1. How Big Is Your Baby?
At this time, your baby weighs about 6¾
pounds (3.1kg). Crown-to-rump length is still about 14 inches (35cm).
Total length is around 19⅔ inches (49.5cm).
2. How Big Are You?
Many women feel uncomfortable
during the last weeks of pregnancy because their uterus is so large.
It’s about 14½ to 15¼ inches (36 to 38cm) between your uterus and the
pubic symphysis. From your bellybutton to the top of your uterus is
about 6½ to 7¼ inches (16 to 18cm).
3. How Your Baby Is Growing and Developing
Specific cells in the lungs produce chemicals needed for breathing immediately after birth. An important factor is the chemical surfactant.
A baby born before its lungs are mature may not have surfactant in its
lungs. It can be introduced directly into a newborn’s lungs and baby
can use it immediately. Many premature babies who receive surfactant do
not have to be put on respirators—they can breathe on their own!
4. Changes in You
Tests You May Have during Labor
If you think you may be in labor and go to the hospital, you will have a labor check.
Vital signs will be taken, a monitor will be placed on your abdomen and
a pelvic exam will be done. Tests are done to find out if you’re in
labor and if your pregnancy is doing OK. If you’re not in labor, you’ll
be given advice and sent home. Instructions may include precautions and
warning signs. No one wants to be sent home, but don’t fret. You’ll be
back soon.
Fetal blood sampling is one way to
measure how well a baby can stand the stress of labor. Before the test
can be performed, your water must have broken, and the cervix must be
dilated at least 2cm (about an inch). An instrument is placed into the
vagina, through the dilated cervix, to the top of the baby’s head and
makes a small nick in baby’s scalp. Baby’s blood is collected in a
small tube, and acidity is checked. This signals whether baby is having
any trouble or is under stress and helps your healthcare team decide
whether labor can continue or if a Cesarean delivery is needed.
In many hospitals, a baby’s heartbeat is monitored with external fetal monitoring or internal fetal monitoring.
External fetal monitoring can be done before your water breaks. A pair
of belts is strapped to your tummy. One strap holds a device that
monitors baby’s heart rate, the other holds a device to measure the
length of contractions and how often they occur.
Internal fetal monitoring monitors the baby more precisely. An electrode, called a scalp electrode,
is placed through the vagina and attached to baby’s scalp to measure
its heart rate. A thin tube is used inside the uterus to monitor the
strength of the contractions. This is done only after membranes have
ruptured. It may be a little uncomfortable, but it’s not painful.
Information is recorded on a strip of
paper; results can usually be seen in your room and at the nurses’
station. In some places, your healthcare provider can check results on
his or her computer.
In most cases, while
you’re being monitored, you must stay in bed. In some places, wireless
monitors are available so you can move around.
5. How Your Actions Affect Your Baby’s Development
Breech and Other Abnormal Presentations
It’s common for a baby to be in the
breech presentation early in pregnancy. However, when labor starts,
only 3 to 5% of all babies, not including multiple pregnancies, are a
breech or other abnormal presentation.
Certain factors can make a breech
presentation more likely. One of the main causes is a baby’s
prematurity. Near the end of the second trimester, a baby may be in a
breech presentation. By taking care of yourself, you may avoid going
into premature labor, which gives baby the best opportunity to change
its position naturally.
Although we don’t always know why a baby is in the breech presentation, we know breech births occur more often when:
• you have had more than one pregnancy
• you’re carrying twins, triplets or more
• there is too much or too little amniotic fluid
• the uterus is abnormally shaped
• you have abnormal uterine growths, such as fibroids
• you have placenta previa
• your baby has hydrocephalus
New research shows a breech position may be inherited from either the mom-to-be or
the dad-to-be. Both men and women who were delivered in a breech
presentation have more than twice the risk of having their firstborn
child in a breech presentation at the time of birth.
Tip for Week 38
If baby may be in a breech
presentation, your healthcare provider may order an ultrasound to
confirm it. It helps determine how baby is lying in your uterus.
There are different kinds of breech presentations. A frank breech occurs when the legs are flexed at the hips and extended at the knees. This is the most common type of breech found at term or the end of pregnancy; feet are up by the face or head. With a complete breech presentation, one or both knees are flexed, not extended.
Other unusual presentations are also possible. One is a face presentation.
The baby’s head is hyperextended so the face comes into the birth canal
first. This type of presentation may need to be delivered by Cesarean
delivery.
In a shoulder presentation, the shoulder presents first. In a transverse lie,
the baby is lying almost as if in a cradle in the pelvis. The baby’s
head is on one side of your abdomen, and its bottom is on the other
side. The only way to deliver these types of presentation is by
Cesarean delivery.
Studies show 30% of all abnormal
presentations aren’t detected before labor begins; your risk increases
if you’re overweight. Your healthcare provider may order a fetal
ultrasound to check your baby’s position toward the end of pregnancy if
you’re overweight.
Delivering a Breech Baby.
If your baby is breech when labor begins, the chance of problems
increases. This has led to debate over the best way of delivering a
breech baby. For many years, breech deliveries were done vaginally.
Then it was believed the safest method was by Cesarean, especially with
a first baby. Today, experts believe a baby in the breech position can
probably be delivered more safely by Cesarean delivery before labor
begins or during early labor.
Some experts believe a woman can deliver
a breech presentation if the situation is right. This usually includes
a frank breech in a mature baby if the woman has had previous normal
deliveries. Most agree a footling breech presentation (one leg extended, one knee flexed) should be delivered by Cesarean delivery.
If your baby is in an abnormal
presentation, your healthcare provider may suggest you get on your
hands and knees, with your hips above your heart, then lower yourself
onto your forearms. This position may help baby turn into a head-down
position.
If you know baby is breech, tell them
when you get to the hospital. If you call with a question about labor
and have a breech presentation, mention it to the person you talk with.
Turning a Breech Baby.
Attempts may be made to turn the baby from a breech to a head-down
(vertex) position before your water breaks, before labor begins or in
early labor. Using his or her hands, the healthcare provider turns baby
into the head-down birth position. This is called external cephalic version (ECV) or just version.
Problems can occur with ECV; it’s
important to know about them. Talk with your physician about whether
this procedure is an option for you. Possible risks include:
• rupture of membranes
• placental abruption
• affect on baby’s heart rate
• onset of labor
More than 50% of the time, turning baby
is successful. However, some stubborn babies shift again into a breech
presentation. ECV may be tried again, but version is harder to perform
as your delivery date draws closer.
