Your 40-week Journey : The End of Pregnancy What to expect (part 1)

- 7 Kinds Of Fruit That Pregnant Women Shouldn’t Eat

When will I start my childbirth classes and what types are there?

Childbirth education classes start around 32 weeks and, if you are attending classes run by a community center, are sometimes free. The classes may run for 4–6 weeks, or some have a monthly afternoon session. Some hospitals provide women-only classes, evening or weekend classes, and yoga and pilates classes . There are also certified childbirth educators in most areas who may offer childbirth classes on a one-on-one or small group basis and childbirth classes may also be available online.

Classes are usually held in the evenings, making them more accessible to partners and friends, and they often provide ongoing postpartum support for up to six months after the birth. There is a fee, although in some cases a reduced fee or assisted places may be offered.

Water aerobics are also popular. These are gentle exercises in the swimming pool along with other pregnant women, and often the teacher is a midwife who also provides prenatal information. Also many obstetric physical therapists run relaxation and breathing technique sessions; your doctor's office may have information on these.

What will I learn in my childbirth classes?

Childbirth classes usually cover a different topic each week, including the physical changes that occur in pregnancy; the three stages of labor; hospital, birthing center, and water births; pain relief, which should include breathing and relaxation techniques; breast-feeding; postpartum care of the baby; and changes in relationships. The most popular childbirth class topics tend to be the stages of labor and pain relief, along with a tour of the maternity unit.

Is it useful to learn and practice breathing and relaxation exercises before the birth?

Preparation before labor and delivery is beneficial for most women and their partners, and breathing and relaxation techniques in particular help you to focus on your breathing, which in turn can help you to feel less tense and increase your confidence for dealing with the contractions. Childbirth classes teach you specific techniques and prenatal yoga also helps you to gain control through breathing.

Q:	Should I practice positions for labor and birth beforehand?
A:	Practicing for labor is a good idea since you may find some positions suit you and others don't. This information can be documented in a birth plan so that it is available for your midwife to discuss with you. It's also good for your partner to know your preferred positions during labor.

Do you have any suggestions for labor positions?

Some popular positions for labor are:

Leaning on a work surface or the back of a chair. Putting your arms round your partner's neck or waist to lean against.
Leaning on to the bed in the delivery room.
Kneeling on a large cushion or pillow on the floor and leaning forward on to the seat of a chair.
Sitting astride a chair and resting on a pillow placed across the top.
Sitting on the toilet, leaning forward, or sitting astride, leaning on to the sink.
Kneeling on all fours.
Kneeling on one leg with the other bent.
Rocking your hips backward and forward or in a circle; this can also be done using a birthing ball.

All of these positions can make your contractions more efficient and help you feel in control. When you are in strong labor, you may find that you don't want to move around much and will find a position that suits you. If possible, keep rocking, leaning forward during contractions, and straightening up in between. If you get tired, lie down on your left-hand side, rather than propped up on your back, which stops the pelvis from being able to open effectively. Lying on your left side is much better for your baby than lying on your back because he receives more oxygen, and the contractions are still effective in this position. If you feel rested after a while, push yourself up with your hands into a sitting position and get up again.

Q:	I'm 36 weeks and my baby is breech. Is this a concern?
A:	Breech position is when your baby is bottom first instead of head first . Quite a lot of babies sit in the breech position in pregnancy and there is still a chance your baby will turn. It's not until about 37 weeks that your midwife or doctor will focus on your baby's position.

Is there anything I can do to help my baby turn?

If your baby is breech toward the end of pregnancy, there are some exercises you can try in an attempt to turn your baby. A “knee-chest” position can help. To do this, kneel on your bed with your bottom in the air and your hips bent at just over 90 degrees. Try to keep your head, shoulders, and upper chest flat on the mattress. Adopt this position for 15 minutes every two waking hours for five days. If you feel nauseous or light-headed, do not continue. Positions in which the buttocks are elevated can also help, and sleeping with a pillow under your buttocks or kneeling on all fours so the weight of your pregnancy is unsupported may help. You can combine “all fours” positions with household chores, such as cleaning the floor. If these are not successful, there are other ways to try to turn your baby.

I've heard about doctors “turning” breech babies. How does this work?

Some obstetricians may try to turn a breech baby in late pregnancy, known as external cephalic version (ECV), which has a success rate of around 50 percent. During an ECV, an obstetrician gently moves your baby by pressing his hands on your abdomen, using an ultrasound as a guide. You may be given a drug to relax the uterine muscles. You will be scanned first and if the baby is in an awkward position the procedure may not continue. Also, if your baby is large this can affect the procedure, as can the amount of fluid around the baby, because a low amount of fluid offers less protection to the baby. If you are Rhesus negative, you will have an injection of RhoGam after the ECV because of a small risk of a bleed around the placenta. An ECV is not recommended if you have a multiple pregnancy, have had bleeding in pregnancy, your placenta is low-lying, your membranes have ruptured, your baby is a footling breach, or there is a known problem with the baby.

The procedure is not without risk and some think it only works with babies who would have turned anyway. If your baby remains breech, a cesarean may be advised, although some obstetricians are willing to try a vaginal delivery. You are not obliged to have an ECV and should discuss your options.

Finally, a form of acupuncture called “moxibustion” is sometimes used, whereby a fragrant herb is held over an acupuncture point, the aim being to relax the uterine muscles to help the baby turn. Talk to your doctor or midwife before trying this and seek advice from a qualified acupuncturist.

What triggers labor?

While there are many theories, no one really knows what triggers labor. One is that the mother's pituitary gland secretes oxytocin, the hormone that stimulates contractions, when the baby is ready to be born. Others now believe that the baby starts labor by sending a signal to the mother's body. One theory is that a baby's lungs secrete an enzyme when they are developed that causes a substance called prostaglandin, which triggers contractions, to be released into the mother's body. Another theory is that, when the baby is ready to be born, its adrenal glands produce hormones; these cause hormonal changes in the mother that start labor.

I don't want to be overdue. How can I help labor to start?

Various methods have been tried, although none is proven. Popular methods include having sex, as the prostaglandins in semen are similar to the ones used to induce labor; stimulating your breasts to trigger the release of the hormone oxytocin, which stimulates the uterus; eating spicy food to bring on a loose bowel movement, thought to stimulate labor; and taking long walks to help the baby move down in the pelvis and put pressure on the cervix. Homeopathic remedies are also available. Always check with your doctor or midwife prior to attempting any induction strategies.

I've heard that raspberry leaf tea can start labor. Is this true?

This is a misconception since raspberry leaf tea doesn't actually bring on labor, but may help reduce the length of labor. In a study in Sydney, 192 first-time moms were given either a 1.2 g raspberry leaf pill or a placebo twice a day from 32 weeks. The pill had no harmful effects, and the women taking the supplement had a shorter second stage of labor and a lower rate of assisted delivery (19.3 percent to 30.4 percent).

Raspberry leaf tea contains an alkaloid, “fragine,” said to strengthen and tone uterine muscles, helping them to contract more efficiently. Start taking raspberry leaf tea from about the last eight weeks of pregnancy. At 32 weeks, you could have one cup of raspberry leaf tea a day, gradually increasing to four cups or pills a day (depending on the strength of the blend).

What is the “nesting instinct” and is this just a myth?

The nesting instinct is a well-documented natural phenomenon. In the final weeks of pregnancy, many women have an urge to clean house and prepare and make the “nest” safe for the new arrival. This is a primal instinct and females of the animal kingdom all have this need. Just as birds make their nests for their young, mothers-to-be do exactly the same.

The act of nesting puts you in control and gives a sense of accomplishment. You may also become a homebody and want to retreat into the comfort of your home and familiar people. The nesting urge can be an indicator that labor is not too far away. If you have the energy, take advantage by doing tasks that you won't have time for after the birth. Take a break every few hours and stay well-hydrated.

Is it true that first babies are often late?

Birth normally occurs at a gestational age of 37 to 42 weeks and, while it certainly isn't the case that all first babies are late, many do arrive after the predicted due date. From the point of view of waiting, if you approach the end of your pregnancy expecting your baby to be a couple of weeks late, then you may avoid feelings of frustration. It is worth considering that your body has never done this before and that your “due date” is an estimate; the majority of babies do not arrive on this date.

I'm 39 weeks and my baby's head isn't engaged. Should I be worried?

Not all babies engage into the pelvis before the beginning of labor. It is likely, from about 36 weeks onward of your pregnancy, that you may experience your baby moving lower down in your abdomen, causing your baby's head to enter the pelvis. This process is known as “engagement ” and simply means that the leading part of the baby has “engaged” the pelvic brim . This is normal and helps to position your baby in preparation for the birth later on.

Engagement often happens earlier with first babies because the uterine muscles have not been previously stretched and so they tend to exert more pressure on the baby, moving it down into the pelvis earlier; whereas a second or third baby may not become engaged until labor actually starts. When your baby's head engages can also depend on other factors, such as the position in which your baby is lying within the womb (see Fetal positions) and the shape of your pelvis.

Am I likely to feel any different once my baby's head has engaged?

Many women report feeling more physically at ease following the engagement of their baby's head since there is a release of pressure within the abdomen. As a result, you may find that it feels easier to breathe, sleep, and walk around.

On the other hand, sometimes when the baby's head engages this can increase the pressure on your bladder and you may experience a sensation of fullness and pressure between your legs. Many women also report shooting vaginal pains. Engagement is also likely to affect bowel sensations.

Q:	My midwife mentioned checking the position of the placenta. Is this normal?
A:	The placental location assessment is part of the screening ultrasound performed between 18–22 weeks. If found to be “low lying,” the scan will be repeated to reassess this at 28–32 weeks.

I'm due and my baby isn't moving so much now—should I be worried?

There is some natural reduction in the range of your baby's movements toward the end of pregnancy as he has less room to stretch his limbs. However, you should still be familiar with your baby's pattern of movement in later pregnancy since this is a good indicator of your baby's health and is just as important as the number of movements a day . The quality or characteristics of your baby's movement often changes as you approach term but the frequency should remain the same. You may find at this stage that your baby is developing a pattern for waking and sleeping, often different than yours, so your baby may be awake when you go to bed and may start kicking. Or your baby may get the hiccups and you will feel the jerk of each hiccup, a sign that your baby is preparing for life after delivery. If your baby's movements have reduced or stopped, contact your doctor. You could also try things like having a cold or hot drink, taking a bath or shower, or massaging your belly. A formal assessment may be recommended and if there are concerns, you will be asked to make a conscious effort to increase your awareness of when your baby moves. There should never be fewer than 10 individual groups of movements a day between 9 am and 9 pm. You may be able to have a cardiotograph to record your baby's movements.

I'm practically incontinent. What can I do to stop this?

During pregnancy, many women find that they leak urine slightly when they cough, laugh, exercise, bend, or lift something. This is known as stress incontinence. The pelvic floor muscles are strained during pregnancy since they have to support the weight of your growing uterus and cope with the changes caused by pregnancy hormones. As a result, a sharp increase in abdominal pressure when you cough may be too much for the muscles to hold back the flow of urine. Stress incontinence may happen at any time in pregnancy, but is more common near the end.

The best treatment for incontinence is regular Kegel exercises to keep the muscles toned . Getting some gentle exercise each day can also help and, although you may not make a full recovery during pregnancy, regular exercise now will minimize the problem and help you toward a full recovery after your baby is born. Stress incontinence is often worse for a few days following the birth, when the muscles of the pelvic floor and other structures are recovering. If it does not get better after this time, talk to your midwife or doctor because you should not have to suffer long term without help. Ask your midwife to refer you to a uro-gynecologist, who can review the problem and offer you advice and monitoring.