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Week 40
MDAdvice.com Home > Health Library > Your Pregnancy: Week by Week > Previous Week > Contents > Glossary

How Big Is Your Baby?

Your baby weighs about 7.5 pounds (3400g). Its crown-to-rump length is about 14.8 to 15.2 inches (37 to 38cm). Total length is 21.5 inches (48cm).

Your baby fills your uterus and has very little room to move. See the illustration on page 339.

How Big Are You?

From the pubic symphysis to the top of the uterus, you probably measure 14.4 to 16 inches (36 to 40cm). From your bellybutton to the top of your uterus is 6.4 to 8 inches (16 to 20cm).

By this time, you probably don't care an awful lot about how much you measure. You feel you're as big as you could ever be, and you're ready to have your baby. You may continue to grow and even to get a little bit bigger until you have your baby. But don't be discouraged¨you'll have your baby soon.

How Your Baby Is Growing and Developing

Bilirubin is a breakdown product from red blood cells. Before your baby is born, bilirubin is transferred easily across the placenta from the fetus to the maternal circulation. Through this process, your body is able to get rid of the bilirubin from the baby. Once your baby is delivered and the umbilical cord is clamped, the baby is on its own to handle the bilirubin produced in its own body.

Jaundice in a Newborn

After birth, if your baby has problems dealing with bilirubin, it may develop high levels of it in the blood. Your baby may develop jaundice¨yellowing of the skin and the whites of the eyes. Bilirubin levels typically increase for 3 or 4 days after the baby's delivery, then decrease.

Your pediatrician and the nurses in the nursery check for jaundice by observing your baby's color. Your baby may have a blood test to measure his or her bilirubin levels at the hospital or at your pediatrician's office.

A baby is treated for jaundice with phototherapy. The baby is placed under special lights; the light penetrates the skin and destroys the bilirubin. If very high levels of bilirubin are present, the baby may undergo an exchange blood transfusion.

Kernicterus in a Newborn

Extremely high levels of bilirubin (hyperbilirubinemia) in a newborn infant cause doctors concern because a very serious condition called kernicterus can develop. Kernicterus is seen more frequently in premature infants than in babies delivered at full term. If the baby survives the kernicterus, it may have neurologic problems¨spasticity, lack of muscle coordination and varying degrees of mental retardation. However, kernicterus in a newborn is a rare occurrence.

Changes in You

What Happens When You're Overdue?

By now you're anticipating the delivery of your baby. You're probably counting the days to your due date. As I've mentioned, not every woman delivers by her due date. A pregnancy is considered to be overdue (postdate) when it exceeds 42 weeks or 294 days from the first day of the last menstrual period.

While the fetus is growing and developing inside your uterus, it depends on two important functions performed by the placenta¨respiration and nutrition. The baby relies on these functions for continued growth and development.

When a pregnancy is postdate, the placenta may fail to provide the respiratory function and essential nutrients the baby needs to grow, and an infant may begin to suffer nutritional deprivation. The baby is called postmature.

At birth, a postmature baby has dry, cracked, peeling, wrinkled skin, long fingernails and abundant hair. It also has less vernix covering its body. The baby appears almost malnourished, with decreased amounts of subcutaneous fat.

Because the postmature infant is in danger of losing nutritional support from the placenta, it's important to know the true dating of your pregnancy. This is one reason it's important to go to all of your prenatal visits.

At Jill's office visit, she wearily asked me, ˘How much longer?÷ She was 39 weeks pregnant, so I explained to her that most doctors agree that once a woman reaches 42 weeks of pregnancy, the baby should be delivered if the cervix is beginning to dilate and to thin, and the baby is in the proper presentation, with the head down.

She was disappointed that her baby wasn't coming yet. But when I explained that it's best for the baby to wait until it is ready to deliver, she agreed it was worth the wait for a healthy baby.

Inducing Labor

If your doctor must induce labor, you will receive oxytocin (Pitocin) intravenously. Medication is gradually increased until contractions begin. The amount of oxytocin you receive is controlled by a pump, so you can't receive too much of it. While you receive oxytocin, you are monitored for the baby's reaction to your labor.

Ripening the Cervix for Induction

It is estimated that obstetricians in the United States induce labor in about 450,000 women a year. Prepidil Gelź (dinoprostone cervical gel 0.5mg) is a drug used to ripen the cervix and induce labor. ˘Ripening the cervix÷ means softening, thinning and dilating the cervix.

Prepidil Gel is most often used to ripen a cervix in a pregnant woman at or near term with a medical or obstetric need for labor induction. These conditions include postmaturity (overdue baby), hypertension, pre-eclampsia or other problems.

CervidilÍ (dinoprostone 10mg) is another preparation that ripens the cervix. It uses a controlled-release system.

In most cases, doctors use Prepidil Gel and Cervidil to prepare the cervix the day before induction. Both preparations are placed in the top of the vagina, behind the cervix. Medication is released directly onto the cervix, which causes it to ripen for induction of labor. Doctors do this procedure in the labor-and-delivery area of the hospital, so the baby can be monitored.

How Your Actions Affect Your Baby's Development

The delivery of your baby is the event you've been planning for! If this is your first baby, you may be very excited and a little apprehensive. Delivery of your baby is something you'll remember for a very long time.

You need to decide who you want with you during delivery. In some cases, family members assume they're invited to the delivery.

Some couples choose to bring young children into the delivery room to see the birth of a new brother or sister. Discuss this with your doctor ahead of time, and get his or her opinion. The delivery of the baby might be very exciting and special to you and your partner, but it may be frightening to a young child.

Many places offer special classes for brothers- and sisters-to-be to help prepare them for the new baby. This is a good way to help older children feel they are part of the birth experience.

You Should also Know

What Happens When You Arrive at the Hospital?

Don't be embarrassed if you have to go to the hospital to be checked for labor. This isn't a nuisance to hospital personnel or your doctor¨that's why they're there! If you're concerned you might be in labor and you aren't sure, talk with your doctor or the nurses at labor and delivery. They'll tell you if you should come in to be evaluated.

When you go to the hospital, you'll be evaluated. A copy of your office record is kept in the labor and delivery area. Those seeing you in the hospital should know about any problems or complications that have occurred during your pregnancy and any other information that is important.

Check-in at the Hospital
You will probably be asked many questions when you arrive at the hospital to check in. They may include the following.

˛ Have your membranes ruptured? At what time?

˛ Are you bleeding?

˛ Are you having contractions? How often do they occur? How long do they last?

˛ When did you last eat and what did you eat?

Other important information for you to share includes medical problems you have and any medications you take or have taken during pregnancy. If you've had complications, such as placenta

previa, tell them when you first come to labor and delivery.

If you think you're in labor, don't eat. Even something light in your stomach can cause nausea. You may have to ask for an antacid for relief of stomach upset.

After you check in, you will be put in a labor room or an evaluation room to determine if you're actually in labor. It's important to know whether you're having contractions, how often they occur, how long they last and how strong they are. This is normally done with an external fetal monitor (discussed in Week 38). The monitor is placed on your abdomen; it shows the frequency and duration of contractions.

It's very important to know whether your membranes have ruptured (your water has broken). Ruptured membranes can be confirmed in any of several ways:

˛ by your description of what happened, such as a

large gush of fluid

˛ with the nitrazine paper test

˛ with a ferning test

You will also be checked to see if you are dilated. It's helpful to know if you were dilated (and how much) when last checked by your doctor. A nurse or doctor performs this exam.

You will be asked to give a brief history of your pregnancy. Mention any other medical problems you have. If you've had any complications during pregnancy, such as bleeding, or if you know your baby is breech, tell them. Don't assume they know. They note your vital signs, including your blood pressure, pulse and temperature.

Evaluation and determination of whether you're in labor is usually not a 5-minute experience. It takes time to check everything out.

If you are in labor and remain at the hospital, other things will happen. Your partner may have to admit you to the hospital if you haven't filled out preadmittance papers. You may be asked to sign a release form or a permission slip from the hospital, your doctor or the anesthesiologist. This is done to ensure you are informed and aware of the procedures that will be done for you and any risks that are involved.

After you have been admitted, you may receive an enema or an I.V. may be started. Your doctor may want to discuss pain relief, or you may have an epidural put in place.

Blood will probably be drawn to be tested for hematocrit and complete blood count (CBC). Other things that are done at the hospital vary depending on where you go, your doctor's preferences and arrangements you have made ahead of time.

Your Labor Coach

In most instances, your partner is your labor coach. However, this isn't an absolute requirement. A close friend or relative, such as your mother or sister, can also serve as your labor coach. Ask someone ahead of time; don't wait until the last minute. Give the person time to prepare for the experience and to make sure he or she will be able to be there with you.

Not everyone feels comfortable watching the entire labor and delivery. This may include your partner. Don't force your partner or labor coach to watch the delivery if he or she doesn't want to. It's not unusual for a labor coach to get lightheaded, dizzy or pass out during labor and delivery. On more than one occasion, I've had a coach or partner faint or become extremely lightheaded when we just talked about plans for labor and delivery or a C-section!

Preparing ahead of time, as with prenatal classes, helps avoid some problems. In the past, you would have been alone with the nurses and doctor while your partner paced in the waiting room. Things have changed!

The most important thing about the labor coach is the support he or she gives you during pregnancy, labor, delivery and recovery following the birth of the baby. Choose this person carefully.

What Can a Partner or Labor Coach Do?

Your partner or labor coach may be one of the most valuable assets you have during labor and delivery. He (or she) can help you prepare for labor and delivery in many ways. He can be there to support you as you go through the experience of labor together. He can share with you the joy of the delivery of your baby.

An important role of the labor coach is to make sure you get to the hospital! Work out a plan during the last 4 to 6 weeks of pregnancy so you know how to reach your coach. It's helpful to have an alternate driver, such as a neighbor or friend, who is available in case you are unable to reach your labor coach immediately and need to be taken to the hospital. Before going to the hospital, your labor coach can time your contractions so you are aware of the progress of your labor.

Once you arrive at the hospital, both of you are going to be nervous. Your coach can do things to help you both relax. Some of these include:

˛ talking to you while you're in labor to distract you and to help you relax

˛ encouraging and reassuring you during labor and when it comes time for you to push

˛ keeping a watch on the door and your privacy

˛ helping relieve tension during labor

˛ touching each other, hugging and kissing (If you don't want to be touched during labor, tell your coach.)

˛ reassuring you it's OK for you to deal vocally with your pain

˛ wiping your face or your mouth with a washcloth, rubbing your abdomen or your back, supporting your back while you're pushing

˛ helping create a mood in the labor room, including music and lighting (Discuss it ahead of time; bring things with you that you would like to have available during labor.)

˛ taking pictures (many couples find still pictures taken of the baby after the delivery help them best remember these wonderful moments of joy)

It's all right for your labor coach to rest or to take a break during labor. This is especially true if labor lasts a long time. It's better if your coach eats in the lounge or hospital cafeteria.

Many couples do different things to distract themselves and to help pass time during labor. These include picking names for the baby, playing games, watching TV or listening to music. A labor coach shouldn't bring work to the labor room. Talking on the phone to clients or doing work is inappropriate and shows little support for the laboring woman.

Talk to your doctor about your coach's participation in the delivery, such as cutting the umbilical cord or bathing the baby after birth. Things like this that can be done vary from one place to another. Understand the responsibility of your doctor is the well-being of you and your baby¨don't make requests or demands that could cause complications for you or your baby.

Talk about who needs to be called ahead of time. Bring a list of names and phone numbers with you. There are some people you may want to call yourself. In most places, a telephone is available in labor and delivery rooms.

Talk to your labor coach about showing the baby to those who are waiting. If you want to be with your partner when friends or relatives first see the baby, make it clear. Don't allow your baby to be taken out of the room unless that's what you want. In most instances, you need some cleaning up. Take 10 or 15 minutes for yourselves. After that you can show the baby to friends and relatives and share the joy with them.

What Happens to You after the Birth?

What happens to you after the birth of your baby depends on the hospital or birthing-center facilities where you have your baby. Hospitals vary in the arrangements and accommodations they have available.

With LDRP (labor, delivery, recovery and postpartum), the room you are admitted to at the beginning of your labor is the room you labor in, deliver in, recover in and remain in for your entire hospital stay. This isn't available everywhere, but these facilities are becoming more popular.

The concept of LDRP has evolved because many women don't want to be moved from the labor area to recovery to another part of the hospital after delivery. The nursery is usually close to labor and delivery and the recovery area. This enables you to see your baby as often as you like and to have your baby in your room for longer periods.

In many places, you will labor in the labor-and-delivery suite, then be moved to a delivery room at the time of delivery. Following this, you may go to a postpartum floor, which is an area in the hospital where you will spend the remainder of your hospital stay.

Most hospitals allow you to have your baby in your room as much as you want. This is called rooming in or boarding in. Some hospitals also have a cot, couch or chair that makes into a bed in your room so your partner can stay with you after delivery. Check the availability of various facilities in the hospitals in your area.

Another concept is the birthing room; this generally refers to delivering your baby in the same room you labor in. You don't have to be moved from the room you're laboring in to another place to have the baby. Even if you use a birthing room, you may have to move to another area of the hospital for recovery.

Whatever you choose, the most important thing is the health of your baby and the welfare of you both. When you decide where to have your baby, be sure you have answered the following questions, if you can.

˛ What facilities and staff do you have available?

˛ What is the availability of anesthesia? Is an anesthesiologist available 24 hours a day?

˛ How long does it take them to respond to and perform a Cesarean delivery, if necessary? (This should be 30 minutes or less.)

˛ Is a pediatrician available 24 hours a day for an emergency or problems?

˛ Is the nursery staffed at all times?

˛ In the event of an emergency or a premature baby that needs to be transported to a high-risk nursery, how is it done? By ambulance? By helicopter? How close is the nearest high-risk nursery, if not at this hospital?

These may seem like a lot of questions to ask, but the answers can help put your mind at ease. When it's your baby and your health, it's nice to know emergency measures can be employed in an efficient, timely manner when necessary.

What Happens to Your Baby after It's Born?

When your baby is delivered, the doctor clamps and cuts the umbilical cord, then the baby's mouth and throat are suctioned out. The baby may be placed on your abdomen in clean blankets. Or the baby may be passed to a nurse or pediatrician for initial evaluation and attention. The Apgar scores (see Week 36) are recorded at 1- and 5-minute intervals. An identification band is placed on the baby so there's no mix-up in the nursery!

It's important to keep the baby warm immediately after birth. To do this, the nurse will dry the baby and wrap it in warm blankets. This is done whether the baby is on your chest or attended to by a nurse or doctor.

If your labor is complicated, the baby may need to be evaluated more thoroughly in the nursery. The baby's well-being and health are of primary concern. You'll be able to hold and to nurse the baby, but if your child is having trouble breathing or needs special attention, such as monitors, immediate evaluation is the most appropriate procedure at this time.

Your baby will be taken to the nursery by a nurse and your partner or labor coach. In the nursery, the baby is weighed, measured and footprinted (in some places). Drops to prevent infection are placed in the baby's eyes. A vitamin-K shot is given to help with the baby's blood-clotting factors. Your baby may receive the hepatitis vaccine if you request it. Then the baby is put in a heated bassinet for 30 minutes to 2 hours. The time period varies, depending on how stable the baby is.

Your pediatrician is notified immediately if there are problems or concerns. Otherwise, he or she will be notified soon after birth, and a physical exam will be performed within 24 hours.

Keep Your Options Open during Labor and Delivery

An important consideration in planning for your labor and delivery is the method(s) you may use to get through labor and delivery. Will you have epidural anesthesia? Are you going to attempt a drug-free delivery? Will you need an episiotomy?

Every woman is different, and every labor is different. It's difficult to anticipate what will happen and what you will need during labor and delivery for pain relief. It's impossible to know how long labor will last¨3 hours or 20 hours. It's best to adopt a flexible plan. Understand what's available and what options you can choose during labor.

During the last 2 months of your pregnancy, discuss these concerns with your doctor and become familiar with his or her philosophy about labor. Know what can be provided for you at the hospital you're going to. Some medications may not be available in some areas.

What Is Natural Childbirth?

Some women decide before the birth of their baby that they are going to labor and deliver with ˘natural childbirth.÷ What does this mean? The description or definition of natural childbirth varies from one couple to another.

Many people equate natural childbirth with ˘drug-free÷ labor and delivery. Others equate natural childbirth with the use of mild pain medications or local pain medications, such as numbing medications in the area of the vagina for delivery, or for an episiotomy and repair of episiotomy. Most agree that natural childbirth is birth with as few artificial procedures as possible. A woman who chooses natural childbirth usually needs some advance instruction to prepare for it.

Natural childbirth isn't for every woman. If you arrive at the hospital dilated 1cm, with strong contractions and in pain, natural childbirth may be very hard for you. In this situation, an epidural might be appropriate.

On the other hand, if you arrive at the hospital dilated 4 or 5cm and contractions are OK, natural childbirth might be a reasonable choice. It's impossible to know what will happen ahead of time, but it helps to be aware of, and ready for, everything.

There are three major philosophies of natural childbirth. Lamaze is the oldest technique of childbirth preparation. It conditions mothers, through training, to replace unproductive laboring efforts with fruitful ones and emphasizes relaxation and breathing as ways to relax during labor and delivery. Bradley classes teach the Bradley method of relaxation and inward focus; many types of relaxation are used. Strong emphasis is put on relaxation and deep abdominal breathing to make labor more comfortable. Classes begin when pregnancy is confirmed and continue until after the birth. Grantly Dick-Read is a method that attempts to break the fear-tension-pain cycle of labor and delivery. These classes were the first to include fathers in the birth experience.

It's important to keep an open mind during the unpredictable process of labor and delivery. Don't feel guilty or disappointed if you can't do all the things you planned before labor. You may need an epidural. Or the birth may not be accomplished without an episiotomy. Don't let anyone make you feel guilty or make you feel as though you've accomplished less if you end up needing a C-section, an epidural or an episiotomy.

Beware of instruction that tells you labor is free of pain, no one really needs a C-section, I.V.s are unnecessary or an episiotomy is foolish. This can create unrealistic expectations for you. If you do need any of the above procedures, you may feel as though you failed during your labor.

The goal in labor and delivery is a healthy baby. If this means you end up with a C-section, you haven't failed. Be grateful a Cesarean delivery can be performed safely. Babies that would not have survived birth in the past can be delivered safely. This is a wonderful accomplishment!

Tip for Week 40
If you want to use a different labor position, massage, relaxation techniques or hypnotherapy to relieve labor pain, discuss it with your doctor at one of your prenatal visits.

Previous Week > Contents > Glossary

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From Your Pregnancy Week by Week by Glade B. Curtis, M.D., OB/GYN. Copyright by Fisher Books. Electronic rights by Medical Data Exchange.


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