dermatologist a few months after your pregnancy is over.
Swelling
Swelling (also called edema) of the hands and legs is very common in the third trimester. It most often occurs after you’ve been on your feet for a while, but it can happen throughout the day. Swelling tends to be even more common in warm weather. Contrary to popular wisdom, no evidence indicates that lowering your salt intake or drinking a lot of water prevents swelling or makes it go away. Here’s what you can do to relieve ordinary swelling:
· Keep your legs elevated whenever possible.
· Stay in a cool environment.
· Wear supportive pantyhose or stockings that aren’t tight around your knees.
· When in bed, don’t lie flat on your back; try to lie on your side.
Although swelling is a normal symptom of pregnancy, it can be a sign of preeclampsia (see Book 6, Chapter 2). If you notice a sudden increase in the amount of swelling or a sudden, large weight gain — 5 pounds or more in a week — or if the swelling is associated with significant headache or right-sided abdominal pain, call your practitioner immediately.
Urinary stress incontinence
Leaking a little urine when you cough, laugh, or sneeze isn’t unusual when you’re pregnant. This kind of urinary stress incontinence occurs because your growing uterus is putting pressure on your bladder. Relaxation of the pelvic floor muscles increases the problem during the late second and third trimesters. And sometimes the baby may give the bladder a swift kick and cause it to leak urine. Kegel exercises — in which you repeatedly contract the pelvic floor muscles as if you’re trying very hard not to urinate — can prevent or markedly reduce the problem. Some women continue to experience a little stress incontinence even after delivery, but it usually goes away after about 6 to 12 months.
If you have a particularly difficult labor, where you push for a long time, or have a very large baby, the stress incontinence may not completely go away. Give it at least six months to see whether it stops. After that, talk to your doctor about how to proceed.
Varicose veins
You may notice that a small road map has suddenly appeared on your lower legs (and sometimes the vulvar area). These marks are dilated veins, referred to as varicose veins. They’re caused by the pressure of the uterus on major blood vessels — the inferior vena cava (the vein that returns blood to the heart) and the pelvic veins, in particular. Pregnancy also causes the muscle tissue inside your veins to relax and your blood volume to increase, and these conditions add to the problem. Women with light skin or with a family history of varicose veins are particularly susceptible. Very often, the bluish-purple highways fade after delivery, but sometimes they don’t disappear completely. They’re most often painless, but they may be associated with discomfort, achiness, or pain.
In rare instances, a blood clot develops in the superficial veins of the legs. This condition, called superficial thrombophlebitis, isn’t a serious problem; it’s often successfully treated with rest, leg elevation, warm compresses, and special stockings. A clot that forms in the deep veins of the leg is more serious (see Book 6, Chapter 3 for a discussion of deep vein thrombosis).
You can’t prevent varicose veins — you can’t fight heredity — but you can reduce their number and severity by avoiding standing for prolonged periods of time or wearing clothes that are very tight around one part of your leg. If you must be relatively stationary, move your legs around from time to time to stimulate circulation, and keep your legs elevated whenever you can. You can also wear support stockings or talk to your doctor about a prescription for special elastic stockings.
BRACING FOR YOUR PARTNER’S EMOTIONAL CHANGES
Hormone levels are very high in the last few months of pregnancy, and, for many women, with hormones come mood swings. Be prepared for the following emotional changes in the last trimester:
· Irritability: When you don’t feel your best physically, everything irritates you. Try not to be one of the “everythings” that drives your partner crazy.
· Self-image issues: Expect to hear your partner make negative comments, and don’t respond to them in kind. The answer to “Do I look fat?” is never “Yes.”
· Weepiness: During the last few months of pregnancy, women cry because they’re happy, or sad, or frustrated, or angry. They cry for reasons they can’t even express to you, which can, of course, be frustrating to you, but you’ll get over it.
Some degree of moodiness, sadness, or depression is normal in late pregnancy. These mood changes should be fleeting, but as many as 10 percent of women become clinically depressed during pregnancy and need medical intervention. Additionally, up to 20 percent develop some depressive symptoms that may also need medical treatment.
Symptoms of clinical depression include sadness that doesn’t lift, feelings of hopelessness or guilt, difficulty sleeping, constant fatigue, or behavior not typical for your partner. Don’t ignore depression that seems extreme or that doesn’t lift after a few days. Head to Book 2, Chapter 7 for information about depression and pregnancy.
Hitting the Home Stretch: Prenatal Visits in the Third Trimester
Between 28 and 36 weeks, your practitioner probably wants to see you every two to three weeks, and then weekly as you close in on delivery. She takes the usual measurements: blood pressure, weight, fetal heart rate, fundal height, and urine tests. These visits are a good time to discuss issues related to labor and delivery with your practitioner.
If you don’t deliver by your due date, your practitioner may want to start performing nonstress tests (see the later section “Nonstress test [NST]” for details). These tests assess fetal well-being. After 40 to 41 weeks, placental function and amniotic fluid may decline, and ensuring that both remain adequate to support the pregnancy is important. By 42 weeks, many practitioners recommend inducing labor (see Book 2, Chapter 4) because the risk of problems for the baby rises significantly after that time.
As your pregnancy winds down, your practitioner may perform certain tests to make sure that your baby is as healthy as possible. Some tests, like Group B strep cultures, are done so you can take measures to avoid certain problems. Other tests, like a nonstress test or a biophysical profile, are performed to ensure fetal well-being.
Taking Group B strep cultures
The only routine test that may be performed during one of your final prenatal visits is a culture for Group B strep, bacteria commonly found in the vagina and rectum. The Centers for Disease Control and Prevention (CDC) and the American Congress of Obstetricians and Gynecologists now recommend that all women be routinely screened for Group B strep at around 36 weeks gestation. About 15 to 20 percent of women harbor this organism. If the culture is positive at 36 weeks, your doctor will recommend that you receive antibiotics during labor to reduce the risk of transmitting the bacteria to the baby. Treating the bacteria any earlier doesn’t help, because it can come back by the time you’re in labor. Currently, no tests that yield immediate results are available, so you can’t test for Group B strep at the time of labor; it must be done in advance.
GAUGING LUNG MATURITY (FOR REPEAT CESAREAN DELIVERIES)
If you’re planning a repeat cesarean delivery (meaning that you had one in an earlier pregnancy) or an elective induction at less than 39 weeks, some practitioners may recommend that you have an amniocentesis to establish that the fetus’s lungs are mature and ready to function. Over the past few years, there has been a movement across the country to stop performing elective deliveries before 39 weeks because newer studies have shown that these place newborns at increased risks for problems in the newborn period, so the need for fetal lung maturity amniocenteses is declining. The American Congress of Obstetricians and Gynecologists and the March of Dimes both strongly discourage such deliveries.
Assessing your baby’s current health
At certain times, your practitioner may suggest that you undergo tests for the baby. These tests, also referred to as antepartum fetal surveillance, check the baby’s well-being. Your practitioner can perform these tests at any time after about 24 to 26 weeks if cause for concern exists or after 41 weeks if you haven’t delivered. Several different tests can be used, as described in the following sections.
Nonstress test (NST)
Nonstress testing consists of measuring the fetal heart rate, fetal movement, and uterine activity using a special monitoring machine. Your practitioner hooks you up to this device, which picks up uterine contractions and the baby’s heart rate and generates a tracing of both. The NST is similar to the device used during labor to monitor the fetal heart rate and contractions. You also receive a button to press each time you perceive fetal movement. The monitoring goes on for about 20 to 40 minutes. The doctor then looks at the tracing for signs of accelerations, or increases, in the fetal heart rate. If accelerations are present and occur often enough, the test is considered reactive, and the fetus is thought to be healthy and should continue to be so for three to seven days. (The fetus is healthy in more than 99 percent of cases.) If the accelerations aren’t adequate (that is, the test is nonreactive), you still have no cause for alarm. In 80 percent of cases, the fetus is fine and probably just in sleep cycle, but further evaluation is needed.
Your practitioner may perform this test (which is usually repeated once or twice a week) for a variety of reasons, including the following:
· You’re past your due date.
· The baby isn’t growing properly.
· You have a decreased volume of amniotic fluid.
· Your blood pressure is high.
· You have diabetes.
· You notice decreased fetal movement.
Your doctor may perform a vibracoustic stimulation test during a nonstress test. During the test, the fetus’s response to stimulation by sound or vibrations is observed. The practitioner “buzzes” the mother’s belly with a vibrating device, which causes a transmission of sound or vibrations to the fetus. Normally, the fetal heart rate accelerates when the fetus is stimulated in this way. Vibracoustic stimulation can often cut down the time necessary to perform a nonstress test, because you see accelerations in the heart rate more quickly. It is often performed if the NST is still not reactive after 20 to 30 minutes.
Contraction stress test (CST)
The contraction stress test is similar to a nonstress test except that the fetal heart is timed in relation to uterine contractions. The contractions sometimes occur by themselves, but more often are brought on with low doses of oxytocin (Pitocin) or by nipple stimulation.
Don’t stimulate your nipples at home to bring on contractions. Perform nipple stimulation only under your doctor’s supervision, because you doctor wants to monitor you and make sure that the uterus doesn’t contract too much.
Three good contractions in a ten-minute period need to be present in order for the test to be interpreted. If the fetal heart rate doesn’t drop after the contractions, the test is considered negative, and the baby is thought to be fine for at least one more week. If the test is positive (the fetal heart rate does drop after the contractions) or suspicious, your practitioner investigates the situation further. Proper management depends on your particular situation. A CST is performed if the results of the nonstress test are inconclusive or if your doctor wants additional testing of fetal well-being.
A CST shouldn’t be performed under certain circumstances, such as if you have placenta previa (see Book 6, Chapter 2) or if you’re at risk of preterm delivery.
Biophysical profile (BPP)
A biophysical profile, which combines ultrasound with a nonstress test (NST), may be performed instead of the NST alone or in addition to the NST if further testing is warranted. Which test is performed (NST or BPP) is often just a matter of physician preference.
The BPP evaluates the following, all by ultrasound: fetal movements, fetal body tone, fetal breathing, and quantity of amniotic fluid.
A perfect score is 10 (2 points for each parameter that’s normal and 2 points for a normal nonstress test). Babies who score 8 out of 10 or better are considered okay. A score of 6 out of 10 is probably fine but usually calls for follow-up testing. A score of less than 6 out of 10 needs further evaluation.
Doppler velocimetry
A doctor performs a Doppler velocimetry test only in certain situations — for example, if certain fetal problems exist (like intrauterine growth restriction; see Book 6, Chapter 2) or if you have high blood pressure. Basically, with this test, your doctor performs a special type of ultrasound exam that assesses the blood flow through the umbilical cord.
Preparing for Labor
Toward the end of your third trimester, you’re likely to think more about delivery and anticipate what that’s going to be like. Many patients want to know when their labor may start and whether they can do anything to influence the timing or to bring it on sooner. This section helps you plan your labor, provides some insight on some classes you can take to get ready for labor, discusses what you can tell your doctor if you want a cesarean section, and gives you some pointers on how to prepare yourself as labor nears.
SYMPATHIZING WITH HER DESIRE TO HAVE THIS OVER, ALREADY
Around the seventh month, many women start expressing a strong desire to have this pregnancy over and done with. Before you jump in with long-winded explanations of how the baby isn’t fully developed yet, it’s too early, or other pompous statements about why being pregnant for just two more months is a good idea, realize that your partner doesn’t really want to have the baby early (well, maybe she does, a little); she’s just tired and frustrated with being pregnant.
The last few months of pregnancy are no picnic, and unfortunately, you can’t truly understand what she’s going through. When she starts talking about getting this baby out by hook or crook the minute she hits 37 weeks, take it with a grain of salt. She’s every bit as concerned about the welfare of this baby as you are, and she’s not going to do anything rash.
Let her vent without giving her a lecture, and in five minutes, she’ll probably be telling her mom how pregnancy has been the best time of her life. That’s how hormones go sometimes.
Making a birth plan
A birth plan is a statement of your preferences for how you want to manage your labor and delivery. It’s about educating yourself about your options and feelings rather than making hard-and-fast, “I absolutely will/won’t” decisions. It involves sorting through things like where you want to deliver, whom you want to have with you during the process, and how you want to manage any pain you may experience. It can be something you simply sort out in your mind and convey verbally, or it can be something you put in writing.
No matter how you develop your plan, make sure you discuss your wishes with your provider well in advance of the big day because obstetric practices vary widely by provider and hospital. The most important part of a birth plan — be it written or verbal — is to provide a platform that fosters an open discussion between you and your provider about your preferences wherever there is a choice. For information on creating a birth plan, refer to Book 1, Chapter 5.
Going back to school: Classes to take
To prepare yourself for labor, you may want to consider taking some birthing classes to find out about breathing, relaxation, and massage techniques that help alleviate the fear, anxiety, and pain associated with labor. Today, a great majority of first-time expectant parents attend childbirth classes.
As you look toward your labor, you need to have a basic understanding of the different types of birthing methods in order to determine which classes may be right for you. The following is a primer on birthing methods:
· Lamaze: Developed in the 1940s by Dr. Fernand Lamaze, a French obstetrician, this birthing method is probably the best known. Lamaze focuses on deep breathing techniques and other exercises aimed at distracting you from the pain associated with childbirth. For more info, go to www.lamaze.org.
· Bradley: Developed in the 1940s by an American obstetrician named Dr. Robert Bradley, this method focuses on a “natural” (drug-free) childbirth. This method involves training in deep breathing and other techniques to control the pain of labor and uses a coach. Check out www.bradleybirth.com.
· Leboyer: The cornerstone of this method is to minimize the shock for the baby of transitioning from inside the uterus to outside. It involves being born in a dimly lit room and immediate bonding with Mom. Although there’s no specific website devoted to this method, you can read the original text of Dr. Leboyer’s book at http://ebookbrowsee.net/birth-without-violence-leboyer-pdf-d123360765.
· Alexander: This method focuses on intensive conditioning of your body to promote balance, flexibility, and coordination, thereby enhancing comfort during labor. Find out more at www.alexandertechnique.com/articles2/pregnancy.
· HypnoBirthing: The origins of this technique were originally described in 1944 by Dr. Grantly Dick-Read, an English obstetrician, in a book called Childbirth without Fear. The focus of this method is to use hypnosis to break the fear-tension-pain cycle, thereby making labor easier. For more information, go to http://hypnobirthing.com.
If you decide to take a class, make sure the one you choose provides reliable and accurate information. Ask your healthcare provider for recommendations, or ask friends who have already attended classes.
Most contemporary childbirth education classes teach a combination of some of these techniques. The greatest benefit of childbirth classes is probably the opportunity they provide to find out what to anticipate during labor, because a little information goes a long way in reducing anxiety and fear about the big event. Other benefits to the classes include
· Bringing your partner into the process of pregnancy: If attending your prenatal visits isn’t always possible for your partner, a class may be the best time for your partner to find out about what’s ahead and to ask questions.
· Meeting other parents-to-be: You may make friends and ultimately find playmates for your child.
· Touring the hospital or childbirth center where you plan to deliver: Seeing where it’s all going to happen is often very helpful. (If your class doesn’t include a tour, ask your practitioner to arrange one.)
You don’t have to believe everything you hear at a childbirth class. If you plan to use medication or anesthesia to reduce the pain of labor and the instructor warns you that all such medications are to be avoided, don’t be bullied into accepting her point of view. In class, just find out whatever you can that may be helpful and take the rest in stride. Ultimately, it’s your labor, and you need to do what makes you feel comfortable.
Childbirth education isn’t for everyone. Some women feel that becoming fully informed about what’s ahead only adds to their nervousness — and that’s a valid concern. Every woman should make her own decision about whether to attend childbirth classes. Also, if for some reason you deliver before you finish your classes, don’t be overly concerned. Most nurses in labor and delivery are trained to show you the techniques you need to know during labor.
BEING PREPARED: INFANT CPR
No one wants to think about finding their newborn unresponsive or having difficulty breathing, but the truth is that being prepared helps pull babies through these scary situations. Hence, infant and child CPR are recommended to all parents and childcare providers.
Infant CPR is a technique that all parents should be familiar with. Many people think it requires intensive training to master, but the American Heart Association has simplified the training so that almost anyone can do it with a minimum of effort. In fact, check out www.americanheart.org. Do a search for “Infant CPR Anytime” for information about a valuable 20-minute training session for parents and family members.
Asking for a c-section on demand
Cesarean section on demand (also known as a cesarean delivery on maternal request) is having a cesarean delivery just because the mom asks for it, even though no medical or obstetrical reasons for a cesarean exist. If you want to have a c-section on demand, make sure you discuss your wishes with your doctor well in advance of your delivery. She’ll talk to you in depth about the risks and benefits of doing this to help you make an informed decision. If you plan on having lots of children, having a c-section on demand probably isn’t a good idea because the risks for some problems increase with each subsequent cesarean delivery.
Over the past ten years or so, having a c-section on demand has become increasingly popular. In fact, statistics show that about 2.5 percent of all deliveries in the United States each year are by c-section on demand.
The potential benefits of this mode of delivery are a lower risk of postpartum bleeding or hemorrhage (see Book 2, Chapter 7) and a lower risk of urinary incontinence. The latter has been shown to be true in the first year after delivery, but after that time, the risk of this problem is equal between moms who deliver vaginally and those who have c-section on demand.
The downsides to c-section on demand are a longer stay in the hospital, transient breathing problems for the baby, and higher risks in your subsequent pregnancies for problems like uterine rupture (see the information in Book 6, Chapter 1 on TOLAC and VBAC) and an adherent placenta (also known as placenta accrete). Also, not all physicians will agree to c-section on demand.
Timing labor
“When am I going to have this baby?” a lot of soon-to-deliver moms want to know. Unfortunately, there’s no foolproof way of knowing, and not even a crystal ball works. Some uncertain signs that something may happen include loss of the mucous plug (not really a plug but thick mucus produced in the cervix), bloody show (an unfortunately named and blood-tinged mucous discharge), increasing frequency of Braxton-Hicks contractions, and diarrhea. But nothing is a sure sign. Loss of the mucous plug or bloody show may occur hours, days, or weeks before labor, or in some cases, not at all. This unpredictability may add to your anxiety, but it also makes the whole process more exciting.
Vigorously rubbing or massaging the nipples can cause contractions, but it shouldn’t be performed at home because it can lead to hyperstimulation of the uterus (that is, too-frequent contractions), which isn’t healthy for you or your baby. It’s not a sure thing, in any case, because as soon as you stop the nipple stimulation, the contractions usually also stop.
Using perineal massage
In the past few years, perineal massage has generated a great deal of interest. This process involves using an oil or cream on the perineum (the area between the vagina and the rectum) and massaging the area in preparation for childbirth. Although studies suggest that this practice decreases the need for episiotomies (cutting the perineum to allow room for the baby to pass during childbirth — see Book 2, Chapter 5) or lacerations, the number of cases in which it has made a clear difference isn’t very large. There’s no harm in trying it, though. If you think perineal massage may help and it’s comfortable for you, go right ahead.
Getting Ready to Head to the Hospital
You’re so close to delivery now that it’s a good idea to make sure you’re ready to walk out the door and head for the hospital. You probably won’t want to stop to pack a suitcase at the last minute, nor will you have time to stop off at the store to shop for a car seat. Getting these must-do items off your pre-delivery checklist now will free you up to concentrate on the important things, like that 437th daily trip to the bathroom.
Packing your suitcase
Many women find it comforting to know that their bag is packed for the trip to the hospital or birthing center. Having your bag ready allows you to concentrate on watching for signs of labor and helps keep you from worrying about being prepared.
You may want to have a few things on hand while you’re in labor, including the following:
· A camera: Don’t forget to charge the batteries and get extra memory cards.
· A cellphone or calling card: Bring along your address book with home, work, and cell numbers.
· Insurance information: Don’t forget your card. (This one is actually a “must bring.”)
· Socks: Your feet will probably get cold, so plan ahead.
· Glasses: They may be less trouble than contact lenses during labor.
· A snack for your partner or coach: You don’t want your partner to leave you for a trip to the hospital cafeteria.
· Hard candies or lollipops: You may have to go for some time without eating or drinking.
· Something your partner can use to massage your back during labor: Some people find that a tennis ball, a narrow paint roller, or a lightweight rolling pin works well.
· A CD or MP3 player, if you find music relaxing: Don’t forget to bring your favorite CDs.
· Change for parking meters, telephones, or vending machines: You never know when someone may need some quarters (hopefully not your practitioner).
After delivery, some additional items can help make your life easier, more comfortable, or more fun:
· A post-delivery snack for yourself
· Champagne for a post-delivery toast, if you like
· Modern, stick-on sanitary napkins
· Sturdy cotton underwear that you won’t mind staining
· A bathrobe and nightgown
· Toiletries
· Extra-large shoes that will accommodate your swollen feet
· Loose, comfortable clothes to go home in
· Clothes for your baby — or babies! — to go home in
· An infant car seat
Determining who’s coming to the hospital
Before the time comes to head to the hospital, take a moment and think about whom you want to accompany you. These days, many hospitals allow more than one family member or friend in the labor and delivery room to offer continuous labor support. You may want to consider having some of the following people in your room during delivery:
· The baby’s father or your partner: This is an obvious choice.
· Your parents: Some women choose to have one or both of their parents with them.
· Your sister or a close friend: Either may provide the support you need.
· A doula: Some women hire a doula, a woman with extensive experience with birth who provides emotional and physical support throughout labor. The following are some doula referral organizations that you may find helpful:
· Doulas of North America (DONA); phone 888-788-DONA; website www.dona.org
· toLabor; phone 804-320-0607; website www.tolabor.com
Continuous labor support refers to the constant, nonmedical care given to a woman in labor. It involves emotional support and encouragement to both the patient and her partner, attention to physical comforts (massage, assistance with positioning and grooming), and, often, providing information and explanations of various procedures and events. Advantages to continuous labor support may include a shorter labor, less need for a cesarean section, less need for pain relief, and a more positive childbirth experience.
Some women with other children may want them to be present during the delivery to share the full family experience. However, you should consider the maturity of the children (or other family members) and whether it would be an emotionally satisfying or unnerving situation for them. Although many labors proceed completely smoothly and without any complications, others may be stressful or more difficult. Keep this in mind when you’re considering whom to bring with you to the delivery.
Choosing — and using — a car seat
Buying a car seat for your baby is one of the most important but confusing purchases you’ll make. You have many choices, so staying informed about what to look for is important. Basically, you can choose from two types available for newborns:
· Infant-only seat: Designed for babies who are under 1 year of age or weigh less than 20 pounds, this car seat is smaller and more lightweight than the alternative and should be used only in a rear-facing position. (A seat that faces the rear is essential for newborns, because it supports the child’s back, neck, and head during a car accident.) This type of seat is also more convenient because it’s lightweight and can also be used as an infant carrier, feeding chair, or rocker.
· Convertible or infant-toddler seat: Car seats of this type are usually larger than infant-only car seats. You use them in a rear-facing position until your baby reaches a certain age and weight — typically 1 or 2 years of age or about 20–30 pounds, but check your state’s car seat laws to make sure you’re up to date. (Go to the Governors Highway Safety Association website to see laws by state: www.ghsa.org/html/stateinfo/laws/childsafety_laws.html.) Some models have weight limits as high as 30 to 32 pounds for rear-facing use. The advantage of this type of seat is that you make only one purchase instead of buying both an infant seat and then a convertible seat after the age of 1.
When shopping, look for a model that’s simple to use. Also, pay attention to price — the higher-priced seats aren’t necessarily better. If you choose a convertible seat, try it out in your car to make sure it fits both backward and forward before you throw away the receipt. Also, check out whether the car seat is easy to install — you shouldn’t need to be a mechanical engineer to properly install your baby’s car seat.
The following considerations are also important when choosing a car seat:
· A five-point safety harness with straps that adjust from the front
· Plenty of head and neck support
· An easy-to-clean seat
After you’ve made your selection, you may want to practice buckling the seat into your car before taking your baby out for her first ride. Remember that your baby should ride in a semi-reclined position (at about a 45-degree angle), with the straps snugly against her body.
If you want to cover your baby, buckle the harness first and then put a blanket over her. A blanket under the harness or even bulky clothing like a snowsuit may make the harness too loose. Often, firefighters can help install and educate parents on proper installation and proper buckling of infants into car seats.
If your baby is a preemie, ask your doctor if the baby needs to be tested in her car seat before discharge. Premature babies are at a greater risk for periods of apnea (absent breathing) or depressed heart rate in a car seat. You may need to use rolled-up towels or diapers on either side of the baby’s head to help keep her head and neck from slumping.
Recognizing Causes for Concern
During the final weeks and months of pregnancy, you see your practitioner more often than before. Still, certain questions and problems may arise between visits. Everything starts to heat up during the later stages of the third trimester, with both the baby and your body preparing for delivery. Here are some of the key things that may lead you to call your doctor.
Bleeding
If you experience any significant bleeding, let your practitioner know immediately. Some third-trimester bleeding is harmless to you and your baby, but sometimes it has serious implications. Getting evaluated to be sure everything is fine makes sense. Possible causes of third-trimester bleeding include the following:
· Preterm labor: This is defined as having contractions and changes in the cervix before you’re 37 weeks along.
· Inflammation or irritation of the cervix or the harmless bleeding of a superficial blood vessel on the cervix: Either of these can occur after intercourse or after a pelvic exam.
· Placenta previa or a low-lying placenta: See Book 6, Chapter 2.
· Placental separation or abruption: See Book 6, Chapter 2.
· Bloody show: This show is usually less than the amount of blood you would see during a normal menstrual period, and it’s often mixed with mucus. See Book 2, Chapter 4.
Breech presentation
A baby is in a so-called breech position when her buttocks or legs are down, closest to the cervix. Breech presentation happens in 3 to 4 percent of all singleton deliveries. A woman’s risk of having a breech baby decreases the further along she goes in her pregnancy. (The incidence is 24 percent at 18 to 22 weeks but only 8 percent at 28 to 30 weeks. By 34 weeks, it’s down to 7 percent, and by 38 to 40 weeks, 3 percent.)
If your doctor determines your baby is in a breech position during your third trimester, she’ll discuss your options, including vaginal breech delivery (which is rarely done these days), external cephalic version (turning the baby), or cesarean section. See Book 6, Chapter 2 for details about handling breech presentation.
Decreased amniotic fluid volume
The medical term for decreased amniotic fluid volume is oligohydramnios. (It also used to be called dry birth.) It may be found on a routine ultrasound, or your doctor may suspect it just by feeling your uterus. This condition can occur in association with intrauterine growth restriction (see the later section “Fetal growth problems”), preterm rupture of the membranes, or other conditions, or the cause may not be identifiable.
Usually, a mild decrease in amniotic fluid isn’t a major cause for concern; however, your practitioner begins to monitor you more closely — with nonstress tests and ultrasound exams — to make sure no problem arises. If you’re very close to your due date, your practitioner may want to deliver the baby. On the other hand, if you’re only 30 weeks along, the best option may be increased rest and close observation. Of course, the management of the problem also depends on its cause. See Book 6, Chapter 2 for details on problems with amniotic fluid.
Decreased fetal movement
If you’re not feeling the amount of fetal movement you’re accustomed to, let your doctor know. Fetal movement is one of the most important things to pay attention to as you near your due date (see the section “Movin’ and shakin’: Fetal movements” earlier in this chapter).
Fetal growth problems
You may find out at a routine prenatal visit that your practitioner thinks your uterus is measuring either too big or too small. This finding isn’t cause for immediate alarm. Often in this situation, your practitioner suggests that you have an ultrasound exam to get a better idea of how big the baby is. Ultrasound is used to measure parts of the baby — the head’s size, the abdomen’s circumference, and the thighbone’s length. Your practitioner then plugs these measurements into a mathematical equation that gives the estimated fetal weight (EFW). That estimate is then entered on a curve plotting the baby’s age in weeks against weight, which represents the average growth of thousands of fetuses at each gestational age.
Your practitioner can check to see where your baby’s weight falls on the curve and thus tell which percentile the baby is in. If the baby’s weight is anywhere between the 10th and the 90th percentiles, the weight is considered normal. Remember, not every baby is at the 50th percentile, so the 20th percentile is still normal and no reason to worry.
Keep in mind that although ultrasound is an excellent tool for assessing fetal growth, it isn’t perfect. Judging the baby’s weight by an ultrasound exam isn’t the same as putting the baby on a scale. Weight estimates can vary by as much as 10 to 20 percent in the third trimester due to variations in body composition. So if your baby is outside the normal range, don’t worry.
If your baby measures very large (macrosomia), your practitioner may suggest you have another glucose screen to check for gestational diabetes (see Book 6, Chapter 3). If your baby measures especially small (intrauterine growth restriction), your doctor may suggest you be followed more closely — that you undergo nonstress tests and repeat ultrasound exams to keep an eye on fetal growth. For information on problems with fetal growth and how to manage them, head to Book 6, Chapter 2.
Leaking amniotic fluid
If you notice your underwear is wet, several explanations are possible. It may be a little urine, vaginal discharge, the release of the mucous plug in the cervix, or actual leakage of amniotic fluid (also known as rupture of the membranes). Often, you can tell what it is by examining the fluid. Mucous discharge tends to be thick and globby, whereas vaginal discharge is whitish and smooth. Urine has a characteristic odor and doesn’t flow continuously without your effort. Amniotic fluid, on the other hand, is normally clear and watery and often is lost in spurts. Sometimes you have a big gush of water when membranes rupture, but if the membrane has only a small hole, the leakage may be scant.
If you think your water might be broken, avoid intercourse, douching, soaking in a bath, or swimming until it’s ruled out by your physician.
If you leak what you think may be amniotic fluid, call your practitioner right away or go to your hospital for evaluation. If you aren’t preterm and the amniotic fluid is clear, leaking fluid isn’t an emergency; however, most practitioners want you to let them know so that they can tell you what to do. If the fluid is bloody or greenish-brown, be sure to let your practitioner know. Greenish fluid may mean the baby has had a bowel movement (meconium) inside the uterus. Most of the time, such an event doesn’t indicate a problem, but sometimes it means the baby is being stressed. Your practitioner makes sure the baby is okay by monitoring the baby’s heartbeat (usually by performing a nonstress test).
Preeclampsia
In preeclampsia, a condition unique to pregnancy, high blood pressure is associated with the spilling of protein into the urine and sometimes swelling (edema) in the hands, face, and legs. Preeclampsia (also called toxemia or pregnancy-induced hypertension) isn’t uncommon; it occurs in 6 to 8 percent of all pregnancies. It can range from being very mild to being a serious medical condition. Book 6, Chapter 2 provides you with the signs and symptoms of preeclampsia.
Preeclampsia usually comes on gradually. Your practitioner may at first notice only a slight elevation in your blood pressure. She may then tell you to rest more, to lie on your side as much as possible, and to come in for more frequent visits. But occasionally, preeclampsia happens suddenly.
Preterm labor
The technical definition of preterm labor is when a woman begins to have contractions and changes in her cervix before she’s 37 weeks along. Many women have contractions but no cervical change — in which case it isn’t real preterm labor. However, in order to find out whether your cervix is changing, you need to be examined. In addition, your practitioner determines how often you’re contracting by placing you on a uterine contraction monitor (like the one used to perform a nonstress test — see the “Nonstress test [NST]” section earlier in this chapter).
The contractions associated with preterm labor are regular, persistent, and often uncomfortable. They usually start out feeling like bad menstrual cramps. (Braxton-Hicks contractions, in contrast, aren’t regular or persistent, and they usually aren’t uncomfortable.) Preterm labor may also be associated with increased mucous discharge, bleeding, or leakage of amniotic fluid.
Diagnosing preterm labor as early as possible is important. Medications aimed at arresting premature labor work best if the cervix is dilated less than 3 centimeters. If labor occurs after 35 weeks, your practitioner probably won’t try to stop your contractions except in rare circumstances (such as poorly controlled diabetes).
If you find that you’re having regular, uncomfortable, persistent contractions (more than five or six in an hour) and you’re not yet 35 to 36 weeks pregnant, call your practitioner. The only way to tell whether you’re experiencing real preterm labor is to be examined. Also, if you think your membranes have ruptured (your water has broken) or if you’re having any bleeding, call your practitioner right away. See Book 6, Chapter 2 for more-detailed coverage on preterm labor.
When the baby is late
For nearly 40 weeks, you think that your baby is going to come on a certain date. But in fact, only about 5 percent of women actually deliver on their due dates. Eighty-two percent deliver between 37 and 42 weeks, which used to be considered “full-term.” Five-and-a-half percent deliver even later, and the rest (12.5 percent) are preterm deliveries.
At one time, what were thought to be post-term pregnancies were often simply a reflection of incorrectly estimated due dates. But today, with the widespread use of ultrasound, the due dates are pretty accurate. An ultrasound performed during the first trimester is especially accurate, usually within three to four days. A third-trimester ultrasound, in contrast, may be off by two to three weeks.
Many practitioners advise that labor be induced if the pregnancy reaches 42 weeks. If your pregnancy goes on any longer, the baby is likely to still be fine, but greater health risks are possible. See Book 2, Chapter 4 for details.
FOR PARTNERS: GETTING DOWN TO THE WIRE
Your partner may begin to feel uncomfortable because of all the changes in her body — and because of her sheer size. Many women have trouble sleeping late in pregnancy, which only makes it harder for them to tolerate their discomfort. As you did during the first and second trimesters, take on more of the day-to-day household duties and give your partner the time she needs to rest. Consider treating her to a day at her favorite salon, or send her out for something else that makes her feel special. She deserves to feel good about herself and the changes her body is going through. And things will go easier for both of you if you can find a way to help her accept her pregnant body, relax, and take things a little easier.
Later in the third trimester, naturally, both of you start to focus on labor and delivery. You may have a million questions: Will the baby be okay? Do I really want to be in the delivery room? How will my partner tolerate labor? How will I tolerate labor? Will I get queasy during the delivery? Psychologically, childbirth can be a real challenge for the partner. You care about the course of events very much, but you’re clearly not in the driver’s seat, and this situation may make you feel anxious.
At the same time, imminent parenthood faces you head-on. And the onset of this new responsibility may cause still more anxiety and more questions: Will I be able to provide for my family? Will I be a good parent? Can I figure out how to change a diaper? How will I know how to handle a fragile newborn? These questions are all normal. Again, they’re probably very similar to the questions running through your partner’s head. Communication is everything. Most couples find they can talk each other through their respective panic attacks.